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Mon Dec 18 01:01:05 GMT 2006

Concerning point 3:

The key first aid for most Australian snakes (elapids) is a LYMPHATIC
TOURNIQUET (based on Struan Sutherland's research). The term used in
first aid courses is "compression bandage" to deliberately avoid the 'T'
word as it is a bad thing to do it too tightly. A 'Venous tourniquet' is
what untrained people end up with if they go too tightly (very
uncomfortable for the patient) and an 'arterial tourniquet' is what this
trauma thread is about.

Is this the same for cobras and mambas, or do you actually want to stop
arterial flow (a proper tourniquet)?

Cheers, Ian

Ian Seppelt FANZCA FJFICM
Senior Staff Specialist
Dept of Intensive Care Medicine
The Nepean Hospital, PO Box 63 Penrith NSW 2751
Clinical Lecturer, University of Sydney

>>> tch at sun.ac.za 14/12/2006 11:55pm >>>
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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