Tourniquets

1. Tourniquets

2. 1、Esmarch tourniquet、 2、Martin sheet rubber bandage、 3、pneumatic tourniquet The categery：

3. The upper arm or the thigh is wrapped with several thicknesses of smoothly applied cotton cast padding. The extremity is then elevated for 2 minutes, or the blood is expressed by a sterile sheet rubber bandage or a cotton elastic bandage. Beginning at the fingertips or toes, the extremity is wrapped proximally to within 2.5 to 5 cm of the tourniquet. A hand towel, folded lengthwise in four layers, is wrapped snugly as high as possible around the upper thigh. The tourniquet is then applied over the towel as follows. The chain end is held over the lateral surface of the thigh with one hand; the other hand is passed under the thigh and grasps the rubber strap near the chain and pulls it taut. The strap is allowed to slip between the thumb and fingers as the hand is brought under and around the thigh; properly performed, this slipping produces a singing sound from friction. When it completely encircles the thigh, the tourniquet is overlapped layer on layer, with no skin or towel caught between the layers. This is repeated, keeping constant tension on the strap, until its application is complete. The hook on the end of the strap is then caught in one of the links of the chain. Care must be taken that excessive tension is not built up gradually as the tourniquet is applied. application

4. The tourniquet should be inflated quickly to prevent filling of the superficial veins before the arterial blood flow has been occluded. 1、The tourniquet should be inflated quickly to prevent filling of the superficial veins before the arterial blood flow has been occluded. notice

5. 2.The exact pressure to which the tourniquet should be inflated has not been determined. Evidence indicates that pressures greater than necessary have been used for many years. The correct pressure depends somewhat on the age of the patient, the blood pressure, and the size of the extremity. notice

6. 3、Reid, Camp, and Jacob used pneumatic tourniquet pressures determined by the pressure required to obliterate the peripheral pulse using a Doppler stethoscope; they then added 50 to 75 mm Hg to allow for collateral circulation and blood pressure changes.

7. 4The Esmarch tourniquet is applied in layers, one on the top of the other; a narrow band produces less tissue damage than a wide one. notice

8. 5、demonstrated that curved tourniquets on conical extremities require significantly lower arterial occlusion pressures than straight (rectangular) tourniquets Notice

9. 6、There is no rule as to how long a tourniquet may be safely inflated. The time may vary with the age of the patient and the vascular supply of the extremity. In an average healthy adult under 50 years of age, we prefer to leave the tourniquet inflated for no more than 2 hours. If an operation on the lower extremity takes longer than 2 hours, it is better to finish it as rapidly as possible than to deflate the tourniquet for 10 minutes and then reinflate it. It has been found that up to 40 minutes is required for the tissues to return to normal after prolonged use of a tourniquet. Consequently, the previous practice of deflating the tourniquet for 10 minutes appears to be inadequate. notice

10. 1. Tourniquet paralysis 2. Posttourniquet syndrome 3 Compartment syndrome, rhabdomyolysis, and pulmonary emboli are rare complications of tourniquet use complication