II. General rules

  1. Avoid clamping any bleeding digital vessels
  2. Avoid narrow width Tourniquet use (e.g. belts)

III. Management: Initial

  1. Step 1: Apply direct pressure to wound for 15 minutes
  2. Step 2: Apply digital Tourniquet
    1. Impromised
      1. Penrose drain clamped with hemostat or
      2. Cross section of glove finger
    2. Commercial
      1. Tournicot
      2. T-Ring
  3. Step 3: Apply compression dressing (e.g ace wrap)
    1. Start wrap proximal to wound site
    2. Ace wrap should also hold bandage at wound site
  4. Step 4: Elevate affected arm
    1. Consider using cast stockinette
    2. Cut stockinette lengthwise 8 inches at each end
    3. Tie one end over patients Shoulder
    4. Tie the other end to top of IV pole

IV. Management: Refractory to above

  1. Step 1: Wrap and elevate arm as above
  2. Step 2: Obtain Tourniquet
    1. Air-inflated arm Tourniquet (used in orthopedics) or
    2. Blood Pressure cuff
  3. Step 3: Apply Tourniquet to arm
    1. Adult pressure: 250 mmHg
    2. Child pressure: 100 to 200 mmHg
  4. Step 3: Clamp Tourniquet tubes with hemostat
  5. Step 4: Remove ace wrap (from Step 1)
  6. Step 5: Emergent orthopedic or vascular surgeon
    1. Tourniquet use cannot exceed 90 to 120 minutes
    2. Longer Tourniquet times risk ischemic limb injury

V. References

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