Medical scenario 1

[Holomon]

We questioned it as well, but we're told that in the Afghan combat torniquets have been regularly used and kept on for upto 24 hours. My own personal thought would be to torniquet for a catastrophic bleed, but to release it every hour for a short period.
There is a huge difference between military and civilian views on torniquets, I would hope that the powers that be can standardise the issue, especially as you can pick up a CAT for less than £20

Honestly, they were talking out of their behinds. Tourniquets have certainly not been regularly used for up to 24 hours in Afghanistan, especially as the average medevac time was just over an hour when I was there.

You use a tourniquet until you can get a suitable pressure dressing on, it's not a long term solution and really will kill off tissue and muscle if left on too long.

There is no difference between the military and civilian view of tourniquet use, it's simple medical fact. Soldier's bodies aren't any different to civilians. You use them as an absolute last choice and for as short a time as possible. (Tourniquets, not soldier's bodies).

Yes of course it's better to tourniquet for 24 hours than bleed out if that's all you have, on the understanding that you'll almost certainly lose the leg but survive. You'd have to be in a situation where you couldn't stop and dress the wound properly though with a pressure dressing to have to leave the CAT on.
That isn't a situation that I'm aware had ever happened in Afghanistan.

I'm an ex-RAMC doctor by the way, so I'd like to think it's a subject I know a bit about!

[Tackleberry]

Many thanks for the correction, I thought it was a bit excessive. It just goes to show we live and learn.

[pseudonym]

I'm an ex-RAMC doctor by the way, so I'd like to think it's a subject I know a bit about!

Thankyou for your Service.

[Holomon]

Many thanks for the correction, I thought it was a bit excessive. It just goes to show we live and learn.

No problem, if there's ever anything I can correct or help with then I'll try. I'm on here when I can and try not to come across as a know it all

[Holomon]

Thankyou for your Service.

Sorry didn't spot that when I replied, thank you! To be honest it was never a hardship, I enjoyed every minute I was in but it's always appreciated.

[Pastiebap]

Honestly, they were talking out of their behinds. Tourniquets have certainly not been regularly used for up to 24 hours in Afghanistan, especially as the average medevac time was just over an hour when I was there.

You use a tourniquet until you can get a suitable pressure dressing on, it's not a long term solution and really will kill off tissue and muscle if left on too long.

Pretty much sums the subject up perfectly. For the love of god, do not put a tourniquet on anybody unless you are a medical professional. The damage you can do with an incorrectly used tourniquet is horrific. Don't lose the limb to stop the bleed. I am astounded that there are people out there teaching this to non-professionals.

[birds&bees]

This is fun!

1) Make sure there is no mutant ninja babies around to also attack you - safety first guiz. Reassure her and ask her to stay still "you're going to be alright"
2) They are alert but drowsy so GCS 15 I interpret that as. This means Airway clear, breathing and circulation adequate to perfuse and oxygenate brain.
3) Lets optimise their position, so long as no breathing issues, lie them flat legs up and arm up.
Next lets turn to the injury

4) Wash out wound with a great deal of clean water. Any foreign body now and game over.
5) Using clean towels apply pressure to the wound if they are no doing so well enough.


They are tachypneac and tachycardic this may be adrenaline / pain related but also are the harbingers of shock.
While I am trained to use fluids, cannula and sutures I do not routinely carry them with me so they are out. Nor do I carry stipticss

6) If bleeding is no being controlled time to get serious, we need to stem the bleeding, I do not want to fully tournequet the arm so pressure applied to the axilla artery for example an apple or tennis ball held tightly in the armpit. Tournequet will be last resort used for no longer than 3 setting before risk of tissue death and secondary infection would outweight preventing bleeding.

7) Last resort cauthery,

Assuming at some point bleeding has been controlled, maintain toileting with clean water. Monitor for 48 hours for signs of infection spreading redness, swelling on going bleeding, discharge and warmth. If infection antibiotics 500mg flucloxacillin four times a day for 7 days would be ideal.

[Bubbles]

Coming from someone with a lot of experience with this, tourniquets are amazing and in the event of a cat bleed I would certainly use one for as long as necessary. Using one doesn't mean losing yor limb, it all depends on the time till care. It's a case of lesser evils. I would rather be incapacitated than dead, I would rather in be in pain than drugged up to the point I pass out.

Celox is a relatively new thing but clotting agents are widely used so I would suggest a pack or two in your kits, next to a cat tourniquet and a first field dressing or two.

This kit is used in the battlefield for a very good reason.

If any non medical people want a quick tip book have a look at the army bcd aide memoire it's a step by step idiots guide (no insult intended)

[Hamradioop]

BATTLEFIELD CASUALTY DRILLS
http://www.222-atc.org.uk/wp-content/Re ... emoire.pdf