DOCSLIB.ORG

Strategies to Enhance Survival in Active Shooter

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Strategies to Enhance Survival in Active Shooter HARTFORD CONSENSUS COMPENDIUM Hemorrhage control devices: Tourniquets and hemostatic dressings by John B. Holcomb, MD, FACS Committee on Tactical Combat Casualty Care Department of Defense Joint Trauma Systems Frank K. Butler, MD, FAAO, FUHM Chairman, Committee on Tactical Combat Casualty Care Department of Defense Joint Trauma Systems Peter Rhee, MD, MPH, FACS, FCCM Committee on Tactical Combat Casualty Care Department of Defense Joint Trauma Systems emorrhage control is the highest priority in on Trauma and the U.S. Department of Transportation caring for for an injured individual. To be max- working group evaluated the evidence for external hem- Himally effective, hemorrhage control must oc- orrhage control measures.2 The group’s conclusions on cur as soon as possible after the wounding event. tourniquets were that: (1) commercial windlass-type Unfortunately, uncontrolled hemorrhage remains tourniquets should be used in the prehospital setting 66 | the single most preventable cause of death after both for the control of significant extremity hemorrhage military and civilian injuries. One of the most impor- when direct pressure is ineffective or impractical, (2) tant lessons learned in the last 14 years of war is that improvised tourniquets should be used only if no com- using tourniquets and hemostatic dressings as soon mercial device is available, and (3) a tourniquet that as possible after injury is absolutely lifesaving.1 The has been properly applied in the prehospital setting resulting sustained focus on hemorrhage control has should not be released until the patient has reached evolved into the widespread use of two devices: com- definitive care. The recommendations on hemostatic mercially manufactured tourniquets and hemostatic agents were that: (1) topical hemostatic agents should dressings. Recent evidence from thousands of injured be used in combination with direct pressure for the patients has demonstrated that the use of tourniquets control of significant hemorrhage in the prehospital does not lead to amputations and the use of tourni- setting when sustained direct pressure is ineffective quets should be considered early on. Technological or impractical, and (2) topical hemostatic agents in a development has also resulted in wound dressings gauze can be used to enhance wound packing. that are impregnated with materials that help stop bleeding more effectively than plain gauze. The U.S. military experience during the conflicts in Afghani- Hemorrhage control with tourniquets stan and Iraq, with more than 50,000 combat casu- In the 26 years between the end of the Vietnam War in alties, taught the military trauma system that both 1975 and 2001, little changed in prehospital hemorrhage tourniquets and hemostatic dressings are extremely control. As a result, preventable deaths from extrem- important for quality care and improved outcome. ity hemorrhage also did not change in almost three decades. After the widespread implementation of the tourniquet recommendations from the Committee on Tourniquets in the civilian setting Tactical Combat Casualty Care (CoTCCC), a 10-year The wounding agents are usually different in battlefield review of 4,596 U.S. combat fatalities noted a significant and civilian trauma, but the lessons learned regarding decrease in combat fatalities from extremity hemor- hemorrhage control and optimal resuscitation are not. rhage.3 The dramatic decrease in deaths from extremity Recently, the American College of Surgeons Committee hemorrhage resulted from the now ubiquitous fielding V100 No 1S BULLETIN American College of Surgeons HARTFORD CONSENSUS COMPENDIUM One of the most important lessons learned in the last 14 years of war is that using tourniquets and hemostatic dressings as soon as possible after injury is absolutely lifesaving. of modern tourniquets and hemostatic dressings on complication is actually very rarely seen. Prolonged the battlefield and aggressive training of all levels of use of a tourniquet can potentially result in amputa- responders in their effective use.4 tion, but saving the life of the individual must always As noted earlier, deaths from extremity hemorrhage take precedence if the tourniquet cannot be removed. can largely be prevented by early use of tourniquets. Because of their proven lifesaving