A tourniquet is a device designed to apply pressure to a limb, effectively stopping blood flow to an injured area. This tool serves as an emergency measure to control severe, life-threatening bleeding. Its primary function is to prevent significant blood loss, which can rapidly lead to shock and further complications.
When Tourniquets Are Necessary
Tourniquets are reserved for extreme circumstances involving severe, uncontrollable bleeding from an arm or leg. These devices are considered a last resort when direct pressure alone cannot stop the hemorrhage. Scenarios that warrant tourniquet use include traumatic amputations, where a limb has been completely or almost completely removed, or when there is arterial bleeding that spurts forcefully.
Another situation demanding a tourniquet arises when there are multiple casualties, making it difficult to apply direct pressure to all severe injuries simultaneously. Injuries in locations where direct pressure is not feasible, such as deep wounds, also necessitate a tourniquet.
Achieving Effective Tourniquet Tightness
The objective of a properly applied tourniquet is to completely stop arterial blood flow to the injured limb. This requires significant pressure to occlude the blood vessels. When applying, place the tourniquet 2 to 3 inches above the wound, ensuring it is positioned between the wound and the heart, and avoid placing it over a joint.
To achieve the necessary tightness, thread the strap through the buckle to create a loop around the limb. Use the windlass mechanism, typically a rod, to twist and tighten the strap. Continue turning the windlass until the bleeding from the wound completely stops. This often requires considerable force and will likely cause pain to the injured person, which is an expected sign of effective compression. The device should become increasingly difficult to tighten further as adequate compression is achieved.
Recognizing Proper Tourniquet Application
Once a tourniquet is applied, several definitive signs indicate it is sufficiently tight and working correctly. The most important indicator is the complete cessation of bleeding from the wound. If blood continues to seep or flow, the tourniquet needs further tightening.
Another confirmation of proper application is the absence of a pulse distal to the tourniquet, such as in the foot if on the leg, or in the hand if on the arm. The skin color of the limb below the tourniquet may also become pale, and capillary refill, which is the return of color to the nail bed after pressure is applied, will be absent.
Important Considerations After Application
After a tourniquet has been applied and determined to be effective, it is important to note the exact time of application. This information is valuable for medical professionals. The tourniquet should remain exposed and not be covered by clothing or blankets, making it visible for arriving emergency personnel.
Once applied and effective, the tourniquet must not be loosened or removed by untrained individuals. Loosening it can cause a sudden rush of blood, potentially dislodging clots and restarting severe bleeding. Seek immediate professional medical attention, as the tourniquet is a temporary measure until definitive medical care can be provided.