Clink on this link below to view an interesting article on tourniquet use. We all know that for the last 10 -15 years tourniquets have come back into protocol as the treatment of choice for severe hemorrhage that has failed to controlled by direct pressure and hemostatic gauze. In a hostile situation there might not be time or room to try homeostatic agents so a tourniquet might be the device of choice. This article, among other issues, examines the use of traditional 1 " wide tourniquets as compared to the newer pneumatic tourniquets. One issue identified was the difficulty in generating enough pressure on the average size male thigh to stop severe lower extremity hemorrhage. The other finding was that tourniquets wider than 1" accomplished hemorrhage control with less pressure and therefore had less tissue injury underlying the tourniquet. It seems that newer pneumatic tourniquets accomplished hemorrhage control quicker and with less complications compared to narrower 1 " tourniquets. Pneumatic tourniquets have been used extensively in orthopedic surgery so they have been well tested in regards to hemorrhagic control. The issue, of course, is how hospital based devices will fare in more rugged conditions. The article mentions one particular device. The Delpi Military Tourniquet. See link below.
The other issues examined was the loosening or removal of a tourniquet prior to surgery and the length of time before tourniquet application results in limb ischemia / damage. It seems that tourniquets applied for under 120 minutes do not result in any additional limb damage. Removal or loosening is more conversational. Protocols differ from region to region, so you must follow your regional protocol. To this author it would seem reasonable to loosen a tourniquet that has achieved hemorrhage control if you are approaching the 120 minute mark and assess for resumption of bleeding. If bleeding does not resume the tourniquet may remained loosened to prevent limb ischemia. Remember this is just a thought and does not constitute a treatment guideline. You must always follow your protocols and Medical Directors guidelines. It would be rare in civilian prehospital emergency medicine to be with a patient who has had a tourniquet on for 120 minutes so the issue is probably not that pressing. Of course you might be performing a back county rescue, dealing with a lockdown / active shooter, or confined space situation so the issue should be addressed and protocols developed.
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