value, tourniquets Because of their effectiveness at hemorrhage con- are now ubiquitous on the modern battlefield, yet adop- trol and the speed with which they can be applied, tion has been slow in many civilian EMS systems. tourniquets are the best option for temporary con- Although limited, there are reports that the trol of life-threatening extremity hemorrhage in adoption of the military practice of tourniquets and the tactical environment when under fire. This con- hemostatic dressings into civilian EMS and emergency cept can apply as well in the civilian arena, with its medicine practice is increasing. One of the key con- increasing number of mass casualty or active shooter cepts that emerged was placing the hemorrhage control events. These concepts become especially applica- devices in the hands of not only all medical provid- ble in terrorist-style bombing events on our home ers, but also the much more numerous nonmedical soil. Direct pressure and gauze compression dress- first-responding personnel. In the civilian sector, many ings can be effective; however, the lack of dedicated police officers and firefighters now carry these devices, | 67 personnel to apply continuous direct pressure, a less- making them widely and rapidly available. Effective than-secure environment, and extremity injuries training in, and use of, hemorrhage control devices that could lead to exsanguination are all indications by nonmedical personnel has been a critical element for rapid tourniquet application. In routine emer- in reducing preventable deaths. gency medical services (EMS) care, the so-called In patients with severe extremity bleeding, pressure dressing for massive external hemorrhage hemorrhage control is a priority. Most extremity is frequently inadequate and only effective when injuries do not require tourniquets, but patients with continuous direct manual compression is applied. life-threatening bleeding do require a tourniquet. As Because of the personnel constraints on most civilian in most trauma situations, over-triage is acceptable, EMS runs, tourniquets and hemostatic dressings are as tourniquets found not to be needed can be safely both medically and logistically beneficial.5 Despite removed on arrival at a hospital. The following descrip- the overwhelming evidence of benefit from the mili- tions are provided as examples of trauma victims for tary experience, recent data indicate that only a few whom tourniquet use is appropriate: EMS systems are using recommended commercially manufactured tourniquets and hemostatic dressings • There is pulsatile or steady bleeding from the for exsanguinating hemorrhage. wound. This situation continues despite numerous mili- tary publications documenting the lifesaving benefit • Blood is pooling on the ground. and low incidence of complications from prehospital tourniquets and hemostatic dressings used in combat • The overlying clothes are soaked with blood. casualties. Although it is somewhat obvious, tourni- quets are most effective in saving lives when applied • Bandages or makeshift bandages used to cover early, before the individual has gone into shock the wound are ineffective and steadily becoming from blood loss. Although tourniquet use has been soaked with blood. discouraged by EMS systems in the past because of concerns about ischemic damage to the extremity, this • There is a traumatic amputation of the arm or leg. SEPT 2015 ACS BULLETIN Supplement HARTFORD CONSENSUS COMPENDIUM Commercial windlass-type tourniquets should be used in the prehospital setting for the control of significant extremity hemorrhage when direct pressure is ineffective or impractical…. • There was prior bleeding, and the patient is now • Pulses distal to every tourniquet should be in shock (unconscious, confused, pale). checked. When treating an individual who is in obvious • Correctly applied tourniquets can cause signifi- shock from bleeding wounds, hemorrhage control cant pain, but this pain does not signify that the should be the first priority, before fluid resuscitation. tourniquet has been applied incorrectly or that it Effective hemorrhage control does not stop with the should be removed. initial tourniquet application. The military experi- ence with tourniquets has provided some key teaching • Pain should be managed with analgesics as appro- points about their use: priate, but not for patients in shock. • Waiting too long to place a tourniquet is a mistake. Mistakes regarding tourniquets