When and How to Remove a Tourniquet ⎮TQ Conversion⎮
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- Опубликовано: 16 июл 2024
- While tourniquets remain a life saving device they come with risk and adverse effects when applied for a long period of time. In some circumstances a TQ conversion can be performed to minimize these harmful effects and decrease patient discomfort. As always, only do this if you are trained, licenced and allowed to do so.
I had to use a TQ in the field a few times. The first time was a fistula that burst and the patient had already lost at least a liter of blood. I put a TQ on and was able to stop the bleeding until we got him in the truck when I realized it was still bleeding through the pressure bandage. I went to put a second TQ on and the blood spurted all over me, guy was conscious and alert the whole time until we got to the trauma center and the trauma surgeon actually laughed and said I had more blood on me than he did
I had no idea what a fistula was and made the mistake of googling it... I don't really get grossed out by stuff but man there were a lot of an*l fistulas that popped up and those are gnarly. I took a video of them and sent it to my buddy, I really hope he's eating when he sees it
@@StayProteus they arnt any more fun in real life man trust me. I looked like something out of a horror movie with the way it spurted out on me
@@tacticalministries3508 yeah I wouldn’t have wanted to be you that’s for sure😂
@@StayProteus That's probably not the kind of fistula he meant :) Look up "arteriovenous fistula".
I had a pt uncontrolled bleeding with fistula and was barely able to control with direct pressure almost went to tq
Thanks for doing these videos. The information you have put out there is greatly useful.
I'm trying to bring tourniquet training into work, mostly due to the fact that we've had incidents that could have lead to the use of one. Our BLS training doesn't cover their usage and the instructors have basically told us that we would never need it. I've received push back because of the old beliefs that the patient will lose the limb if one is used (regardless of how long its been on) and the supposed response time of First Responders. This is in spite of the fact that our aid bags have them in them.
Thanks and keep up the awesome work!
Look into 'Stop The Bleed' training. Most places have a trainer closer by and I believe it's all free. It's easier to approach management/admin about things if there is no additional cost involved.
@@BigWheelBallin.45 looking forward to our local FD doing their classess
Just carry one on your ankle, no one needs to know
@Solar General the US Army basically disproved that myth. They kept TQs on patients for extended times and the results showed very minimal damage to the tissues
I really love the fact you also mentioned a suspect being the person a tourniquet to be applied on!
That's not really surprising, police officers aren't judges, even though a lot of us officers beg to differ.
@@germedicsam it’s not surprising that it’s applied on, I just think it is good to talk about everyone who might be in need for a tourniquet. I am a fireman and paramedic too, sometimes even in Switzerland and Germany the suspect comes “later”.
Great skill to learn/understand for those who only have access to the stop the bleed course.
You're a rockstar! Thanks for all the great information and demonstration.
Great video as always, keep up the outstanding work!
Really appreciate your channel brother, keep em comin you're doin the good work likely more than you know bein the direction the world seems to be headed today well done sir.
Outstanding knowledge transfer! Thanks for the details that could potentially save lives, heaven forbid in such a serious life threatening situation. Appreciate the content.
Kinda wondered about this. Thanks for sharing the information .
Thank you for this video!
Thank you!
