pressure points for heavy blood loss

[skammer]

What???

By volumous I meant heath care systems are not large enough or organized enough to deal with mass casualties, New Orleans point of example. Avian flu a future example possibly.

Never claimed to be a spec ops medic no Dr. Just and an above average learned lamen with an above average medical inclination. It is true though Dr's do not like to be questioned its part of their training to be arrogant I think

Stop equating my words with non normal health care I am refering to survival medicine hear. My family gets all the top notch health care they need thanks.
Just some simple common issues are treated at home. Any questionable situations gets professional treatment.

That said I do not count on any help and plan for the worst.

Vet meds apples to apples are no less quality than human meds (arguably more so). That 4 million dollar prized stallion horse or that westminster bound best of breed dog proves this theory and my vet confirmed it.

Why do you insist on this battle?

It is what it is, deal.

Skam

 

[Ebbtide]

I aint a lamen,
Eat alot o' Ramen,
Don't eat no seal,
Aint got no deal,
Argue with a doc,
Is just a crock,
Get my meds from a vet,
Hey not on a bet,
Pry with my knife,
Not on your life,
So much drivel,
Makes me snivel,
Ivory tower,
Give the power,
Make me wanna shower.

Boom Sha Lakka Boom

 

[skammer]

I aint a lamen,
Eat alot o' Ramen,
Don't eat no seal,
Aint got no deal,
Argue with a doc,
Is just a crock,
Get my meds from a vet,
Hey not on a bet,
Pry with my knife,
Not on your life,
So much drivel,
Makes me snivel,
Ivory tower,
Give the power,
Make me wanna shower.

Boom Sha Lakka Boom

Typical New Yorker

Skam

 

[LSkylizard]

...It is true though Dr's do not like to be questioned its part of their training to be arrogant I think...

You are entitled to your OPINION

...Vet meds apples to apples are no less quality than human meds (arguably more so). That 4 million dollar prized stallion horse or that westminster bound best of breed dog proves this theory and my vet confirmed it...

Again, you are entitled to your OPINION. Not all vets are payed by pure bred champion horse breeders. Again, the quality of shipping, handling, and storage, etc... is not regulated at the same level...deal with it. Vets quite often try to claim your point (and mine simultaneously). Largely because they do not want private citizen to cut them out of the loop and go directly to the distributors. While I was at AMEDD training with a large assortment of vets, the vets (from all over the country) kept spouting how "unethical" it was to mail order meds and vaccines because....quality of shipping, handling, and storage, etc were not well regulated. They stated how important it was to pay them for the service...though they used the same distributors. Basically, they argued my point to benefit their check book. Finally, animals often tolerate more disease then we ever will. Their ability to achieve champion status/performance has as much if not more to do with training, science nutrition, and other ingredients beyond the chronic (often excessive) antibiotics and vaccines.

...Never claimed to be a spec ops medic...

No, I never thought you did. However, you often cite Spec Ops practices in a manner that suggests you or others should/can do things because they do. I think most Spec Ops Medics will tell you, "you want to act like a Spec Ops Medic? Then complete the Q-Course"


I think the otherside/perspective is now published. Readers can choose if they desire to provide primary care medicine with vet medications and no physician or choose the route of the physician. I personally choose to provide health care to GIs & their families because I believe they are entitled to the best healthcare and medications possible by the best trained. I am greatful to the medics providing frontline care when an MD is NOT available.

 

[LSkylizard]

As a PA, I resent your comment. How many times have you actually had any of those you mentioned say they have used Vet Meds? As a mandated reporter did you report them? (after all wouldn't that be child abuse)...PA-NP have enough access to get scripts and usually have INSURANCE so I find your comment reeking of exaggeration...

I have reported individuals for innappropriate practice outside the laws and licensure. I apologize if you take offense. The unfortunate reality is that a great number of individuals (not saying the majority) practice outside, above, and beyond their qualifications. I have seen radiologists, dentist, chiropractors, and psychiatrists trying to treat things they lacked the appropriate training to treat. Just as I have seen numerous neighbors take their kids to the nurse living down the street when I was growing up. Yes, routinely NP & PAs can write scripts. Some however, will fall into the trap of (as suggested in this forum)... the meds for million dollar champion horses are cheaper and of better quality and start buying it for THEIR family. I have not seen them dispense for other families...but have seen individuals encourage other families to order it their self and what to order, etc...

...Vet meds apples to apples are no less quality than human meds (arguably more so). That 4 million dollar prized stallion horse or that westminster bound best of breed dog proves this theory and my vet confirmed it...

