Tourniquet – Shock

 Apply A Tourniquet  –  Field Dressing  –  Pressure Dressing  -

Check and Treat for Shock

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 A tourniquet is a constricting band placed around an arm or leg to control bleeding. A soldier whose arm or leg has been completely amputated may not be bleeding when first discovered, but a tourniquet should be applied anyway. This absence of bleeding is due to the body’s normal defenses (contraction of blood vessels) as a result of the amputation, but after a period of time bleeding will start as the blood vessels relax. Bleeding from a major artery of the thigh, lower leg, or arm and bleeding from multiple arteries (which occurs in a traumatic amputation) may prove to be beyond control by manual pressure. If the pressure dressing under firm hand pressure becomes soaked with blood and the wound continues to bleed, apply a tourniquet.

WARNING: Casualty should be continually monitored for development of conditions which may require the performance of necessary basic life-saving measures, such as: clearing the airway, performing mouth-to-mouth resuscitation, preventing shock, and/or bleeding
control. All open (or penetrating) wounds should be checked for a point of entry or exit and treated accordingly.

*The tourniquet should not be used unless a pressure dressing has failed to stop the bleeding or an arm or leg has been cut off. On occasion, tourniquets have injured blood vessels and nerves. If left in place too long, a tourniquet can cause loss of an arm or leg. Once applied, it must stay in place, and the casualty must be taken to the nearest medical treatment facility as soon as possible. DO NOT loosen or release a tourniquet after it has been applied and the bleeding has stopped.

a. Improvising a Tourniquet. In the absence of a specially designed tourniquet, a tourniquet may be made from a strong, pliable material, such as gauze or muslin bandages, clothing, or kerchiefs. An improvised tourniquet is used with a rigid stick-like object. To minimize skin damage, ensure that the improvised tourniquet is at least 2 inches wide.

 

WARNING: The tourniquet must be easily identified or easily seen.

WARNING: DO NOT use wire or shoestring for a tourniquet band.

WARNING: A tourniquet is only used on arm(s) or leg(s) where there is danger of loss of casualty’s life.

b. Placing the Improvised Tourniquet.

(1) Place the tourniquet around the limb, between the wound and the body trunk (or between the wound and the heart). Place the tourniquet 2 to 4 inches from the edge of the wound site. Never place it directly over a wound or fracture or directly on a joint (wrist, elbow, or knee). For wounds just below a joint, place the tourniquet just above and as close to the joint as possible.

(2) The tourniquet should have padding underneath. If possible, place the tourniquet over the smoothed sleeve or trouser leg to prevent the skin from being pinched or twisted. If the tourniquet is long enough, wrap it around the limb several times, keeping the material as flat as possible. Damaging the skin may deprive the surgeon of skin required to cover an amputation. Protection of the skin also reduces pain.

c. Applying the Tourniquet.

 (1) Tie a half-knot. (A half-knot is the same as the first part of tying a shoe lace.)

(2) Place a stick (or similar rigid object) on top of the half-knot.

(3) Tie a full knot over the stick.

(4) Twist the stick until the tourniquet is tight around the limb and/or the bright red bleeding has stopped. In the case of amputation, dark oozing blood may continue for a short time. This is the blood trapped in the area between the wound and tourniquet.

(5) Fasten the tourniquet to the limb by looping the free ends of the tourniquet over the ends of the stick. Then bring the ends around the limb to prevent the stick from loosening. Tie them together under the limb.

NOTE: Other methods of securing the stick may be used as long as the stick does not unwind and no further injury results.

NOTE: If possible, save and transport any severed (amputated) limbs or body parts with (but out of sight of) the casualty.

   File:Improvised tourniquet.jpg

(6) DO NOT cover the tourniquet–you should leave it in full view. If the limb is missing (total amputation), apply a dressing to the stump.

(7) Mark the casualty’s forehead, if possible, with a “T” to indicate a tourniquet has been applied. If necessary, use the casualty’s blood to make this mark.

(8) Check and treat for shock.

(9) Seek medical aid.

