Contents
A tourniquet is a means of temporarily stopping bleeding. It is used in critical situations when a large blood vessel is injured and the victim is rapidly losing a large amount of blood. The tourniquet is a strong long strip that can be made of any material (in most cases, rubber). What you need to know about medical instruments, how to use a tourniquet correctly, what are the indications, contraindications and possible risks?
General characteristics
A tourniquet is a device to stop bleeding. They squeeze the soft tissues of the affected limbs in order to temporarily stop blood loss and have time to deliver the victim to the doctor. The bandage is necessary to stop extensive bleeding from the main vessels. In other cases, squeezing and applying a tight bandage is sufficient.
Ideally, the tourniquet is applied for a maximum of 30-40 minutes, regardless of the person’s condition, season, environmental conditions and other factors. Why? In fact, the limb is “disconnected” from the general blood flow, which can be fraught with tissue necrosis, infringement of the nerve trunks of the organ, and even death. In a separate part of the body, oxygen starvation develops. The tissue ceases to receive vital components such as blood, oxygen and nutrients. The result is the death of the limb and the need for amputation.
What if you can’t get a tourniquet in an emergency? Make an impromptu bleeding stopper using cloth tape, rope, your own belt, and anything else you can get your hands on. They will help stop blood loss and fix the affected area no worse than medical instruments. The main difference lies in the convenience of the person providing first aid. Most rubber bands are pre-punched or self-tightening. This simplifies the provision of emergency first aid, but even an ordinary piece of cloth, hastily torn from clothing, will perform an identical function (subject to proper use).
Indications / contraindications for use
If you are not confident in your own abilities, the condition of the victim, or if you are holding a tourniquet in your hands for the first time, wait for the doctors to arrive or try to take the person to a medical facility as soon as possible. Unprofessional actions will only aggravate the condition of a person, but will not help in this situation. To avoid a painful choice – get trained and learn how to provide first aid.
| Показания | Противопоказания | ||
|---|---|---|---|
| Absolute | Relative | Absolute | Relative |
| Amputation of a limb | Minimize blood loss during surgery | Presence of acute infection of the affected limb | Vascular diseases (for example, thrombosis, atherosclerosis, etc.) |
| Long squeezing syndrome | Prolongation of local/regional anesthesia | Minor blood loss (mostly from small vessels) that can be controlled with pressure and a tight bandage | |
| Traumatization of a large vessel (provided that blood loss cannot be stopped by other methods) | Injury to the limb, in which it is impossible to determine the intensity of blood loss and its danger to the victim (a tourniquet is applied until the condition is clarified, after which it is left or changed to a pressure bandage) |
Varieties of harnesses
There are only two types of tourniquets – tape and collar, which are commonly called turnstiles. The band is a small piece of rubber band. It can have holes for buttons and the buttons themselves, metal elements that make it easier to work with the knot and speed up first aid.
Gate turnstiles are designed for use in extreme conditions. The tourniquet looks like a relatively wide band of dense synthetic material. The device is equipped with a Velcro fastener or other part that is responsible for a strong fixation and tension of the belt. Many tourniquets have a built-in medical beacon that helps track the time the tourniquet is applied.
| Name | A type | Material Features | Advantages | Disadvantages |
|---|---|---|---|---|
| Esmarch’s tourniquet | Tape | Rubber band with convex grooves and rubber loop | Easily available (sold in pharmacies) | Inconvenient to use; often breaks at the attachment point |
| Stretch wrap and tuck (SWAT) | Tape | Rubber cut 10,5 centimeters wide, 1,3 meters long | Versatility; images on the tape, which help to control the correct application of the tourniquet; can replace elastic bandage | High price; increased risk of pinched skin; it is impossible to assess the degree of blood loss due to the density of the material |
| Rapid Application Tourniquet System (RATS) | Tape | Flat vulcanized rubber cord with nylon sheath and aluminum locking mechanism | Versatility; ease of use; reliable fixation; low price | High risk of pinched skin; minimum width (about 2 centimeters), which may not be enough to stop bleeding |
| LCD medical plant | Vorotkovy | Compression band with Velcro fastener, signal tongue, loop and spool to it | Easy to use; dosed compression, which prevents tissue death; automatic fixation with loop and reel | A sticky fastener can become clogged and less effective; using a tourniquet requires fine motor skills that are impaired in a state of shock |
| Combat application tourniquet (CAT) | Vorotkovy | Harness with adhesive, plastic clips, transport beacon | Versatility; reliability thanks to brackets-clamps; can be used with one hand | High price; Velcro clogging; low stability of plastic fittings |
| SOF tactical tourniquet | Vorotkovy | Classic turnstile with aluminum gate, plastic retainers, clamp or automatic buckle | wear resistance; possibility of application in extreme conditions; fast and high-quality fixation; easy to apply | High price; in the cold season sticks to the skin / wet gloves |
General Terms of Use
There are specific rules for applying a tourniquet to certain parts of the body. The following is general information that can be used during first aid.
