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Thu Dec 14 12:55:19 GMT 2006

Guys

(Pret, Ron and Karim - this is in support of all you have said thus far!)

There are some indications for tourniquets:
1) Traumatic amputation with active haemorrhage - (rare, since most such stumps will spasm and tamponade anyway)
2) Blast injury in warfare, with active bleeding, particularly where there is major tissue loss
3) Bite from a Cape Cobra (Naja nivea) or Black Mamba (Dendroaspis polylepis) if more than 1 hour to definitive care and no antivenin available

They should in any event be released every 30 minutes for a minute or so and then re-applied to the point of abse nt blood-flow / no pulse. They should be removed with adequate myoglobinuria prophylaxis on board.

tim
Dr T C Hardcastle
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-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]On Behalf Of Ronald Gross
Sent: Thursday, December 14, 2006 2:01 PM
To: trauma-list at trauma.org
Subject: Re: tourniquets

I ain't young, but may be able to speak with some authority,
unfortunately having cared for many of the very same injuries you
discussed - and you are absolutely correct in your assessment!
Happy Holidays,
Ron

>>> <bensonblues at comcast.net> 12/14/2006 2:47 AM >>>
Pret had something with his "compare Baghdad to Baltimore" statement.
I'll take the liberty to compare Da Nang (circa '69) to Detroit: The
homeboys in Detroit 1) can't shoot straight (thank God), and 2)
(usually) use low velocity weapons (thank God again). Low-velocity GSWs
tend to crush tissue, and bleeding from an extremity is usually
adequately controlled with direct pressure.  Wounds produced by
high-velocity rounds, however, such as the 7.62 x 39 mm (AK-47) produce
considerable soft tissue injury and sometimes near-amputation of an
extremity. Bleeding from these injuries can be difficult to control with
direct pressure, and in many situations using a tourniquet may be all
that a corpsman can do to keep his Marine from bleeding to death. I
doubt that much has changed in terms of GSWs in Bahgdad - the AK-47 is
still a favorite killing tool. Likewise, wounds produced by "Bouncing
Bettys" (a creative VC modification of the Claymore mine) or the
contemporary IEDs are likely t
 o prod
uce extremity wounds in which hemorrrhage is difficult to control with
available hands, thus necessitating a tourniquet. Any young combat
medics out there with input?

DB
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