Trauma
Life-threatening hemorrhage and tourniquets
BLS guidelines, signed March 28, 2023 · Page 49
Protocol
Signed page
Life threatening hemmorhage control
Indication
Patients with a traumatic injury, who present with potentially life-threatening hemorrhage which is not controlled by direct pressure or effective dressings.
- AApply a tourniquet if placement is applicable (extremity injury). See procedure below.
- BIf a tourniquet is not applicable, apply a hemostatic agent with direct pressure to the bleeding source
- CDo not remove impaled objects unless airway compromised. Splint extremity and secure in place
Tourniquet application
Precautions
- AApplying a tourniquet incorrectly can increase blood loss. If applied too loosely, only venous return may be inhibited and the patient will worsen.
- BApplying a tourniquet can cause nerve and tissue damage whether applied correctly or not. Proper patient selection is of utmost importance.
- CInjury due to a tourniquet is unlikely if the tourniquet is removed within 1 hour. In cases of life-threatening bleeding, benefit outweighs risk.
- DDo not clamp bleeders.
- EThe commercially made tourniquet provided by SJC is the preferred tourniquet. If not available, a blood pressure cuff inflated to a pressure sufficient to stop bleeding an acceptable alternative.
Procedure
- ABegin Initial Trauma Care › per guidelines.
- BFirst attempt to control hemorrhage by using direct pressure or compression dressing over the bleeding area.
- CIf a discrete bleeding vessel can be identified, point pressure over the vessel is more effective than a large bandage and direct pressure.
- DIf hemorrhage continues, apply tourniquet proximal to injury. Tighten tourniquet until the bleeding stops.
- EFrequently re-evaluate extremity for further bleeding.
- FCare of Amputations › per protocol, if necessary.
- GNotify ERP of all tourniquets upon arrival to ED.