Place the tourniquet around the limb and weave the strap through the buckle. Alternatively, in tourniquets that come preassembled, they can be slipped over the limb. If possible, clothing should be removed prior to placement. If this is not possible, avoid placing tourniquet over bulky clothing or pockets.
Hemorrhage is the leading cause of preventable death in trauma. Immediate control of visible external bleeding is critical.
Direct pressure and/or wound packing remain the mainstay for hemorrhage control of extremity and junctional (neck, axilla, and groin) trauma.
Several local hemostatic agents are available.
If direct pressure is not possible or effective, the use of a tourniquet for extremity bleeding may be life-saving.
The low complication and high success rates of tourniquets for extremity bleeding have been well established in the military medical system. Their use is becoming increasingly popular in the civilian sector.
Universal precautions should always be used.
Several types of tourniquets for extremity trauma are available and approved by the Committee on Tactical Combat Casualty Care.
While windlass tourniquets may be used in the pre- and in-hospital settings, pneumatic tourniquets are most frequently used intraoperatively.
Procedure for Extremity Tourniquet Application
1. Place the tourniquet around the limb and weave the strap through the buckle (Figure 23.1). Alternatively, in tourniquets that come preassembled, they can be slipped over the limb. If possible, clothing should be removed prior to placement. If this is not possible, avoid placing the tourniquet over bulky clothing or pockets.
2. Tighten the tourniquet snugly down onto the limb, 2–3 inches proximal to the injury. Avoid placement over a joint (Figure 23.2). Remember: “high and tight.”
3. Wrap the excess strap around the extremity and secure using the velcro strap (Figure 23.3). Do not pass the retention device so as not to block the bar from turning.
4. Turn the bar until the bleeding stops (Figure 23.4). This may take multiple turns. The bar may be turned in either direction.
5. The bar is then locked under the retention clip (Figure 23.5).
6. Place the velcro strap across the clip to prevent the rod from being displaced. Note the application time directly on the tourniquet (Figure 23.6). Do not remove the tourniquet until the patient has reached definitive medical care.