include the following: • Tourniquets should be applied just proximal to the site of the severe bleeding and never placed • Not having an effective commercial tourniquet 68 | directly over a joint. available • Tourniquets should be tightened as necessary to • Not using a tourniquet when one should be used stop bleeding from the distal injury. • Using a tourniquet for minimal or minor bleeding • If bleeding is not controlled with one tourniquet, when one should not be used a second tourniquet should be applied just proxi- mal to the first. • Putting the tourniquet on too proximally • The need for a second tourniquet is especially appli- • Not making the tourniquet tight enough to effec- cable when applying tourniquets to generously tively stop the bleeding
Load more

Recommended publications
  • Tourniquet Use in Out-Of-Hospital Emergency Care: a Systematic Review
    Emergencias 2019;31:47-54 REVIEW ARTICLE Tourniquet use in out-of-hospital emergency care: a systematic review Mara Alonso-Algarabel 1, Xavier Esteban-Sebastià 2, Azucena Santillán-García 3, Rafael Vila-Candel 4,5 Objective. Uncontrolled bleeding from serious injuries continues to be one of the main causes of preventable deaths Author affiliation: 1Surgery Unit and Outpatient, outside hospitals. Tourniquets could be useful for quickly stemming blood flow and prevent exsanguination, although Hospital Universitario Miguel evidence supporting their use and effectiveness in civilian accidents is limited. To analyze the effectiveness of tourni - Servet, Zaragoza, Spain. quets for stopping bleeding in out-of-hospital emergencies and to explore factors associated with effectiveness. 2Emergency Department, Hospital Comarcal Vinarós, Castellón, Methods. We undertook a systematic review of the literature in Spanish and English. Search protocols to identify Spain 3 studies that evaluated the use of various devices and their effectiveness in stemming arterial blood flow. We included Cardiology Department, Hospital Universitario de Burgos, Burgos, studies published between 2011 and 2016 in which tourniquets were used to prevent massive blood loss. Spain 4Department of Obstetrics and Results. We included 17 articles. Tourniquets were effective in stopping massive bleeding in all studies. Pain, the most Gynecology, Hospital Universitario frequently described adverse effect, was observed in 420 patients (35.7%). Delayed application of a tourniquet was de la Ribera, Alzira, Valencia, associated with more negative outcomes. Spain. 5Nursing Department, Conclusions. Tourniquets are effective for stopping massive blood loss. There are few complications, most of which are Universidad Católica de Valencia attributable to the critical state of patients rather than to application of the tourniquet.
    [Show full text]
  • July 23, 2021 the Musicrow Weekly Friday, July 23, 2021
    July 23, 2021 The MusicRow Weekly Friday, July 23, 2021 Taylor Swift’s Fearless (Taylor’s Version) SIGN UP HERE (FREE!) Will Not Be Submitted For Grammy, CMA Award Consideration If you were forwarded this newsletter and would like to receive it, sign up here. THIS WEEK’S HEADLINES Fearless (Taylor’s Version) Will Not Be Submitted For Grammy, CMA Awards NSAI Sets Nashville Songwriter Awards For September Big Loud Records Ups 5, Adds 2 To Promotion Team Dylan Schneider Signs With BBR Music Group Taylor Swift will not be submitting Fearless (Taylor’s Version), the re- recorded version of her 2008 studio album that released earlier this year, Dan + Shay Have Good for Grammy or CMA Awards consideration. Things In Store For August “After careful consideration, Taylor Swift will not be submitting Fearless (Taylor’s Version) in any category at this year’s upcoming Grammy and Scotty McCreery Shares CMA Awards,” says a statement provided to MusicRow from a Republic Details Of New Album Records spokesperson. “Fearless has already won four Grammys including album of the year, as well as the CMA Award for album of the Chris DeStefano Renews year in 2009/2010 and remains the most awarded country album of all With Sony Music Publishing time.” Natalie Hemby Announces The statement goes on to share that Swift’s ninth studio album, Evermore, New Album released in December of 2020, will be submitted to the Grammys for consideration in all eligible categories. Niko Moon’s Good Time Slated For August Release Evermore arrived only five months after the surprise release of Folklore, Swift’s groundbreaking eighth studio album.
