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Wed Dec 20 21:00:35 GMT 2006

Yeah Mark, that's what I meant.  For any type of pre hospital benefit of
using one.  
Thanks'.

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Mark Hellaby
Sent: Tuesday, December 19, 2006 3:26 PM
To: trauma-list at trauma.org
Subject: Crush and tourniquets 

Anthony , it was more the treatment / initial management of crush and
control of metabolittes etc i was getting at, i presume that tourniquets
would have no benifficial effects on compartment syndrome in fact would make
it worse 

Stefan cheers for your reply, 

A couple of questions for you , would you (presumeing you were able to apply
tourniquets in the field ) release them there after extrication or wait
until the patiend was at a definitive care facility with blood gas analysis
on site. 

Has anyone ever considered whether it would be possible to look at tissue
perfusion with such cases using a modified pulse oximeter to look at tissue
saturation and not arterial ....just something i was wondering about 

Think it is also intersting to note that although the initial rescue may be
succesful the underlying renal damage maybe catasphoic , as has been born
out following research after earthquake rescues

I am interested whether you feel these guidelines could be used for patients
suffering from suspension trauma, a combination of orthostatic shock and a
pseudo type crush syndrome with similar metabolic build up and the potential
for catastrophic cardiac collapse following release, the management of these
cases is frought with questions and difficulties, current suggestions are to
keep the harness under tension durring transfer to hospital (??!!!) and
maintaining patient in an upright or semi recumbant position (!!)  

Regards

Mark Hellaby 

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