Abstract
Background
Life-threatening hemorrhage from extremity injuries can be effectively controlled
in the prehospital environment through direct pressure, wound packing, and the use
of tourniquets. Early tourniquet application has been prioritized for rapid control
of severe extremity hemorrhage and is a cornerstone of prehospital trauma resuscitation
guidelines. Emergency physicians must be knowledgeable regarding the initial assessment
and appropriate management of patients who present with a prehospital tourniquet in
place.
Discussion
An interdisciplinary group of experts including emergency physicians, trauma surgeons,
and tactical and Emergency Medical Services physicians collaborated to develop a stepwise
approach to the assessment and removal (discontinuation) of an extremity tourniquet
in the emergency department after being placed in the prehospital setting. We have
developed a best-practices guideline to serve as a resource to aid the emergency physician
in how to safely remove a tourniquet. The guideline contains five steps that include:
1) Determine how long the tourniquet has been in place; 2) Evaluate for contraindications
to tourniquet removal; 3) Prepare for tourniquet removal; 4) Release the tourniquet;
and 5) Monitor and reassess the patient.
Conclusion
These steps outlined will help emergency medicine clinicians appropriately evaluate
and manage patients presenting with tourniquets in place. Tourniquet removal should
be performed in a systematic manner with plans in place to immediately address complications.
Keywords
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Article info
Publication history
Published online: December 07, 2020
Accepted:
October 4,
2020
Received in revised form:
October 1,
2020
Received:
August 16,
2020
Footnotes
Disclaimer: The views expressed in this manuscript reflect those of the authors alone and do not reflect the official policy or position of the Uniformed Services University of the Health Sciences, Department of the Army, Department of the Air Force, Department of Defense, or the United States Government.
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
