List Archives

Thu Dec 14 18:06:20 GMT 2006

1) Traumatic amputation with active haemorrhage - (rare, since most such 
stumps will spasm and tamponade anyway)

Most system practice this- but if we claim to practice evidence based 
medicine as well, we should pay good attention to jhon pillgram's work. I've 
seen no further work examaning his approach.
Anyone cares to enlight me?

>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

I think that this can be limited to use only by physicians or under 
permition by medical control.

>From: "Hardcastle, Tim, Dr <tch at sun.ac.za>" <tch at sun.ac.za>
>Reply-To: "Trauma &amp; Critical Care mailing list" 
><trauma-list at trauma.org>
>To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
>Subject: RE: tourniquets
>Date: Thu, 14 Dec 2006 14:55:19 +0200
>
>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
>M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
>Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)
>ATLS  instructor and DSTC Cape Town Course Director
>Intern program Coordinator: Surgery
>M.Med (Emergency Medicine) Executive Committee member
>Clinical Head (Director): Diana Princess of Wales Trauma Unit
>Division of Surgery (General) Room 4064
>Department of Surgical Sciences
>Tygerberg Hospital / University of Stellenbosch
>PO Box 19063
>Tygerberg 7505
>Western Cape
>South Africa
>e-mail: tch at sun.ac.za
>Cell: +27824681615
>Office: +27219389281 or 4911 pager 0302
>
>
>
>-----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
>--
>trauma-list : TRAUMA.ORG
>To change your settings or unsubscribe visit:
>http://www.trauma.org/traumalist.html
>
>Confidentiality Notice
>
>This e-mail message, including any attachments, is for the sole use of
>the intended recipient(s) and may contain confidential or proprietary
>information which is legally privileged.  Any unauthorized review, use,
>disclosure, or distribution is prohibited.  If you are not the intended
>recipient, please promptly contact the sender by reply e-mail and
>destroy all copies of the original message.
>--
>trauma-list : TRAUMA.ORG
>To change your settings or unsubscribe visit:
>http://www.trauma.org/traumalist.html
>--
>trauma-list : TRAUMA.ORG
>To change your settings or unsubscribe visit:
>http://www.trauma.org/traumalist.html

_________________________________________________________________
Express yourself instantly with MSN Messenger! Download today it's FREE! 
http://messenger.msn.click-url.com/go/onm00200471ave/direct/01/

List Archives

For your convenience, find the Trauma List Archive Below

tourniquets