    [Show full text]
  • A Stylistic Analysis of 2Pac Shakur's Rap Lyrics: in the Perpspective of Paul Grice's Theory of Implicature
    California State University, San Bernardino CSUSB ScholarWorks Theses Digitization Project John M. Pfau Library 2002 A stylistic analysis of 2pac Shakur's rap lyrics: In the perpspective of Paul Grice's theory of implicature Christopher Darnell Campbell Follow this and additional works at: https://scholarworks.lib.csusb.edu/etd-project Part of the Rhetoric Commons Recommended Citation Campbell, Christopher Darnell, "A stylistic analysis of 2pac Shakur's rap lyrics: In the perpspective of Paul Grice's theory of implicature" (2002). Theses Digitization Project. 2130. https://scholarworks.lib.csusb.edu/etd-project/2130 This Thesis is brought to you for free and open access by the John M. Pfau Library at CSUSB ScholarWorks. It has been accepted for inclusion in Theses Digitization Project by an authorized administrator of CSUSB ScholarWorks. For more information, please contact [email protected]. A STYLISTIC ANALYSIS OF 2PAC SHAKUR'S RAP LYRICS: IN THE PERSPECTIVE OF PAUL GRICE'S THEORY OF IMPLICATURE A Thesis Presented to the Faculty of California State University, San Bernardino In Partial Fulfillment of the Requirements for the Degree Master of Arts in English: English Composition by Christopher Darnell Campbell September 2002 A STYLISTIC ANALYSIS OF 2PAC SHAKUR'S RAP LYRICS: IN THE PERSPECTIVE OF PAUL GRICE'S THEORY OF IMPLICATURE A Thesis Presented to the Faculty of California State University, San Bernardino by Christopher Darnell Campbell September 2002 Approved.by: 7=12 Date Bruce Golden, English ABSTRACT 2pac Shakur (a.k.a Makaveli) was a prolific rapper, poet, revolutionary, and thug. His lyrics were bold, unconventional, truthful, controversial, metaphorical and vulgar.
    [Show full text]
  • 2018 Arkansas Minimum Pre-Hospital Clinical Guidelines
    2018 Arkansas Minimum Pre-hospital Clinical Guidelines These guidelines were developed by the Medical Directors Council of the National Association of State EMS Officials (NASEMSO). These guidelines were then reviewed by the Arkansas Core Medical Directors Committee to address Arkansas specific guidelines. These guidelines will be maintained by both NASEMSO and the Arkansas Core Medical Directors to address updates in clinical guidelines, protocols or operating procedures. Arkansas medical directors and encouraged to use the guidelines at their discretion. These guidelines are considered the minimum guidelines that all EMS Agencies should adopt. EMS Agencies clinical guidelines, protocols or operating procedures should at a minimum meet these guidelines. These guidelines are either evidence-based or consensus-based and have been formatted for use by field EMS professionals. Arkansas Updated May 2018 2 National Model EMS Clinical Guidelines VERSION 2.0 Contents INTRODUCTION .................................................................................................................................6 PURPOSE AND NOTES ........................................................................................................................7 TARGET AUDIENCE ......................................................................................................................................... 8 NEW IN THE 2017 EDITION ............................................................................................................................
    [Show full text]
  • Mediated Music Makers. Constructing Author Images in Popular Music
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Helsingin yliopiston digitaalinen arkisto Laura Ahonen Mediated music makers Constructing author images in popular music Academic dissertation to be publicly discussed, by due permission of the Faculty of Arts at the University of Helsinki in auditorium XII, on the 10th of November, 2007 at 10 o’clock. Laura Ahonen Mediated music makers Constructing author images in popular music Finnish Society for Ethnomusicology Publ. 16. © Laura Ahonen Layout: Tiina Kaarela, Federation of Finnish Learned Societies ISBN 978-952-99945-0-2 (paperback) ISBN 978-952-10-4117-4 (PDF) Finnish Society for Ethnomusicology Publ. 16. ISSN 0785-2746. Contents Acknowledgements. 9 INTRODUCTION – UNRAVELLING MUSICAL AUTHORSHIP. 11 Background – On authorship in popular music. 13 Underlying themes and leading ideas – The author and the work. 15 Theoretical framework – Constructing the image. 17 Specifying the image types – Presented, mediated, compiled. 18 Research material – Media texts and online sources . 22 Methodology – Social constructions and discursive readings. 24 Context and focus – Defining the object of study. 26 Research questions, aims and execution – On the work at hand. 28 I STARRING THE AUTHOR – IN THE SPOTLIGHT AND UNDERGROUND . 31 1. The author effect – Tracking down the source. .32 The author as the point of origin. 32 Authoring identities and celebrity signs. 33 Tracing back the Romantic impact . 35 Leading the way – The case of Björk . 37 Media texts and present-day myths. .39 Pieces of stardom. .40 Single authors with distinct features . 42 Between nature and technology . 45 The taskmaster and her crew.
