oppression hemostasis with caution tourniquet!
oppression hemostasis with caution tourniquet!
in the process of emergency perennial clinical work, the author found that many patients in pre-hospital emergency or in the process of transfer to the hospital, can not take the correct way of hemostasis. Even many patients have improperly used the wrong hemostasis method, which was originally intended to stop bleeding for the limbs, but it has become a terrible "bloodletting" in actual use ". Oppression hemostasis is the most simple, easy and reliable hemostasis method in field first aid and casualty transportation.
, as the name implies, can take the method of direct compression, in order to achieve the purpose of hemostasis. Compression hemostasis can be used not only for limb injuries, but also for bleeding in the head, neck, trunk and groin. The specific method of operation is as follows: First, observe whether there is a foreign body in the wound, such as glass, sharp wood chips, metal foreign bodies, etc. If there is no such foreign body, you can use a clean towel, gauze, etc., directly press on the bleeding wound. Try not to use paper, especially toilet paper, facial tissue, etc. These paper products are easy to become debris when stained with liquid, which will increase the difficulty of wound cleaning. Bleeding of limbs can compress the wound with gauze and towel, and then use gauze to bandage the wound under pressure. If there is no bandaging condition, it can also be pressed continuously by hand and transferred to the hospital for emergency treatment. If it is the head and neck, groin, armpit or elbow puncture caused by arterial blood spray, bleeding is severe, too late to find a towel or gauze and other items for hemostasis, you can also use the palm of the hand to directly compress the wound. Once this compression is effective to stop bleeding, do not loosen it until it is sent to the hospital. After the hemostatic conditions are sufficient or emergency surgery is ready, it will be loosened according to the doctor's guidance.
the use of tourniquets is limited to bleeding caused by injuries to the extremities. From clinical experience, the damage caused by inappropriate tourniquet use is mainly due to increased bleeding caused by insufficient pressure. There are two kinds of common standard tourniquet, one is the pressure tourniquet, one is the buckle tourniquet. Emergency also common to non-standard tourniquet items, including: all kinds of wires, ropes, ties and so on. Because non-ordinary medical staff have no concept of arterial blood flow pressure and venous blood flow pressure, many people use tourniquets on their limbs, because the pressure does not reach the pressure of blocking arterial blood flow, and mistakenly blocks the return of superficial veins, which leads to wound bleeding and aggravates blood loss in patients.
, the air pressure tourniquet is also facing this problem. When the air pressure tourniquet is just used, the pressure can still reach the hemostasis requirement. However, in the process of transportation, due to the inability to effectively monitor and control, the air pressure of the tourniquet drops, which can block the blood return of the limbs and increase the blood loss. Therefore, in our hospital emergency work tourniquet use system requirements, once the use of pneumatic tourniquet patients, unless transferred to the operating room, the rest are not allowed to leave the rescue room for use, medical staff must pay attention to limb bleeding and tourniquet pressure change.
In addition, the tourniquet has requirements for the time of use. After 40 to 50 minutes of use, it should be released once to restore the blood supply of the limbs; and when the tourniquet is opened, it is also necessary to compress the wound, otherwise it will cause More bleeding. In the process of transportation or waiting for surgery, when releasing the tourniquet, it is difficult to have surplus medical staff to help compress the wound to carry out this operation of restoring limb blood supply. Logically, if it can be compressed in this open gap, it means that compression hemostasis can solve the problem. At the same time, after the use of tourniquet on the limb, because there is no anesthesia to relieve pain, the pain caused by the overall limb ischemia is also unbearable for the patient.
from the limb trauma site subdivision, can be compressed hemostasis, but not suitable for tourniquet injuries include: first, hand trauma, cutting stab wounds, crushing injury, strangulation, etc., mainly to compress hemostasis, not suitable for the use of tourniquet. Second, the upper arm, forearm, elbow injury, even if there is a large bleeding, direct compression is faster and more convenient than the tourniquet, single operation and multi-person operation are easy. 3. crush and strangulation, in most cases, the blood vessels of the wound are damaged, and the early bleeding of the wound is stopped by itself. Even if the wound is not treated, the blood loss will not be much. However, after using tourniquet, it will cause rebleeding of the wound that has stopped bleeding.
Key words: hemostasis; tourniquet; first aid products; medical products; first aid
