If application of pressure does not stop bleeding, and a tourniquet is available, what should be the decision making process for tourniquet application vs continuing the efforts to stop the bleeding with pressure? How the decisions on the tourniquet application be affected if the medical help needed for a safe removal of tourniquet is hours away? days away? weeks away? not expected to be available at all?
Common sense suggests to apply the tourniquet if applying local pressure does not stop bleeding, thus not fainting quickly and gaining some time to figure out how to reach the medical help to treat the wound and to remove the tourniquet safely. But are there some non-obvious considerations I may be missing?
No, you have it right. If direct pressure either with hands or a dressing doesn't stop the bleeding, a tourniquet is the recommended next step, provided the bleeding is severe enough to be life-threatening and the location is appropriate for a tourniquet (not junctional like armpit or groin). I'll be doing a future post solely dedicated to TQ use/Stop The Bleed.
It's been shown that leaving a tourniquet on at appropriate pressure for 2 hours or less is generally safe and unlikely to cause any permanent harm. This is done as a matter of routine in many orthopedic surgeries. Beyond that, the longer it is left on, the greater the likelihood of muscle or nerve damage.
If no help is coming, the decision to take it down vs leave it on comes down to the degree of bleeding. If every time you take it down there's major bleeding, you don't have a choice and will have to accept the damage to the limb, else bleed out. If you take it down and the bleeding has stopped, then other wound dressing measures can be applied.
If application of pressure does not stop bleeding, and a tourniquet is available, what should be the decision making process for tourniquet application vs continuing the efforts to stop the bleeding with pressure? How the decisions on the tourniquet application be affected if the medical help needed for a safe removal of tourniquet is hours away? days away? weeks away? not expected to be available at all?
Common sense suggests to apply the tourniquet if applying local pressure does not stop bleeding, thus not fainting quickly and gaining some time to figure out how to reach the medical help to treat the wound and to remove the tourniquet safely. But are there some non-obvious considerations I may be missing?
No, you have it right. If direct pressure either with hands or a dressing doesn't stop the bleeding, a tourniquet is the recommended next step, provided the bleeding is severe enough to be life-threatening and the location is appropriate for a tourniquet (not junctional like armpit or groin). I'll be doing a future post solely dedicated to TQ use/Stop The Bleed.
It's been shown that leaving a tourniquet on at appropriate pressure for 2 hours or less is generally safe and unlikely to cause any permanent harm. This is done as a matter of routine in many orthopedic surgeries. Beyond that, the longer it is left on, the greater the likelihood of muscle or nerve damage.
If no help is coming, the decision to take it down vs leave it on comes down to the degree of bleeding. If every time you take it down there's major bleeding, you don't have a choice and will have to accept the damage to the limb, else bleed out. If you take it down and the bleeding has stopped, then other wound dressing measures can be applied.
Thank you for the detailed and informative answer!
Great post, Doc! Yes--hands ARE stupidly complicated. Ask me how I know that:
...Dupuytren contracture surgery aficionado. Caused by a few drops of Viking blood somewhere down the hereditary line.
Thanks CPL!
Like a lot of things, we take hands for granted until they don't work right. Then they make it obvious how much we need them.