Part of the mentality of practicing outside of ones qualifications is unfortunately stimulated by politics. Numerous organizations have pushed to give NPs & PAs almost equal status to an MD in order to allow independent practice. This has occurred in some states. Those in other states have looked and probably thought, "if my classmate over in state X can do this then I can". However, situations of independent practice have actually been intended in an almost emergent/urgent circumstance in which the area is underserved and the NP/PA is the only primary care those individuals will receive. Arguably, the most qualified AVAILABLE in the underserved area but not the ideal circumstance. In the USA, the average physician completes 4 years of medical school (a minimum of 2 being primarily clinical) followed by at least 3 years of intense clinical training. In many, if not most states, unrestricted licensure for a physician requires completion of at least two years post-graduate clinical training.

Now if you were to talk of Docs/PA/NP going to each other to get a script instead of seeing a another provider legitimately I would agree.(Hey Paul can you write me a Z-Pac...)

I agree this is a real problem and a violation of license that does occur regularly.

I wouldn't cut corners with my family.

I believe most professionals will agree with you.

 

[c1328chase]

the pressure of a tourniquet tied around a limb is applied over the circumference of that limb, therefore there isn't direct pressure on that parcticular artery, so you have to tie the tourniquet tighter to restrict that vessel, a pressure point is direct pressure, also quick tip, if you are ever positive you are about to be in a knife fight and you have a few minutes before the person catches up to you (if you run like a smart person), ready-made tourniquets are great ideas, you go ahead and tie tourniquets to all four limbs ( high on the limb, near shoulder and groin ) so that when you take a cut, because everyone bleeds in a knife fight, you get cut but there is already not a lot of blood there because you just tourniqueted it off it won't keep bleeding and less chance of bleeding out in the fight and less blood running down your arm means tighter grip on the knife and less blood on your feet means surer footing, take heed this advice comes from a 14 year old, who has watched too many jean claude van damne movies, jk , lol but no i learned that from the fight scene at the end of "the hunted" with tommy lee jones

 

[LSkylizard]

...the pressure of a tourniquet tied around a limb is applied over the circumference of that limb, therefore there isn't direct pressure on that parcticular artery, so you have to tie the tourniquet tighter to restrict that vessel...

...Real estate…A TQ cuts off a whole lot of it while PP will specifically isolate a region (in general). Ideally, the pressure point will be distal enough to allow other collateral vessels to branch. This means uninjured vessels are free to perfuse the limb while you compress the injured vessel. A TQ compresses all vessels distal to it as it is circumferential and functions in a strangulating fashion…
TQ applies global pressure. It will require enough pressure to tamponade the injured vessels. By coincidence, this is generally the exact amount of pressure required to stop the healthy vessels from perfusing…
...there are changes in the wind about using a TQ in place of DP. This of course is for the trained professional. It involves having the right supplies...It is not used in a patient in shock...

If you read earlier in the thread, I believe you will see we have covered much of your points or questions. I am posting the highlights above. However, we do use TQs all the time in the OR for prolonged periods without significant problems. Of course, these are properly designed and not improvised TQs. The military now issues new, high speed, quality TQs (for the FIELD). Again, only to be used in a properly trained fashion.

...ready-made tourniquets are great ideas, you go ahead and tie tourniquets to all four limbs ( high on the limb, near shoulder and groin ) so that when you take a cut...not a lot of blood...

I do NOT recommend this idea...with all do respect to Van Damme movies.

 

[Brommeland]

Howdy, all!

Well, back to Cliff's original question regarding tourniquets/pressure points/direct pressure:

Direct presure: Pressure applied directly to the wound site. This can be done by placing a bare hand or dressing on the wound and pressing firmly. Wrapping the wound site in a tight bandage/ace wrap is called a pressure dressing. It works best when used in conjunction with elevating the injury site above heart level.

Pressure point (digital pressure): This is a term used to describe slowing blood flow to an injury site by compressing the artery between the heart and injury site. (IE the brachial artery in the armpit to slow bloodflow to an injured arm)

Tourniquet: The total restriction of bloodflow to a limb by wrapping material above the injury site and applying tension (usually a LOT of tension). This often causes significant injury to the limb in question and can result in amputation quite often. This is a technique reserved for a situation in which all of the above have failed, and death is otherwise imminent from blood loss.

