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Sun Dec 17 17:05:35 GMT 2006

I actually teach tourniquets for snake bites as part of the "what not to do 
list". They often sound the claim that tourniqets should be used but 
sporadically loosen. I don't know what about you, but I don't want any 
layman playing too much with a tourniquet. Might be dangerous.

>From: "peter" <taliente at tiscalinet.it>
>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: R: tourniquets
>Date: Sat, 16 Dec 2006 15:11:49 +0100
>
>Many bites from venemous snakes don’t necessarily inject venom, so one has
>to be cautious on the use of a tourniquet. There is a lot of ignorance on
>snakes and if the message reaches lay people that tourniquet could help, we
>will get a lot of patients bitten by black snakes with them on! The black
>mamba is not black but it is a common error to think so.
>Peter
>
>-----Messaggio originale-----
>Da: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
>Per conto di oded private
>Inviato: giovedì 14 dicembre 2006 19.06
>A: trauma-list at trauma.org
>Oggetto: RE: tourniquets
>
>
>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
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R: tourniquets