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Catastrophic Haemorrhage
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
When a patient is under threat from severe limb haemorrhage, there should be a low threshold for applying a tourniquet. If the patient is then removed from immediate threat (for example, extracted from a car wreck), then the requirement for the tourniquet should be immediately re-evaluated, as splints and dressings may now be enough to control the bleeding. Despite regular use of arterial tourniquets in orthopaedic practice, no clear consensus exists on the upper limit for limb ischaemia times. It is clear however that after two hours of complete arterial occlusion, deleterious metabolite build-up and cellular death slowly begins. Applying a tourniquet does not therefore mandate amputation; it does, however, mandate rapid evacuation to a surgeon. Better the bleeding is stopped leaving a live patient than an academic argument about what should have been done on a pale corpse.
Basics of nail surgery
Published in Archana Singal, Shekhar Neema, Piyush Kumar, Nail Disorders, 2019
Shilpa Kapanigowda, Biju Vasudevan
A tourniquet is a mechanical device used for the temporary control of the blood circulation, especially used in surgeries of extremities. The nail derives its blood supply from the lateral digital arteries, which give rise to numerous branches and proximal and distal arcades, which anastomose extensively.9 All nail surgical procedures require the use of a tourniquet. The nail bed, being a very vascular structure, needs to be exsanguinated at the start and then a tourniquet needs to be tied at the base. A number of tourniquets have been described, including a Foley’s catheter, a Penrose drain, a rubber strip, or a rubber band.10 An ideal material for use as tourniquet should not be thin, twisted, and constrictive like a rubber band. It should be sterile as it comes in close contact with the operative field.
Catastrophic haemorrhage
Published in Ian Greaves, Keith Porter, Chris Wright, Trauma Care Pre-Hospital Manual, 2018
Ian Greaves, Keith Porter, Chris Wright
The SAM®Junctional Tourniquet (SAM Medical Products®, Wilsonville, Oregon, United States) consists of a belt with two inflatable bladders called Target Compression Devices (TCD). The two TCD are moveable and can be positioned over a wound or the junctional vessels if proximal control is the aim. It can be applied in under 25 seconds. When applied to the inguinal region the belt can also be used as a pelvic binder. An auxiliary strap is required for application to the axilla. Tourniquet time should not exceed 4 hours.
Preoperative Simulation and Three-Dimensional Model for the Operative Treatment of Forearm Double Fracture: A Randomized Controlled Clinical Trial
Published in Journal of Investigative Surgery, 2022
Yin Zhang, Junchao Luo, Li Cao, Shuijun Zhang, Yu Tong, Qing Bi, Qiong Zhang
The patients were required to lay on their backs and were placed under local anesthesia. A tourniquet was applied to the upper limb and the operation was conducted in a sterile area. Henry approach was used on the metacarpal side of the forearm to cut the skin and subcutaneous tissue in order to expose the flexor carpi radialis, radial artery, and separated artery. The surgeon then entered the space between the brachioradialis muscle and the radial carpal flexor muscle, peeled off the starting point of the pronator muscle and the pronator teres muscle under the periosteum, and then exposed the fracture end. For the ulnar fracture, a longitudinal surgical incision was made at the center, and the skin, subcutaneous tissue, and deep fascia were cut. Thereafter, the surgeon entered the space between the ulnar wrist flexor muscle and ulnar wrist extensor muscle to expose the fracture end.
Tourniquet Application for Bleeding Control in a Rural Trauma System: Outcomes and Implications for Prehospital Providers
Published in Prehospital Emergency Care, 2022
Hala Bedri, Hadeal Ayoub, Jacklyn M. Engelbart, Michele Lilienthal, Colette Galet, Dionne A. Skeete
Tourniquet use is not without risks. Tourniquets applied incorrectly can lead to paradoxical bleeding associated with incomplete arterial occlusion and venous congestion (21). This improper application is associated with expanding hematomas, compartment syndrome, and worsening hemorrhagic shock (21). Complications are not exclusive to improper use; even appropriate tourniquet application has been associated with reversible nerve palsy, rhabdomyolysis, compartment syndrome, and wound infections (22–24). Prolonged tourniquet duration has been associated with amputation in the military setting (23). Unfortunately, there is no consensus on how long a tourniquet can be applied without the development of tourniquet-related complications (21). Keeping these issues in mind, tourniquet use in the rural setting needs careful analysis of utilization and impact on outcomes.
Managing in-transit melanoma metastases in the new era of effective systemic therapies for melanoma
Published in Expert Review of Clinical Pharmacology, 2019
Rebecca L Read, John F Thompson
The ILI technique was subsequently developed to reduce the complexity and morbidity of ILP [112]. In ILI a minimally invasive percutaneous approach is used to insert small-calibre catheters into the axial artery and vein of the limb under radiological guidance. The limb is then isolated with a pneumatic tourniquet. Circulation is performed by syringe aspiration and re-injection throughout the procedure and the limb become progressively hypoxic and acidotic, potentiating the cytotoxic effect of melphalan. The advantage of ILI over ILP is that it is well tolerated even in frail and elderly patients and can easily be repeated in the event of relapse. A systematic review that included studies from seven centres, involving 536 patients, reported an overall response (OR) rate of 73% and a CR rate of 33% [116]. Analysis of 687 first time ILIs at nine Australian and US centres reported an OR rate of 64.1% and a CR rate of 28.9% [111]. In both these studies limb toxicity was graded using the Wieberdink classification and was generally mild. Only 2% [116] and 3.9% [117] of patients developed grade IV toxicity (extensive epidermolysis and/or deep tissue damage, actual or threatened compartment syndrome) and no patient developing grade V toxicity (severe tissue damage necessitating amputation).