II. Precautions
- Avoid clamping any bleeding digital vessels
- Avoid narrow width Tourniquet use (e.g. belts)
III. Management: Initial
- Step 1: Apply direct pressure to wound for 15 minutes
- Step 2: Apply digital Tourniquet
- Impromised
- Penrose drain clamped with hemostat or
- Cross section of glove finger
- Commercial
- Tournicot
- T-Ring
- Impromised
- Step 3: Apply compression dressing (e.g ace wrap)
- Start wrap proximal to wound site
- Ace wrap should also hold bandage at wound site
- Step 4: Elevate affected arm
- Consider using cast stockinette
- Cut stockinette lengthwise 8 inches at each end
- Tie one end over patients Shoulder
- Tie the other end to top of IV pole
IV. Management: Refractory to above
- Step 1: Wrap and elevate arm as above
- Step 2: Obtain Tourniquet
- Air-inflated arm Tourniquet (used in orthopedics) or
- Blood Pressure cuff
- Step 3: Apply Tourniquet to arm
- Adult pressure: 250 mmHg
- Child pressure: 100 to 200 mmHg
- Step 3: Clamp Tourniquet tubes with hemostat
- Step 4: Remove ace wrap (from Step 1)
- Step 5: Emergent orthopedic or vascular surgeon
- Tourniquet use cannot exceed 90 to 120 minutes
- Longer Tourniquet times risk ischemic limb injury
V. References
- Antosia in Marx (2002) Rosens Emergency Med, p. 493-534
- Daniels (2004) Am Fam Physician 69(8):1949-56 [PubMed]
- Lahham (2011) West J Emerg Med 12(2): 242–9 [PubMed]