PrepMedic, a Tourniquet I assisted in removing in the Combat Setting was the Same Tourniquet I applied 22 hours prior
And as far as I know that guy still has his arm
thank you for sharing
Thank you🙏
Good staff
Long but needed post so thanks if you read it - Can you make a follow up video to this and even better a series on the best course of action for different medical issues in a SHTF situation where you can't even plan on being able to see a doctor and are forced to improvise the complete treatment even if its high risk? In other words let's say we get nuked and in the chaos of leaving the surrounding area of that city you get shot in the arm, you are probably going to spend at least 2 hours or so getting yourself and your family out of the area before you would even be able to see a doctor but more than likely you are going to end up have to go well beyond that 2 hour mark especially if you are near a major city and thus a mass exodus and even if you can its likely not ideal because it would be a target for supplies/busy/under staffed so it would be insanely helpful for us civilians to see what the best course of action would be if there wasn't a hospital or a doctor. For instance I think I heard a PJ or some sort of spec ops medic talk about slightly loosening and retightening the CAT on a leg with a major bleed where they had to wait a long time to get to a med center - presumably to allow a little blood to circulate to help prevent amputation without bleeding out or letting too much of the toxins into the rest of the system? Could we go to a vet clinic off the beaten path and find what we needed there to help with the cardiac arrest and the toxins? What about a feed store since they sell some antibiotics and livestock medicine? If not what about a pharmacy or urgent care? Are there any weird or normally poisonous (for example how rat poison and vitamin k counteract each other and alcohol counteracts antifreeze) substances/herbs/plants etc that could possibly be used if there was zero other option? I'm right between 2 major cities that are each 30ish mins away on either side of me with 1.5mil population each and because of the geography there's almost a 100% chance that at least one would be a or the target if there was a nuke or major terrorist attack so I would be asking for a death sentence seeking a doctor anywhere near me in a SHTF situation and while I could procure some meds beforehand through various grey areas it would be nice to know what those were and what the alternatives were since 99% medical video plan on being able to see a doctor at some point even though you may not be able to in that situation and if taught how you may be able to survive without it. If you're still reading thank you and I don't expect you to answer all my questions as they were mostly examples for topics to cover in a future video that I honestly think would get a massive amount of views especially if you shared it guys like Mike Glover, S2 underground and other people that have a SOF or technical background with a business/network and large following focused on realistic preparation for emergency situations
Can you do a review about snakestaff systems Everyday Carry Tourniquet (ETQ) ?
Спасибо, братишка.
This is interesting to me, I’m currently in EMT school and gonna be on a volunteer service soon, and I what I have been taught about TQs is that once we put on a TQ you never take it off not sure if protocols change and only doctors takes it off and not yourself, unless this is for paramedics and not BLS, if it’s taught to paramedics only it makes sense to me cause EMT is BLS and paramedic is ALS. Or that may have changed over the years cause protocols in my state have changed a bit within as little 4 months. If your curious about our protocols when comes to an arterial bleed is that you don’t apply a TQ first dumb Ik, we pack the wound first and if it doesn’t stop then we apply a TQ if it doesn’t stop.
We are taught in paramedic school once you apply a TQ, you leave it. The only time you would remove one is if it was not placed properly
@@okinshield7167 it seems like that it’s state dependent then, cause I was confused for a minute lol.
@@Chris09978 this is more tccc it seems like
@@maddog980 I see, that kinda makes sense
The reason is quite simple. -> It's a question of evac. time. If you have 15 minutes, or maybe even 40 to the next hospital, just leave it on. In TCCC it can be different, where evac. can easily take half a day. A tourniquet which has been first applied high and tight might be converted to one closer to the wound. This can allow for better usage of the limb (a tourniquet above the knee pretty much stops anyone from walking normally), and less damage if kept on for an extended time period. But that is rare. Never change a running system
Thanks for the vidéo. Why is the +1 TQ applied 2-3inch above, instead of directly beside the Original? Tks
Wow that was some good information thank you for sharing
Keep up the good work
Do you take estimated blood loss prior to the tourniquet being applied into consideration for doing the conversion?
Shouldn´t the second TQ be placed side by side with the 2-3inch-above-wound TQ? If memory serves me correctly; TQ effectiveness is primarily a function of how wide it is (wider TQ needs less pressure to close of arteries, pressure being the one thing injuring nerves). Two TQ´s _apart_ will probably need higher pressure for occlusion. (Wall et al. Tourniquet and occlusion: The pressure of design. Mil. Med. 178,5:578, 2013).
Im thinking "Tourniquet Conversion" or "Tourniquet Repositioning".
Btw! Thanks for a great channel!
thank you for the disclaimer at the beginning! :)
T-Kits are best used for gunshot wounds(IMHO). nearly everything else can be treated better with a (or more) simple bandages. in most cases you do not need extensive pressure or to "stop" the blood flow. reduce it to a level where the patient can survive to the point that Emergency Services arrive.