A tourniquet should only be used if you have not been able to eliminate blood loss by other methods. Ideally, any contact with blood/other body fluids should be done with gloves. Absolutely all mucous membranes (eyes / mouth / damaged parts of the body) must be protected from infection, but in critical situations, medical supplies are rarely at hand. Instead, you can use a plastic bag, film, a paper file, and anything that will help reduce the risk of infection.
Before applying the tourniquet, try to bend the victim’s limb as much as possible in order to press the artery or directly press on the wound. The list of actions depends on the intensity of blood loss and its location. So you can partially stop the outflow of fluid and successfully apply a tourniquet. To avoid necrosis or pinching of the skin, be sure to cover the affected area with clothing, a towel, gauze, bandage, or any other clean cloth.
A tourniquet is applied above the site of bleeding (for example, on the thigh when the foot is injured). The rule does not apply only to traumatic amputation of a limb. In this case, the tourniquet is placed as close as possible to the damaged area. Burning the forearm or lower leg is considered ineffective. The vessels in these parts of the body lie too deep, so even a strong tension on the tourniquet will not help stop blood loss.
The time spent by the tourniquet on the limb is limited. In the warm season, it should not exceed 60 minutes, in the cold – 30, but doctors advise limiting yourself to 30-40 minutes, regardless of the season. If during this time the ambulance does not have time to arrive, it is allowed to loosen the tourniquet for 10 minutes to restore blood flow. During these 10 minutes, you should press the damaged artery with your fingers, and then re-install the tourniquet.
If possible, attach a note to the tourniquet, which will record the time and date of its imposition to the nearest minute. A similar inscription can be left on the forehead or other visible areas of the body. This information can save the victim’s life and help doctors determine what to do next.
Every victim needs anesthesia. Installing and loosening the tourniquet brings unbearable pain, which is aggravated by the trauma received during the incident. When calling an ambulance, specify the waiting time for the brigade and agree on the issue of anesthesia. Try to create the most comfortable conditions for the victim before the arrival of doctors. Cover him with clothes or a blanket (even in the warm season), help him take a comfortable position and calm the person if he is conscious.
Common mistakes when using a tourniquet
Doctors identify several main mistakes during first aid:
- tourniquet without appropriate indications;
- fixation of the knot on bare skin, which leads to infringement and necrosis of tissues;
- too weak fixation, which does not affect the intensity of blood loss;
- too strong fixation, which leads to tissue injury;
- incorrect application of a tourniquet, in which only the vein is compressed, which leads to increased blood loss, swelling, redness and blueness of the skin;
- incorrectly selected part of the body for applying a tourniquet;
- lack of information about the time of first aid;
- covering the tourniquet with a bandage.
How to determine that the harness is installed correctly? The bleeding will stop, the skin will turn pale, the pulsation of the peripherally located arteries of the limb will disappear.
Possible complications
The most common complication is prolonged crush syndrome or crush syndrome. It occurs due to prolonged circulatory failure, compression of soft tissues, their pathological changes. There are several forms of the syndrome, which depend on the period of compression of the limb: mild (up to 4 hours), medium (up to 6 hours), severe (up to 8 hours), extremely severe (both limbs up to 6 hours) . After removal of the tourniquet, the victim develops shock. The body swells, becomes pale, kidney failure develops, the limbs cease to function fully, and urine does not enter the bladder. With proper and timely treatment, symptoms can be eliminated in two weeks. It will take at least one month for the body to fully recover.
In non-sterile conditions, anaerobic infection may develop. This is a severe toxic wound infection that is directly associated with anaerobic microorganisms. After the tourniquet is applied, air stops flowing into the limb. The tissue becomes an ideal place for bacteria to grow – it has a wound for penetration, a nutrient medium in the form of affected skin, and the temperature necessary for development and division. The risk of infection increases when the skin is contaminated with earth, dust, natural fluids.
Incorrect tourniquet application can also cause complications. Excessive compression of the limb leads to nerve damage, neuralgia, paralysis or paresis. A large number of blood clots form in the veins and arteries (the risk of thrombosis increases against the background of atherosclerosis). Frostbite is a common complication in winter. It is impossible to predict the body’s reaction to blood loss and exposure to low temperatures. Symptoms range from bluish skin, vomiting to dizziness or trouble breathing. A combination of some or all of the above complications results in limb amputation.
A tourniquet is a rather controversial first aid tool. It can save the life of the victim or, conversely, cause death / irreversible changes in the body. Doctors agree in one opinion – only a trained person (with a special education or who has completed training courses) can use a tourniquet. Only in this case can we hope for a favorable outcome of the incident.