CAUTION: DO NOT LOOSEN OR RELEASE THE TOURNIQUET ONCE IT HAS BEEN APPLIED BECAUSE IT COULD ENHANCE THE PROBABILITY OF SHOCK.

 

Apply A Pressure Dressing

 

Pressure dressings aid in blood clotting and compress the open blood vessel. If bleeding continues after the application of a field dressing, manual pressure, and elevation, then a pressure dressing must be applied as follows:

a. Place a wad of padding on top of the field dressing, directly over the wound (Figure 2-35). Keep injured extremity elevated.

NOTE: Improvised bandages may be made from strips of cloth. These strips may be made from T-shirts, socks, or other garments.

b. Place an improvised dressing (or cravat, if available) over the wad of padding (Figure 2-36). Wrap the ends tightly around the injured limb, covering the previously placed field dressing (Figure 2-37).

c. Tie the ends together in a nonslip knot directly over the wound site (Figure 2-38). DO NOT tie so tightly that it has a tourniquet-like effect. If bleeding continues and all other measures have failed, or if the limb is severed, then apply a tourniquet. Use the tourniquet as a LAST RESORT. When the bleeding stops, check and treat for shock.

NOTE: Wounded extremities should be checked periodically for adequate circulation. The dressing must be loosened if the extremity becomes cool, blue or numb.

NOTE: If bleeding continues and all other measures have failed (dressing and covering wound, applying direct manual pressure, elevating limb above heart level, and applying pressure dressing maintaining limb elevation), then apply digital pressure.

Apply A Field Dressing

 

a. Use the casualty’s field dressing; remove it from the wrapper and grasp the tails of the dressing with both hands (Figure 2-28).

WARNING: DO NOT touch the white (sterile) side of the dressing, and DO NOT allow the white (sterile) side of the dressing to come in contact with any surface other than the wound.

b. Hold the dressing directly over the wound with the white side down. Pull the dressing open (Figure 2-29) and place it directly over the wound (Figure 2-30).

c. Hold the dressing in place with one hand. Use the other hand to wrap one of the tails around the injured part, covering about one-half of the dressing (Figure 2-31). Leave enough of the tail for a knot. If the casualty is able, he may assist by holding the dressing in place.

d. Wrap the other tail in the opposite direction until the remainder of the dressing is covered. The tails should seal the sides of the dressing to keep foreign material from getting under it.

e. Tie the tails into a nonslip knot over the outer edge of the dressing (Figure 2-32). DO NOT TIE THE KNOT OVER THE WOUND. In order to allow blood to flow to the rest of an injured limb, tie the dressing firmly enough to prevent it from slipping but without causing a tourniquet-like effect; that is, the skin beyond the injury becomes cool blue, or numb.

Check and Treat for Shock

 

Causes and Effects

a. Shock may be caused by severe or minor trauma to the body. It usually is the result of–

  • Significant loss of blood.
  • Heart failure.
  • Dehydration.
  • Severe and painful blows to the body.
  • Severe burns of the body.
  • Severe wound infections.
  • Severe allergic reactions to drugs, foods, insect stings, and snakebites.

b. Shock stuns and weakens the body. When the normal blood flow in the body is upset, death can result. Early identification and proper treatment may save the casualty’s life.

c. See FM 8-230 for further information and details on specific types of shock and treatment.

Signs/Symptoms

Examine the casualty to see if he has any of the following signs/symptoms:

 

  • Sweaty but cool skin (clammy skin).
  • Paleness of skin.
  • Restlessness, nervousness.
  • Thirst.
  • Loss of blood (bleeding).
  • Confusion (or loss of awareness).
  • Faster-than-normal breathing rate.
  • Blotchy or bluish skin (especially around the mouth and lips).
  • Nausea and/or vomiting.

Treatment/Prevention

In the field, the procedures to treat shock are identical to procedures that would be performed to prevent shock. When treating a casualty, assume that shock is present or will occur shortly. By waiting until actual signs/symptoms of shock are noticeable, the rescuer may jeopardize the casualty’s life.

a. Position the Casualty. (DO NOT move the casualty or his limbs if suspected fractures have not been splinted.)