    [Show full text]
  • Prehospital Assessment of Trauma
    Prehospital Assessment of Trauma a b c, Joshua Brown, MD, MSc , Nitin Sajankila, BS , Jeffrey A. Claridge, MD, MS * KEYWORDS Prehospital Emergency medical services Trauma Triage Air medical Transport KEY POINTS A significant amount of variability exists between the various prehospital trauma systems that provide early postinjury care in the United States. This variability includes differences in emergency medical services provided, types of transport available, protocols guiding care, and cooperation between hospitals and pro- viders involved. Although advances have been made to prehospital care, more research is necessary to see how uniformly these advances are implemented. Further research on determining the best care practices and the development of uniform protocols is also necessary. INTRODUCTION AND HISTORY OF PREHOSPITAL TRAUMA CARE As with many of the advancements in trauma care, prehospital trauma care has evolved significantly with periods of military conflict. Most credit Baron Dominique Jean Larrey, Napoleon’s surgeon, with the concept of the ambulance in 1792.1 The genesis of an organized ambulance corps in the military, however, was not until the United States Civil War. This experience was furthered in World War II, when medical personnel were assigned to combat companies to provide care at the point of wound- ing, becoming the first combat medics. It was then during the Korean War and Vietnam conflict that en route care by medics for the wounded solider became the standard, alongside the rapid transport of patients
    [Show full text]
  • Chasing the Light the CLOUD CULT STORY Mark Allister
    Chasing the Light Chasing the Light THE CLOUD CULT STORY Mark Allister Foreword by Mark Wheat University of Minnesota Press Minneapolis • London Interview excerpts from the film No One Said It Would Be Easy are repro- duced by permission of John Paul Burgess. Cloud Cult lyrics are reproduced by permission of Cloud Cult/Craig Minowa. Photographs reproduced by permission of Cloud Cult/Craig Minowa unless otherwise credited. Thanks to Jeff DuVernay, Cody York (http://www.cody yorkphotography.com), and Stacy Schwartz (http://www.stacyannschwartz. com) for contributing photographs to the book. Copyright 2014 by Mark Allister Foreword copyright 2014 by Mark Wheat All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher. Published by the University of Minnesota Press 111 Third Avenue South, Suite 290 Minneapolis, MN 55401– 2520 http://www.upress.umn.edu {~?~IQ: CIP goes here.} Printed in the United States of America on acid- free paper The University of Minnesota is an equal- opportunity educator and employer. 20 19 18 17 16 15 14 10 9 8 7 6 5 4 3 2 1 For Meredith Coole Allister, partner extraordinaire When your life is finished burning down, You’ll be all that’s left standing there. You’ll become a baby cumulus, And fly up to the firmament. No one gets to know the purpose, We need to learn to live without knowing. But all we are saying is Step forward, step forward.
