Circulation part 1, converting tourniquets.

After finishing Respiration we move into Circulation. Circulation actually holds a lot of steps in it. But it can be broken down fairly easily.

First, we start with another algorithm (I know, more algorithms). PTF. Pulses, tourniquets, fluids.

With pulses, we are checking for an absence or presence of a radial pulse. The radial pulse is the one you see checked on medical shows and movies. On the wrist just inside of the wrist bone. That bone is your radius bone, hence the radial pulse. If there is no radial pulse, check for a carotid. That’s the pulse on your neck. If they don’t have a pulse there the chance of your interventions at a basic level being successful is very rare. Best to save your resources for the casualty with a higher chance.  If they do have a carotid pulse they are low on blood (hypovolemic) and really need our help. Either way, as long as they have a carotid (regardless of having a radial) we next look at the tourniquets we applied in care under fire or massive hemorrhage.

Tourniquets is where we look at converting tourniquets. We want to start with any hasty’s applied during care under fire as converting them could do the most good for our patient. The idea being is that since the tourniquet was placed high and tight when we had no visual of the wound there is a chance we could place a deliberate tourniquet (What were the 5 characteristics again?) or switch to a wound packing and not only increase the amount of blood in the circulating volume but also decrease the amount of tissue that has no blood flow.

Before we can get to converting tourniquets we have to talk about the decision to convert them. Because not every tourniquet can be converted. For starters, a tourniquet applied to an amputation can never be converted in the field. That is a job for a surgical team. If there is space for a deliberate tourniquet to be applied, then it can be converted. And this isn’t just limited to converting to tourniquets or wound packings. You could realize you were WAY too overzealous with your tourniquet application and the wound just needs a pressure bandage without any wound packing. But that is up to you to decide, you can always err on the side of caution and just convert to a deliberate tourniquet if you are not comfortable with your ability to pack wounds. It all comes down to good clinical judgment. Which is only built through experience. This is why we train.

Now that we’ve decided to convert to a deliberate tourniquet we will apply the deliberate same as any other deliberate tourniquet. 2-3 inches above the wound, not over a joint, directly over the skin, taped and timed. However, we know how tight to get tourniquets because we tighten until all bleeding has stopped. But how do we tighten until bleeding stops if there is already a tourniquet stopping the bleeding? Start by tightening the tourniquet as tight as you can. Then we are going to slowly loosen the tourniquet a quarter turn at a time while looking at the SOURCE OF THE BLEED. If you notice bleeding to start as you loosen the original tourniquet, stop and tighten the original tourniquet until bleeding stops and then adust the deliberate you just placed. Once you have corrected any problems try to loosen again while watching the source of the bleed. If you do not see bleeding then fully loosen the first tourniquet. Do not remove it, just loosely place it above the deliberate in case you need it later. Make sure to annotate that you converted the tourniquet on your casualty care card. It’s the same steps for converting to wound packing, you just turn a half turn in order to lock the windlass back into the retaining clip in order to pull back at the edges to check for blood or blood-soaked gauze. Then follow with a pressure dressing.

Once you have converted all tourniquets you will go back and check the casualty’s pulses again. Remember, we were doing this in order to see if we could bring back an absent radial pulse.

The next step of circulation will be covered in the next article.

We have classes on the schedule, come learn how to do this. I’d love to have you out.

The next class is in Tellico Plains hosted by Bob Griswold of Readymade Resources. I’m sure he’s going to have night vision out there if you wanted to snag a set.

Have you ever gotten a radial pulse before?