 

(1) Move the casualty to cover, if cover is available and the situation permits.

(2) Lay the casualty on his back.

NOTE: A casualty in shock after suffering a heart attack, chest wound, or breathing difficulty, may breathe easier in a sitting position. If this is the case, allow him to sit upright, but monitor carefully in case his condition worsens.

 

(3) Elevate the casualty’s feet higher than the level of his heart. Use a stable object (a box, field pack, or rolled up clothing) so that his feet will not slip off (Figure 2-44).

WARNING: DO NOT elevate legs if the casualty has an unsplinted broken leg, head injury, or abdominal injury.

 

 

 

WARNING: Check casualty for leg fracture(s) and splint, if necessary, before elevating his feet. For a casualty with an abdominal wound, place knees in an upright (flexed) position.

(4) Loosen clothing at the neck, waist, or wherever it may be binding.

CAUTION: DO NOT LOOSEN OR REMOVE protective clothing in a chemical environment.

(5) Prevent chilling or overheating. The key is to maintain body temperature. In cold weather, place a blanket or other like item over him to keep him warm and under him to prevent chilling (Figure 2-45). However, if a tourniquet has been applied, leave it exposed (if possible). In hot weather, place the casualty in the shade and avoid excessive covering.

 

 

(6) Calm the casualty. Throughout the entire procedure of treating and caring for a casualty, the rescuer should reassure the casualty and keep him calm. This can be done by being authoritative (taking charge) and by showing self-confidence. Assure the casualty that you are there to help him.

 

(7) Seek medical aid.

b. Food and/or Drink. During the treatment/prevention of shock, DO NOT give the casualty any food or drink. If you must leave the casualty or if he is unconscious, turn his head to the side to prevent him from choking should he vomit (Figure 2-46).

c. Evaluate Casualty. If necessary, continue with the casualty’s evaluation.

First Aid

  1. Check the person’s airway (open if necessary); check breathing and circulation. If necessary, begin rescue breathing, CPR, or bleeding control.
  2. Try to calm and reassure the person as much as possible. Amputation is painful and extremely frightening.
  3. Control bleeding by applying direct pressure to the wound. Raise the injured area. If the bleeding continues, recheck the source of the bleeding and reapply direct pressure, with help from someone who is not tired. If the person has life-threatening bleeding, a tight bandage or tourniquet will be easier to use than direct pressure on the wound. However, using a tight bandage for a long time may do more harm than good.
  4. Save any severed body parts and make sure they stay with the patient. Remove any dirty material that can contaminate the wound, if possible. Gently rinse the body part if the cut end is dirty.
  5. Wrap the severed part in a clean, damp cloth, place it in a sealed plastic bag and place the bag in ice cold water.
  6. Do NOT directly put the body part in water without using a plastic bag.
  7. Do NOT put the severed part directly on ice. Do NOT use dry ice as this will cause frostbite and injury to the part.
  8. If cold water is not available, keep the part away from heat as much as possible. Save it for the medical team, or take it to the hospital. Cooling the severed part will keep it useable for about 18 hours. Without cooling, it will only remain useable for about 4 to 6 hours.
  9. Keep the patient warm.
  10. Take steps to prevent shock. Lay the person flat, raise the feet about 12 inches, and cover the person with a coat or blanket. Do NOT place the person in this position if a head, neck, back, or leg injury is suspected or if it makes the victim uncomfortable.
  11. Once the bleeding is under control, check the person for other signs of injury that require emergency treatment. Treat fractures, additional cuts, and other injuries appropriately.
  12. Stay with the person until medical help arrives.

DO NOT

  • Do NOT forget that saving the person’s life is more important than saving a body part.
  • Do NOT overlook other, less obvious, injuries.
  • Do NOT attempt to push any part back into place.
  • Do NOT decide that a body part is too small to save.
  • Do NOT place a tourniquet, unless the bleeding is life threatening, as the entire limb may be harmed.
  • Do NOT raise false hopes of reattachment.

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