A tourniquet is the absolute DEAD LAST option to stop bleeding. When you decide to use a tourniquet, you have decided to sacrifice that arm or leg. When you get to medical assistance, it WILL BE amputated.

Most bleeding can be stopped with pressure. If the bleeding is from an artery or large vein, that person isn't going anywhere except on a stretcher or travois. Help will generally have to be brought to him.

It would be a good idea to read up on how to stop bleeding, as 98% of what you've see in movies & TV is garbage.

Sue

Not entirely true regarding the tourniquet - it's time dependent. If you can get to help in a few hours, the limb can possibly be saved (ischemia times greater than about 4-6 hours tend to greatly reduce this chance). That's why it's important to note the time the tourniquet was placed.

As to suturing wounds - easy enough skill to learn, but it takes a while to get good at it & to develop the clinical judgement to know when to close & when not to. In a field environment, my opinion is to clean the wound as best as possible (cleanest water you have available - the solution to pollution is dilution <img src="/images/graemlins/smile.gif" alt="" /> ), apply the cleanest dressing you can, and get to help. Most wounds, even big ones, don't necessarily need sutures to heal - sutures do a few things: speed healing time by holding tissues in approximation, improve cosmetic outcome, and contain maintain anatomical integrity (in the case of tendons/fascia/etc... The risk of infection is pretty high in a contaminated wound, which includes essentially all of wounds acquired in the boonies.

Good luck, stay safe!

Sam

If someone's life depended on me threading 'em up, they're past tense. I can't even sew a button worth a darn.

But back to a tourniquet ... a tourniquet applied long enough to pack and bandage the wound is not a good idea?

And, to open another can o' worms ... anyone here of the Crazy Glue school?

I generally carry both a tube of Crazy Glue and a tube of EMT Gel (for the dogs) in the FAK i carry pheasant hunting.

And there's always wound strips and duct tape.

Perhaps. Orthopedic surgeons routinely use tourniquets to control bleeding during surgery. In the above hypothetical situation, you are alone with a massive gunshot wound to a long bone and are symptomatic from blood loss. Time to use a tourniquet if direct pressure will not stop the bleeding. A GSW to the femur (in this case a high powered rifle), good chance are you are going to lose the limb anyway. The decision to amputate is based on whether or not the extremity is viable.

I've used Dermabond which is basically the same thing as crazy glue. It's the same glue they use in hospitals IIRC. Pretty expensive stuff. I got lucky and happened upon a small bottle of the stuff for free. From what I understand the only problem with using Crazy Glue or Super Glue is that some people are allergic to it. I have never had the guts to find out if I'm one of those people.. <img src="/images/graemlins/smile.gif" alt="" />

I must admit to using superglue, quite recently, in fact, when I managed to slice the pad of my thumb, and really could not spare the dexderity that would be sacrificed by a big bandage. So, I approximated the edges well, glued it -- two coats -- let it dry and put heavy clothsurgical tape over it. It worked great. It hurt some, but not really more than the dilute providone iodine I irrigated with.

I don't recommend it on sensitive areas of skin.

Well, yes and no. 'Clamp time' must be monitored quite closely, and in the event that a major vesel is not totally severed the tournquiet must be loosened periodically to restore some blood flow to oxigenate the tissues. Different tissues are tolerant to different degrees of ischemia, and there is a degree of temperature dependency. If you can get tissue temp down with ice, it can tolerate ischemia longer.

I spent a very long, very cold trip in the back of a horse trailer once loosening the torniquet on a horse's leg for five minutes out of every 30. Three hour trip in. He did OK.

The use of a tourniquet in the shaking hands of a inexperienced person who doesn't really know what they're doing is virtually guaranteed to be a disaster.

If you're in a situation with a doctor or veterinarian tending to you, they probably know what to do, and how to do it with the minimal amount of damage. But under most conditions, performed by an untrained, frightened, shaky Good Samaritan, the limb will start to die in about 20 minutes.

Yes, if the arm or leg has been mostly ripped off or blown off (or the arm is stuck under a boulder & you have to cut it off), get the tourniquet on, as your choices are non-existent. But some (most?) people are so upset at the sight of a goodly amount of blood that they don't consider the consequences of their first and only thought: stop the bleeding with a tourniquet. It's simple and easy. They've seen John Wayne do it.

Tourniquets: Create-A-Cripple in one easy step.

Sue

Deja vu all over again. This thread comes around a lot.
I've been on two backcountry trips in which someone got a severe laceration. Both times, there were two surgeons present on the trip (and enough medical supplies to stock a MASH unit!). NEITHER time did the surgeon(s) want to suture. Asked recently, both agree that they'd never suture in the field. NEVER. They may use a suture to ligate a bleeder, but would never, never, never suture a wound closed.

So... I suggest a poll of forumite who are actually MDs, or EMS/EMTs.

1) Would you use a suture to ligate or tie-off a bleeder... in the field.. if you had no hemostat?

2) Would you suture a wound closed in the field. (Assuming all the "sterility" you can muster in the field)

During one year of rotations in the actual ER as a Paramedic I got to learn how to suture pretty well (way out of my scope of practice) but young docs always find pleasure in showing off and teaching others. I would not atempt to stich a face or a child since my threads are not the pretiest and I rather have somebody who does it every day and not once a week do it. But with rest anything goes. I would drop off my patient from a cardiac call than walk thru the er and doc would yell "hey Matt finish up for me" and there I go stiching somebodys arm. I know how to do it, I know the proper way of cleaning the wound but I would never stich anyone in the field . I would use direct pressure, elevation and pressure point and tk if had to, I even throw in up to 3000 cc of fluid in there to maintain you. Infection risk is to great as oposed to benefit. Plus sutures give false sense of secuirty. Yeah you stiched my leg it's not bleeding anymore I can go further.

Now to ligate a bleeder... I saw it being done but never did it my self. So this is plain simple no unless it is a case book scenario procedure I watched being done. Anything complicated (and it always is) would have to be controlled using bls stuff.

And some wounds are really tempting to stich too. They look easy and are not deep enough to be hard to clean. Still it's a no go. I will cover it, clean it, make buterflies out of tape but will not stich it.