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When to use TQ over pressure bandage?

Discussion in 'BLS Discussion' started by SplintedTheWrongLeg, Feb 3, 2018.

  1. SplintedTheWrongLeg

    SplintedTheWrongLeg Forum Probie

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    I may be answering my own question here, but wouldn’t you use a pressure bandage on a wound that CAN be controlled with direct pressure and a TQ on a wound that CANNOT?

    We didn’t go over a lot of different bandages in EMT school, just the different jack-of-all-trades applications of a few. The reason I’m asking though is because I saw an ankle holster (Tacticool, right?) that holds a TQ and an Israeli Bandage. I was wondering why I would need both, when I could just use a SWAT-T brand TQ as a pressure bandage and a TQ? Maybe I’m thinking too much into this, idk.

    Thank you for enlightening me,
    - a guy with too much time on his hands
     
  2. Flying

    Flying Mostly Ignorant

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    My first thought is, who cares, just be familiar with and use what is given to you. SWAT, CAT, RAT, whatever.

    Tourniquets are primarily indicated for life threatening extremity wounds that can't be controlled by direct pressure or other means. Having a multitask TQ seems a bit frivolous to me (then again, so is an ankle holster for medical supplies).

    Embrace the jack of all trades.
     
    Last edited: Feb 3, 2018
    MackTheKnife likes this.
  3. hometownmedic5

    hometownmedic5 Forum Asst. Chief

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    An ankle holster for bleeding control items? Are you effing kidding me?

    As a general rule, you use the least invasive measure possible to accomplish your goal. Central lines are awesome, right? Multiple ports, almost instantaneous addition to central circulation, you can do massive volume infusions very quickly. Why doesn't every patient int he hospital have a central line then? Because the risk of iatrogenic complications is staggering, so they are only used when necessary. Tourniquets come with risks. They are used when all less invasive measures have failed.

    If you can get the job done with a pressure bandage, do so. If not, grab the tourniquet. And don't buy an ankle holster for this crap, unless you're working executive protection and need inconspicuous but instantaneous access to these items. or you're going to look like a jackass. I can forgive a bat belt and other minor affectations of the industry, but this is a bridge too far...
     
    MackTheKnife likes this.
  4. VFlutter

    VFlutter Flight Nurse

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    Actually pretty useful. If you CCW you should have an IFAK on you. Ankle kit conceal well with normal jeans and much more comfortable than on your belt. To each their own.

    http://soldiersystems.net/2018/01/12/149694/
     
    CCCSD and SplintedTheWrongLeg like this.
  5. SplintedTheWrongLeg

    SplintedTheWrongLeg Forum Probie

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    It may be a bit much for some applications, but it makes sense to me for an edc.
     
    MackTheKnife likes this.
  6. MackTheKnife

    MackTheKnife RN, EMT-P

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    You did answer your own question.
     
  7. MackTheKnife

    MackTheKnife RN, EMT-P

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    Tourniquets are not that risky. EBP proves it.
     
  8. medichopeful

    medichopeful NRP, ICU RN, CCRN, CEN

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    If there's any question about which to use, go with the tourniquet.
     
  9. DesertMedic66

    DesertMedic66 Forum Troll

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    I prefer the style of the ankle holster TQ and denim shorts
     
    johnrsemt likes this.
  10. hometownmedic5

    hometownmedic5 Forum Asst. Chief

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    “Not that risky” is not the same as without risk.
     
  11. MackTheKnife

    MackTheKnife RN, EMT-P

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    Ok. Let me CLARIFY what I was trying to say that I thought everyone would know what I meant without using big words: There are minimal attendant neurovascular sequelae with the use of compression vascular devices on the extremities when used for several hours. Translation into English: Not that risky.
     
    CCCSD likes this.
  12. Tigger

    Tigger Dodges Pucks Community Leader

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    An Israeli/Pressure bandage is not the same as a tourniquet. You cannot generate nearly as much force with the bandage as the tourniquet. Israeli bandages are useful for wounds that don't need a TK, they've got everything you need in one wrapper and are pretty easy to apply. Also can apply them in places that TKs don't go but you'll probably need to apply real manual pressure on top of it. SWAT-T has no actual dressing in it.
     
    Flying, Jim37F and MackTheKnife like this.
  13. ffxemt

    ffxemt Forum Ride Along

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    Per TECC, "When you see the victim and think/say "Holy &(*& that's a lot of blood"". Apparently you can't really go wrong with a TQ anymore, based on the studies done (I can find them if required), a negligible risk is posed for most EMS situations. I would definitely still go through the motions and not throw a TQ on a missing finger.
     
  14. Akulahawk

    Akulahawk EMT-P/ED RN Community Leader

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    There's basically two times you would use a TQ. One is that time you outlined (and I bolded) above. The other is when you're still too early in the fight to get to that point and you're attempting (and failing) to control bleeding using direct pressure. Knowledge of pressure points is good at this point as you might want to use them to slow bleeding down further while you're applying a TQ.
     
    EpiEMS likes this.
  15. EpiEMS

    EpiEMS Forum Deputy Chief

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    Definitely.

    @SplintedTheWrongLeg, it's better to throw on the TQ early and discontinue it later than to not put it on. It's not as if we can (most EMS providers) put more blood in.
     
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  16. VFlutter

    VFlutter Flight Nurse

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    I like the idea of starting with a TQ to quickly stop the bleeding so you can correctly place a pressure dressing with less stress then remove the TQ if not necessary. However I know logistically some protocols don't allow removal of TQ after application.
     
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  17. EpiEMS

    EpiEMS Forum Deputy Chief

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    My protocols (stupidly) expressly prohibit it - "Do not remove or loosen tourniquet once hemostasis achieved". Of course, that's totally inconsistent with the guidelines I've seen (TECC guidlines, for example).

    Tourniquets can save time (by reducing the need for extra hands) - I'm busy trying to move this patient, and there's only two people, we can't hold pressure *and* start getting them moving to the surgeon.

    Maybe I should petition for a change...
     
  18. VFlutter

    VFlutter Flight Nurse

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    I understand the concern for re-perfusion injury and circulatory collapse upon tourniquet removal however realistically that isn't going to be an issue in the few minutes it takes for you to move the patient, gather supplies, and apply an alternative dressing.

    Maybe clarify TQ for treatment of Arterial Hemorrhage vs as an adjunct to pressure dressing?

    When I used to pull Venous and Arterial sheaths (5-9fr) in the Cath lab i could completely control the arterial puncture site with a single 4x4 and two fingers. As opposed to when someone inadvertently dislodged a sheath and I had to use my fist and multiple dressings to get incomplete control just to identify where the actual puncture was. If prepared and starting without active bleeding most hemorrhages can be easily controlled with direct pressure or dressings.
     
  19. EpiEMS

    EpiEMS Forum Deputy Chief

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    Seems reasonable to me!

    Totally didn't think about that as the worry...
    Though I'm not sure why you'd (prehospitally) remove a tourniquet on a profoundly injured extremity...
     
  20. ParamagicFF

    ParamagicFF Forum Crew Member

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    I see a large amount of traumatic injuries in my area, generally penetrating trauma or pedestrian vs vehicle. We have recently been issued Israeli bandages, and we have always had some type of commercial TQ. Part of my decision making comes from a quick determination of the patient's overall condition aside from the individual bleed. Next I quickly try to determine if the actual source of bleeding can be accessed. If either of those are in question, I will apply a TQ and move on. It goes without saying that gross deformity with significant bleeding gets a TQ unless there is some reason it cannot be applied. I am 10-15 minutes from a major trauma center, so I believe the benefit outweighs the risk.
     

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