    [Show full text]
  • “Writing About Music” Vol
    UCLA Department of Musicology presents MUSE An Undergraduate Research Journal “Writing About Music” Vol. 1, No. 1 “Dissonant Ones: The Harmony of Lou Reed and “Waitress! Equalitea and Pie, Please” John Cale” Irena Huang Gabriel Deibel “Boy Band: Intersecting Gender, Age, Sexuality, “A Possible Resolution for the Complicated and Capitalism” Feelings Revolving Around Tyler, the Creator” Grace Li Isabel Nakoud “Being the Cowboy: Mitski’s Rewriting of Gender Roles in Indie Rock” Jenna Ure Winter 2020 2 3 UCLA Department of Musicology presents MUSE An Undergraduate Research Journal Volume 1, Number 1 Winter 2020 Contents Introduction from the Editors 4 Being the Cowboy: Mitski’s Rewriting of Gender Roles in Indie 6 Rock Editor-in-Chief Jenna Ure Matthew Gilbert Waitress! Equalitea and Pie, Please 16 Managing Editor Irena Huang Alana Chester Dissonant Ones: The Harmony of Lou Reed and John Cale 26 Review Editor Gabriel Deibel Karen Thantrakul Boy Band: Intersecting Gender, Age, Sexuality, and Capitalism 36 Technical Editors Grace Li J.W. Clark Liv Slaby A Possible Resolution for the Complicated Feelings Revolving 46 Gabriel Deibel Around Tyler, the Creator Isabel Nakoud Faculty Advisor Dr. Elisabeth Le Guin Closing notes 62 4 Introduction Introduction 5 Introduction Li’s discussion of the exploitation of boy band One Direction, Gabriel Deibel’s essay on the influence of John Cale on the Velvet Underground’s experimental sound, a feminist exploration by Irena Huang of the musical Alana Chester, Matthew Gilbert, and Karen Waitress (composed by a UCLA alumnus, Sara Bareilles), and a critique Thantrakul of the music industry through indie singer Mitski’s music by Jenna Ure.
    [Show full text]
  • Guidance for the Selection and Use of PPE in the Healthcare Setting
    Guidance for the Selection and Use of Personal Protective Equipment (PPE) in Healthcare Settings 1 PPE Use in Healthcare Settings: Program Goal Improve personnel safety in the healthcare environment through appropriate use of PPE. PPE Use in Healthcare Settings The goal of this program is to improve personnel safety in the healthcare environment through appropriate use of PPE. 2 PPE Use in Healthcare Settings: Program Objectives • Provide information on the selection and use of PPE in healthcare settings • Practice how to safely don and remove PPE PPE Use in Healthcare Settings The objectives of this program are to provide information on the selection and use of PPE in healthcare settings and to allow time for participants to practice the correct way to don and remove PPE. 3 Personal Protective Equipment Definition “specialized clothing or equipment worn by an employee for protection against infectious materials” (OSHA) PPE Use in Healthcare Settings Personal protective equipment, or PPE, as defined by the Occupational Safety and Health Administration, or OSHA, is “specialized clothing or equipment, worn by an employee for protection against infectious materials.” 4 Regulations and Recommendations for PPE • OSHA issues workplace health and safety regulations. Regarding PPE, employers must: – Provide appropriate PPE for employees – Ensure that PPE is disposed or reusable PPE is cleaned, laundered, repaired and stored after use • OSHA also specifies circumstances for which PPE is indicated • CDC recommends when, what and how to use PPE PPE Use in Healthcare Settings OSHA issues regulations for workplace health and safety. These regulations require use of PPE in healthcare settings to protect healthcare personnel from exposure to bloodborne pathogens and Mycobacterium tuberculosis.
    [Show full text]
  • Wound Care Management During a Mass Casualty Emergency: an Evidence-Based Approach for Triage, Tourniquets, Wound Packing, and Chest Seals
    Wound Care Management during a Mass Casualty Emergency: An Evidence-Based Approach for Triage, Tourniquets, Wound Packing, and Chest Seals The Athletic Trainers Ability to think beyond the basics On Field or Off, you may face the event Introductions • Mr. Edward Strapp, TP-C/FP-C, NRP, ATC – Trooper/Flight Paramedic, Maryland State Police – Rotational Athletic Trainer, US Ski and Snowboard Provider Disclaimer • In compliance with continuing education requirements, all presenters must disclose any financial associations with the manufacturers of commercial products, supplies of commercial services, or commercial supporters as well as any use of unlabeled product(s) or product(s) under investigational use. • Event committee, and the presenters for this seminar do not have financial or other associations with the manufacturers of commercial products, suppliers of commercial services, or commercial supporters. • This presentation does not involve the unlabeled use of a product or product under investigational use. • There was no commercial support for this activity. ***Warning*** Some pictures may be graphic in nature. Presenter Conflict • No Conflict • The views expressed in these slides and the today’s discussion are ours • Our views may not be the same as the views of our company’s clients or our colleagues • Participants must use discretion when using the information contained in this presentation Learning Objectives • Understand the need for the rapid identification and management of gross bleeding in the trauma patient. • Identify the phases of shock and the physiological changes. • Identify the rationale for the application of different advanced wound care interventions. Learning Objectives • Acquire the skills needed for tourniquet and wound packing interventions.