5:25 Thank you! :D
So that’s half true. We do not change treatment based on mechanism. TQs are for any and all life threatening bleeding from any extremity, which could be from a gunshot, chain saw, car crash, glass etc……
Hi, it might be out of scope for your channel, but could you make a vid on what the Dr. Would be doing at the hospital in this situation?
Most work will be done by a vascular surgeon. When the tourniquet is released the patient will be given a cocktail of albuterol, calcium, dextrose, sodium bicarbonate, and insulin to blunt the wash of potassium and other products of anaerobic cellular metabolism and cellular breakdown.
Would it make sense to add the time applied for the 2nd tourniquet?
I was taught in med school to avoid the use of TQs unless absolutely required (you have no other options and direct pressure and pressure points aren't working, which is extremely rare).
In a shtf scenario, you need to ask yourself, are you going to keep a pressure point for hours?
Can a paramedic do a field amputation in a disaster situation?
so when is it good to apply a 2 TQ to a patient, dose it depend on the severity of the wound or something else ?
I have a question. So I work In construction and now I have a full trauma kit because of a injury that happened to my boss and all that was available was a really crapy first aid kit. What happened was he got a deep laceration on his arm from a very sharp piece of tile while doing a bathroom demo. All we had were bandaids, a small roll of gause and painters tape. He put pressure on it and tried to stop the bleeding, which worked a little bit but we were trying to put bandaids across the cut to keep it closed before wrapping it with gause. This didn't work, the bandaids just came right off, we resorted to using tape then quickly wrapped it up but it was still bleeding through so we got him to a hospital. Now that I have a full trauma kit with the right bandages I probably could have stopped the bleeding without a turniket just using hemostatic gause and a pressure dressing, but could I have used a turniket to help stop the bleeding to a point where I could apply wound closure strips and a good pressure dressing and then removed the turniket? Or should it just be left on? The cut wasn't huge, about 3 inches and in most case's probably wouldn't need a turniket, but I'm just curious if a turniket can be used to stop bleeding to make it easier to close up the wound and dress it, then remove said turniket. I love your videos, thanks!
If someone is bleeding badly enough that you need to use a tourniquet to treat the injury they really need to get to a hospital. Most bleeding can be stopped with a combination of pressure and raising the extremety above the heart. If that does not work or the bleeding is severe, a tourniquet is a great tool. Regardless, the patient will need to go to the hospital to get assessed. There are other complications that can arise from seemingly minor wounds. #notmedicaladvice
If you want to be more prepared there are stop the bleed classes that you can take (at least here in the USA) that will give you a good overview of how to deal with some emergencies while waiting for EMS or transport to definitive care.
Life or death no hospital available
Okay so if you dealing with a gun shot wound you have applied the turnicate packed the wound. What would the steps be I think that would be a awesome video
Get some.
Someone just told me this is old info and a tq can be left on for 40 plus hours according to their "knowledge" from the army. I trust prep medic and his knowledge I work in healthcare and I agree with the toxic shock that can from releasing a tq after 6 plus hours the ER doc and nurses I work with back him. However anyone care to add?
If the wound is a thru and thru, let's say GSW, do you pack the wound? I would imagine just packing it from the most accessible wound and then wrap.
Is there a need for pharmaceutical intervention in the 2-6 hour window? Or does anything about the TQ conversion change, if doing it at say hour 5 compared to hour 1.
From the information i learned about it (not a professional) there is a very low risk without pharmaceutical intervention after up to 2 hours. From that point forward the risk increases until at 6 hours you are really playing with the patients life just to safe the limb. (as in you should definitly not do that if you have to ask the question. This is more about the knowledge that removing a torniquet under 2 hours usually doesn't require special pharmaceutical intervention.)
Hypothetically, if you had a tq on a limb ( I understand it may be situational) can you release it for a small time to try to get some circulation possible or release bad blood? This being obviously if your not in shock and in-between the 2 to 6 hour area.... I've heard this before and can kinda see the point if your wittingly going to pass the 6 hour.... In hope to "save the limb" or have a better chance.