This is NOT stuff that you can learn from a book/forum/magazine or other "chairborne ranger" training media. If you actually spend a lot of time in the outdoors under circumstances in which such measures might well be needed, then AT THE VERY LEAST you need to take an EMT course and spend some time riding squad or working in an ER. (You'll also need a boatload of gauze - WAY MORE than you'll find in a typical first aid kit - certainly more than will fit in the handle of a survival knife).
Successful treatment of significant blood loss will likely require MAST and IV's - neither of which will typically be available in the field (unless you carry a 50 + pound trauma box).
In short, don't try this at home, boys and girls....

 

[LSkylizard]

...often causes significant injury to the limb in question and can result in amputation quite often...

Generally NOT true for a properly applied TQ. That is why it is a common component of orthopedic surgery today. Amputation is generally the result of not having the resources for definitive care available...not the result of a properly placed TQ.. A properly placed TQ used under appropriate circumstances saves lives and actually helps save a limb by default.

...This is NOT stuff that you can learn from a book/forum/magazine or other "chairborne ranger" training media...In short, don't try this at home, boys and girls...

I generally agree with that.

...Successful treatment of significant blood loss will likely require MAST...

MAST is used by some and NOT by others...it is rapidly becoming an outdated modality. There actually is mortality associated with the use of MAST in trauma.

...Successful treatment of significant blood loss will likely require...IV's ...

Generally a VERY true statement. Survival from hypovolemic shock requires rapid and aggressive resuscitation.

 

[Brommeland]

Generally NOT true for a properly applied TQ. That is why it is a common component of orthopedic surgery today.

The operative word here being "properly". As far as fatalities associated w/ the use of MAST, it is my understanding that such fatalities result from their improper use - specifically deflating them too rapidly.
Otherwise, we seem to be pretty much in agreement.

 

[LSkylizard]

...fatalities associated w/ the use of MAST, it is my understanding that such fatalities result from their improper use - specifically deflating them too rapidly...

Don't know about the deflation fatalities...I am talking about from "properly used" fatalities...that is a whole other topic. I will just leave it with my original statement.

...MAST is used by some and NOT by others...it is rapidly becoming an outdated modality. There actually is mortality associated with the use of MAST in trauma...

A final point as it really seems this topic is spent...There is sufficient data to show that improvised TQs are not appropriate. If you really want to have TQs at your disposal for first responder treatment, you need something with capabilities (similar/equal) to the The Special Operations Forces Tactical Tourniquet (SOFTT). So, get the training and have the right equipment to employ your training. The first step in saving lives is proper planning with proper preparation and gear.
http://www.tacmedsolutions.com/SOFTT.htm
http://www.matourniquet.com/ I have tried neither of these systems so I can not speak to there application.
http://www.spservices.co.uk/product...=3587&osCsid=645a00685bfba0f42887f99d19d33521

 

[pcnorton]

The tourniquet applied in orthopaedic surgery is not what you would think of as an emergency tourniquet. Its wide over 4", It is a glorified BP cuff, it is not put on bare skin. The skin is wrapped with webril padding (no tissue damage) Also the tourniquet is on a timer and its pressure is measured.

I imagine the tourniquets of <4 inches with no padding put on in the field do some tissue damage.

PA/NP may be pushing for independent practice(I don't agree with that, I like having the Ortho Surgeon to bounce thing off) but hey I'll take a 10 year Primary care PA/NP over a fresh FP Doc grad. Medicine is all about what you see and read. The PA/NP are reading the same journals and texts. (pick the guy/gal with most experience)

Everyone has their specialty and there areas, when they get out of their areas thats when crap happens. A few of the PG3 PG2 do ride alongs in Hartford CT with ambulances, they commented on that. They thought they were "docs" and would be comfortable in the Paramedic role..but they all agreed they were lost and believe the paramedics do what they do best.


I am a 2003 PA grad, doing Ortho since graduation, make no bones (pun intended) about what I don't know. Unfortunately Med Residencies don't seem to foster that, admitting you don't know something is a weakness.


Paul

 

[LSkylizard]

The tourniquet applied in orthopaedic surgery is not what you would think of as an emergency tourniquet...

Agreed. I did not intend to suggest one take an OR TQ into the field...not practical. I am simply saying that a proper designed and used/deployed TQ is not going to cause significant injury or limb loss.

...we do use TQs all the time in the OR for prolonged periods without significant problems. Of course, these are properly designed and not improvised TQs. The military now issues new, high speed, quality TQs (for the FIELD). Again, only to be used in a properly trained...

 

[onowa]

Typical New Yorker

Skam

 

[onowa]

I keep coming back to this place,hoping to learn something. Wondering why??? I frequent many forums,but I have never seen so much bickering in all my life. I wonder why some do not get banned for their sarcasm ans BS ? It is quite obvious some just like to fight,and some do not Know crap on the subjects.

