Tourniquets

In 1957 US Army surgeon Douglas Lindsey wrote about the ‘much-maligned’ and ‘controversial’ tourniquet for controlling limb hemorrhage. “Many decry its use. Others consider it indispensable. Some label it a technique of last resort. A few exhort that it should be used without delay” [1].


A few battlefield descriptions, dead soldiers with extremity injury being the only apparent wound, and some anecdotal evidence and we are left with the admonition to avoid “too little, too loose, and too late.” A strong recommendation, but Dr. Lindsey stops short of condoning widespread use. “The question of issuing a tourniquet to every soldier and citizen is, I admit, a controversial one.”


No longer. The development and advancement of programs

such as he Tactical Combat Casualty Care and subsequent Stop the Bleed campaign have brought the tourniquet back out of the doghouse [2, 3]. Little controversy remains, but questions abound. Are tourniquets useful in babies? Are they actually reducing blood transfusion or saving lives? What do we have to consider when removing a tourniquet? In this journal club, our inaugural one, we talk about these questions, current standards, and future directions in tourniquet use for control of hemorrhage.

References

1. Lindsey D. The case of the much-maligned tourniquet. AJN The American Journal of Nursing. 1957 Apr 1;57(4):444-5.

2. Goodwin T, Moore KN, Pasley JD, Troncoso Jr R, Levy MJ, Goolsby C. From the battlefield to main street: tourniquet acceptance, use, and translation from the military to civilian settings. Journal of Trauma and Acute Care Surgery. 2019 Jul 1;87(1S):S35-9.

3. Stop the Bleed. https://www.stopthebleed.org/our-story

4. photo by OMNA Inc., from pixabay.com



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