Just releasing the tq for seconds .... Not leaving it off...
NO! Can you measure how many blood was lost by patient? That small time will not save patients arm/leg, but can kill him because of loosing more blood. And, for example, can you be sure that evac will get injured person soon ( in 15 min. -2 hours), or he will stay on the battlefield for 12+ hours. i'm not even saying abot risks that TQ can not work on second time, or do harm to persons limb. We had such sad examples, when combatants were thinking with hypothetical logics and tried to check that theory, because they heard from someone that ideas... THEY DIED RIGHT THERE!!! Also, some foreign veterans were telling same SH*T to our servicemen and I had to loose a lot of time to FIX it, telling about the whole process and some basic anatomy stuff, etc.
What do you prefer, to lose an arm/leg or your life? Easy to answer, I think.
Apply tourniquet and rush to the hospital. But he/she keeps living.
Yes if it was needed in the first place , with most of people running med kits with tq that want to be the guy who uses one freaks out doesn't assess the person and applies one . I've seen it several times
@@waterhead1359 I rather like to see a few too many applied than people not applying them when it really was needed if they couldn't assess properly.
@@erikcederb when they don't assess the pt think they have a gunshot to the arm and apply one then realize it was a small laceration
When and how should we apply antiseptic to the wound(s)? What forms/types/brands of antiseptic do you recommend?
Pretty sure that’s something prehospital shouldn’t be too concerned about in a civilian capacity. The military has a pill pack with antibiotics that they give the patient right away
@@EnPeeSee I dunno, still worried about infection at the would site. If there is anything that can lessen complications and inflammation in general, I’d wanna do it.
@@yoongiwifeinthenextlife leave that for the hospital. There are too many specific antibiotic treatments that we don’t mess with that since it could cause problems later down the line. Sterile dressing is plenty fine to try and prevent infection
@@yoongiwifeinthenextlife just leave it. Throwing stuff into the wound cavity would only melt the clot. Massive haemoorage kills in seconds, infections in days
@@yoongiwifeinthenextlife The best thing to do is leave it, as soon as the patient gets to the hospital they’ll usually get antibiotics and anti inflammatories. For minor wound care and basic first aid, you can use a brand called bactine and look for the bottle with BZK and lidocaine, I use that and it works well.
Kick ass videos!
Question though. In the event of the conversion, the conversion fails. And now you’re stuck with x2 tourniquets, 2-3in apart. Are you not creating an additional compartment?
I understand, EVERYTHING “depends” in medicine.
My questions are.
Are you leaving both in place?
And
If so, why not side-by-side them in the event that you need to?
All due respect intended. Simply curious why the spacing?
Same question here, and actually, why do we need the second one at all? If you are in the fields, TQs is a valuable resource and you can't simply use it "just in case". And if you are in the ambulance or in medevac with a good stock of TQs, then why would you need the conversion at all? TCCC says (correct me if I'm wrong) - pack the wound or put the pressure dressing and then slowly loosen the TQ within 1 minute and if you don't see the bleeding restored - you are a happy camper, just leave the TQ where it is, ready to be tightened again. Would love to get the author's feedback. ty
I discuss this in the video brother.
@@PrepMedic, well not really, at least I didn't see a good explanation why are we using a second TQ put higher than the initial one. Don't want to be a pain, but you are making an advanced first-aid tutorial, and this is quite serious. So when we REPLACE the TQ from the high-and-tight position closer to the wound, it makes total sense. But when you do the opposite - not sure it made any sense for me. Thank you in advance for explaining this.
@@mh_fotik listen at 6:24 for a bit it will tell you why
I was taught to put the second TQ as close as possible to the initial TQ to avoid compartment syndrome. What are your thoughts on that? Were you never taught that because it doesn’t apply to EMS since evac times are typically short or did you just forget to?
The plus 1 TQ should be placed 2-4 inches above the wound to not interfere with the pressure dressing. The initial TQ which is high and tight should be slowly, 1/2 turn every 60-90 seconds, NOT loose all at once, and reasses bleeding thru dressing. The reason moving TQ closer to wound is to allow blood flow, perfusion, to heathy uninjured tissue.