Just my 2 cents!

 

[Brommeland]

Agreed. I did not intend to suggest one take an OR TQ into the field...not practical. I am simply saying that a proper designed and used/deployed TQ is not going to cause significant injury or limb loss.

But the original discussion was about controlling blood loss IN THE FIELD.

 

[LSkylizard]

But the original discussion was about controlling blood loss IN THE FIELD.

I am not sure of your point as issue of in the field has been hit multiple times in this thread. There are quality TQs made for FIELD application. Final Synopsis:

...There's a picture of one pressure point at the cert site under the title :disaster medical operation 1.
http://training.fema.gov/emiweb/CERT/mtrls.asp

...With a tourniquet, you stop all flow entering and leaving the affected area. If you need to apply one...put it as close to the wound as possible and write down the time that it was started. Preferably write on the leg or arm itself in Sharpie...

...As I understand it, you hold pressure or use a "pressure dressing" on a wound when there is a reasonable expectation that the wound will clot and that the bleeding will stop long before the patient is in danger of dying. OTOH, a tourniquet is applied when there is no expectation that the wound will clot and a belief that the bleeding will not stop with pressure alone...

With massive blood loss, don't forget to also check for and likely treat for shock...Remember, shock kills.

Bear in mind that when you apply pressure to a major vessel to reduce bleeding, you aren't constricting other, smaller blood vessels, thus allowing blood supply to tissue in the affected area and "below", whereas a tourniquet constricts all vessels in the affected limb, shutting off total blood supply...

...The difference is one of "real estate". A TQ cuts off a whole lot of it while PP will specifically isolate a region (in general). Ideally, the pressure point will be distal enough to allow other collateral vessels to branch. This means uninjured vessels are free to perfuse the limb while you compress the injured vessel. A TQ compresses all vessels distal to it as it is circumferential and functions in a strangulating fashion...

...wound healing takes time!...you do not apply a minimal TQ to allow enough hemorrhage control for the wound to &#8220;heal&#8221;. The ischemia induced by low blood flow is counterproductive to healing. Second, TQ applies global pressure. It will require enough pressure to tamponade the injured vessels. By coincidence, this is generally the exact amount of pressure required to stop the healthy vessels from perfusing&#8230;There is no shortcut to being properly trained...

...The military now issues new, high speed, quality TQs. Again, only to be used in a properly trained fashion...

...Amputation is generally the result of not having the resources for definitive care available...not the result of a properly placed TQ.. A properly placed TQ used under appropriate circumstances saves lives and actually helps save a limb by default...

.

...we do use TQs all the time in the OR for prolonged periods without significant problems. Of course, these are properly designed and not improvised TQs. The military now issues new, high speed, quality TQs (for the FIELD). Again, only to be used in a properly trained...

If you really want to have TQs at your disposal for first responder treatment, you need something with capabilities (similar/equal) to the The Special Operations Forces Tactical Tourniquet (SOFTT). So, get the training and have the right equipment to employ your training. The first step in saving lives is proper planning with proper preparation and gear..

 

[Brommeland]

I am not sure of your point as issue of in the field has been hit multiple times in this thread. there are quality TQs made for field application.

My posts, up till now have been directed at Cliff's original questions that started this thread. You are the individual that has chosen to run down a bunch of unrelated bunny trails. The Orthopedic Surgical TQ, or some such BS.
Rather than attempting to dazzle us all with your vast medical knowledge, why not simply answer the man's questions in a polite, direct manner?

 

[LSkylizard]

...You are the individual that has chosen to run down a bunch of unrelated bunny trails. The Orthopedic Surgical TQ, or some such BS.
Rather than attempting to dazzle us all with your vast medical knowledge, why not simply answer the man's questions in a polite, direct manner?

Ok, if that is your interpretation. I think my preceding posts do address field hemorrhage control. The citation of ortho TQs is a common comparison and citation used to explain the safe application of FIELD TQs in the military. This is in part response to what I feel was an innacurate statement on your part:

...Tourniquet:...often causes significant injury to the limb in question and can result in amputation quite often...

It is unfortunate that you are unable to see that comparison. I cite it because it is an EVERYDAY example of safe usage. I understand there are some differences in application and size of equipment. However, facts remain the same. A proper FIELD TQ device, applied by a properly trained individual, under proper circumstances/indications is not a detriment to the limb and provides greater chance of life and limb salvage.

Try to avoid being so dazzled by simple comparisons...I will try to use smaller words for you next time.

 

[Brommeland]

I see that the maturity level here hasn't changed much in my absence.