Tourniquet application
This is the most reliable method to block arterial blood flow, used primarily on the extremities. A standard tourniquet is a rubber band applied proximally (above) the injury site over a fabric pad to prevent skin damage.
The first two to three turns are applied with maximum band tension, while all subsequent turns are overlapped in a shingled pattern. The procedure is completed by fixing the hook into the chain. Key rule: a note with the exact time of application must be left.
Exceeding the allowable time (1.5–2 hours) causes severe complications: paresis and paralysis due to nerve trunk compression, as well as the risk of anaerobic infection (gas gangrene) against the background of acute tissue hypoxia. During prolonged transport, the tourniquet must be periodically loosened for 10–15 minutes (in winter — every 30 minutes, in summer — every hour), replacing it with digital pressure. After a brief rest, the tourniquet is reapplied slightly above or below the original level.
In case of a carotid artery injury, a Kramer wire splint or the victim's arm from the uninjured side thrown over the head is used. This creates a rigid frame that protects the trachea and healthy vessels from asphyxiating pressure. Applying a tourniquet to the abdomen to compress the abdominal aorta is strictly prohibited due to the risk of crushing internal organs.
Digital arterial pressure
This method is used as a first step for emergency hemostasis before applying a dressing or tourniquet, as well as during its repositioning. The principle involves strongly pressing the vessel against the nearest bone proximal to the wound. It is effective, but maintaining this maneuver for longer than 15–20 minutes is difficult due to rescuer physical fatigue.
Main anatomical landmarks:
- Brachial artery (a. brachialis) — compressed against the medial surface of the humerus.
- Femoral artery (a. femoralis) — compressed against the pubic bone.
- Common carotid artery (a. carotis communis) — against the carotid tubercle of the transverse process of the sixth cervical vertebra.
- Subclavian artery (a. subclavia) — against the first rib.
- Facial artery (a. facialis) — against the lower border of the mandible.
- Temporal artery (a. temporalis) — against the bone anterior to the ear tragus.
- Axillary artery (a. axillaris) — in the armpit against the humeral head.
The subclavian artery is the most technically difficult to compress. If this fails, the victim's arms are pulled back behind the back as far as possible and fixed — the vessel is mechanically occluded between the clavicle and the first rib.
Alternative surgical and physical methods
In addition to basic methods, there are additional temporary cessation techniques, the choice of which depends on the wound location and available instrumentation.
- Tight packing and pressure dressing. Used for venous bleeding and minor arterial damage. The wound is tightly filled with gauze. Contraindication: wounds of the popliteal fossa (high risk of ischemia and gangrene).
- Maximum limb flexion. For high wounds of the forearm, lower leg, or thigh, the limb is flexed to the stop in the elbow, knee, or hip joint, respectively, and then rigidly fixed.
- Clamp placement in the wound. Performed by a physician in deep wounds when external compression is impossible. The vessel is first compressed with fingers (to avoid blind nerve inclusion), the wound is dried, and a surgical clamp is applied.
- Temporary shunting. A rigid plastic tube is inserted into the ends of the damaged main artery and secured with ligatures. The method fully restores blood circulation, allowing surgeons to gain from several hours to a day before definitive reconstructive surgery.
Briefly: answers to topical questions
What physical and mechanical methods of temporary bleeding cessation exist, besides the tourniquet and digital pressure?
In addition to the tourniquet and digital arterial pressure, the following temporary bleeding cessation methods are used:
- Maximum limb flexion — fixation of the arm or leg in a position of maximum flexion at the joint.
- Wound packing and pressure dressing application — tight insertion of a gauze pack followed by fixation, sometimes using weight pressure and cooling.
- Digital vessel compression in the wound — compression of the vessel directly within the wound.
- Hemostatic clamp placement — application of an instrument to the bleeding vessel after drying the wound.
- Temporary vessel shunting — insertion of a rigid-elastic tube into the ends of the damaged artery.
- Balloon tamponade — used for bleeding from esophageal varices.
What types of hemostatic tourniquets are used in modern medicine?
Standard-issue and improvised types of hemostatic tourniquets are used in medical practice.
- Standard-issue rubber tourniquet — a 1.5 m rubber band equipped with a metal chain on one end and a hook on the other.
- Special military tourniquet — used as an alternative standard-issue device.
- Pneumatic cuff — used on the proximal part of the limb with pressure slightly exceeding arterial pressure to prevent complications.
- Improvised tourniquet (Spanish windlass) — a makeshift tourniquet created from improvised materials using a lever.
What set of measures must be performed for a victim immediately after applying a tourniquet prior to transport?
Immediately after applying a hemostatic tourniquet, the following set of measures must be performed:
- Labeling — mandatory indication of the exact tourniquet application time in a note.
- Immobilization — mandatory application of a transport splint to the injured extremity.
- Thermoregulation — wrapping the extremity in cold weather to prevent frostbite due to the absence of blood flow.
- Analgesia — administration of analgesics to reduce pain syndrome.
After performing these actions, the victim must be urgently transported to the clinic in a supine position.
To remember the essence of digital pressure, keep the rule in mind: the artery is always compressed against a bone whose name most often matches or is anatomically close to the name of the vessel (brachial — to the humerus, temporal — to the temporal bone).
Class and exam questions
Why is it unacceptable to leave a tourniquet on a limb for longer than 1.5–2 hours?
Prolonged ischemia of tissues leads to their death (ischemic necrosis) and damage to nerve trunks. Furthermore, hypoxia of distal segments creates favorable conditions for the development of gas gangrene.
What is the specific feature of applying a tourniquet to the neck?
The tourniquet is applied only using a protective frame on the uninjured side. For this, a Kramer splint or the patient's raised arm is used to avoid compressing the airways and the healthy carotid artery.
Where is tight wound tamponade contraindicated?
Tamponade is strictly prohibited for wounds in the popliteal fossa area, as strong compression of the neurovascular bundle in this zone frequently leads to gangrene development.
What actions must be performed after applying a tourniquet?
The extremity must be immobilized with a transport splint, analgesics administered to the patient for pain relief, and in cold weather, the extremity must be wrapped. The patient is urgently transported in a supine position.
What else to study on this topic
- Methods of definitive hemostasis
- Prevention and treatment of anaerobic infection in trauma
- Rules of transport immobilization and types of splints
- Vascular suture technique
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