    [Show full text]
  • Prolonged Prehospital Tourniquet Placement Associated with Severe Complications: a Case Report
    CASE REPORTS RAPPORT DE CAS Prolonged prehospital tourniquet placement associated with severe complications: a case report Christian Malo, MD, MSc*†; Bruno Bernardin, MD*; Joe Nemeth, MD*; Kosar Khwaja, MD, MBA† Keywords: Tourniquet, Prehospital, Extremity Injury, beats/min). Because no blood products were available, Ischemia, Hemorrhage, Gunshot Wounds the patient was administered crystalloids. At 10:20 pm, the trauma team leader at our institution was contacted by INTRODUCTION the local physician in the closest village, and, at 2:30 am, the local physician had arrived at the patient’sbedside Emergency tourniquet application to arrest hemorrhage with blood products. Due to continued hemodynamic in major limb trauma, particularly in the military context, compromise and agitation, the patient was intubated, – has been shown to be a life-saving manoeuvre.1 3 Due to started on a norepinephrine infusion, and administered the potential for significant complications (including five units of packed red blood cells and three units of clots, myonecrosis, pain, palsy, abscess, blisters, contu- fresh frozen plasma. The left lower extremity distal to the sions, abrasions, renal failure, compartment syndrome, tourniquets was reportedly cold, cyanotic, and edematous, and amputation)4 and the paucity of evidence of its role in at this time. The patient responded to fluid resuscitation, the non-military context, controversy persists regarding and the norepinephrine was gradually weaned. tourniquet use. We describe a civilian case in which The patient was transported from the remote village improvised tourniquets were applied to an extremity for to the nearest community hospital, arriving at 6:00 am. 17 hours following a penetrating lower limb injury in a The first venous blood gas measurement showed a pH remote area of Quebec.
    [Show full text]
  • CPR/AED for Professional Rescuers and Health Care Providers HANDBOOK
    CPR/AED for Professional Rescuers and Health Care Providers HANDBOOK American Red Cross CPR/AED for Professional Rescuers and Health Care Providers HANDBOOK This CPR/AED for Professional Rescuers and Health Care Providers Handbook is part of the American Red Cross CPR/AED for Professional Rescuers and Health Care Providers program. By itself, it does not constitute complete and comprehensive training. Visit redcross.org to learn more about this program. The emergency care procedures outlined in this book refl ect the standard of knowledge and accepted emergency practices in the United States at the time this book was published. It is the reader’s responsibility to stay informed of changes in emergency care procedures. PLEASE READ THE FOLLOWING TERMS AND CONDITIONS BEFORE AGREEING TO ACCESS AND DOWNLOAD THE AMERICAN RED CROSS MATERIALS. BY DOWNLOADING THE MATERIALS, YOU HEREBY AGREE TO BE BOUND BY THE TERMS AND CONDITIONS. The downloadable electronic materials, including all content, graphics, images and logos, are copyrighted by and the exclusive property of The American National Red Cross (“Red Cross”). Unless otherwise indicated in writing by the Red Cross, the Red Cross grants you (“recipient”) the limited right to download, print, photocopy and use the electronic materials, subject to the following restrictions: ■ The recipient is prohibited from selling electronic versions of the materials. ■ The recipient is prohibited from revising, altering, adapting or modifying the materials. ■ The recipient is prohibited from creating any derivative works incorporating, in part or in whole, the content of the materials. ■ The recipient is prohibited from downloading the materials and putting them on their own website without Red Cross permission.
    [Show full text]