@@uToobSucks should the initial tourniquet not be put 2-4 inches above the wound? That would mean your first and second tourniquets would be overlapping or extremely close together I think.
Sorry if I misunderstood you, I know very little about this kind of stuff and am trying to learn
@@ChickentNug Good question, ask anything. There are 2 places an initial tourniquet can be placed.
The first place, is high and tight on the arms and legs, so high up in the armpit or high up in the groin. This is based on Tactical Combat Casualty Care (TCCC also called T triple C), if your life is in immediate danger, your taking fire, being shot which is called Care Under Fire\Threat, put the tourniquet high and tight, is you see life threatening bleeding, there is no time to identify where the life threatening bleeding is coming from.
The second initial place for a tourniquet is when you can easily identify where the bleeding is coming from. This situation is non-combative, you are not in danger and you can easily identify the bleed and know there is no injury above it.
Remember tourniquets only go on a single bone, above the elbow or above the knee.
Ask, if you need clarification or something else.
@@uToobSucks Unfortunately, you are wrong, (at the stage of tactical conditions "TFC", if we are talking about combat operations, TCCC protocol) the tourniquet can also be placed in places where there are two bones (it hurts, but it works), the main thing is not to apply it on the joints (knees, elbows, wrists), preferably even above/below, where there are muscles that take part in the process of squeezing and increase the effectiveness of the tourniquet. It is also extremely important to take the first puff! If it is not done, the TQ may not work. Conversion or translocation of the TQ is a HUGE pain in our days! BUT IT IS VERY IMPORTANT TO EMPHASIZE THAT THIS SHOULD BE DONE BY ANOTHER PERSON WHO IS TRAINED TO DO IT!!! Otherwise, the wounded begin to do it themselves, which leads to irreversible - fatal consequences!!! So if there is nobody close to you who can do that? wait, untill that person will appear and ask him to do that, after doublecheck everything according to protocol before he/she starts (Symptomes of shock, time, etc.) Compartment and guillotine syndromes are separate themes to discuss. Be safe! G2UA!
Another question: if I will not be able to monitor the wound during transport, should I even loosen the tourniquet after hemostatic gauze and a pressure bandage has been applied?
No
Question can this be done if an artery is severed or does it have to be stitched up before releasing the TQ
You would leave the tourniquet on, the only reason to convert a tourniquet is if the tourniquet was not necessary. Like sam said, it’s pretty common for officers and military personnel to apply a tourniquet immediately after being shot regardless if the wound needs it or not, once the scene is safe and you can asses the injury, you can check to see if there is any major vessel bleeding like an artery or vein, if there isn’t and it’s just capillary then convert, if an artery or vein is bleeding, leave it on and get the patient to a hospital.
Weird. Medic from canada here... our medical directives do not allow for removal of a TQ. Our order is Direct digital pressure, presure bandage, TQ, Second TQ and Hemostatic dressing. We are told on the trauma surgeon can remove them once we get them to a proper center
From what I know about the Canadian EMS system the trauma guidelines need some updating. Even the order of intervention listed is about 10 years behind current practice of TQ first line for life threatening hemorrhage
In the video text it says, “If primary TQ is loosened and bleeding continues, the +1 TQ is tightened,” but later in the video you said that if profuse bleeding is observed after loosening original TQ then you would re-tighten the original TQ that was just loosened. Did I miss something?
If bleeding continues when you tighten the plus 1 then retighten the original
I respectfully disagree about loosing the TQ all at once and a non-medic has only two hours to convert the TQ, after that only a qualified medic should.
How can I get in touch with you?? I want to share info for vid
Brother, idk about civilian side aid that much, but youd never want to losen a tq unless another is tightened. Its like kinking a garden hose, then unkinking it its gonna gush out quite fast....
The whole point of a conversion is to take off the TQ. I didn’t make this process up, this is actually a thing and this is how you do it/how we do it in professional practice
@@PrepMedic I'm not arguing with you, I am just curious to further my knowledge, sorry I worded it weird and kinda blunt, but if the TQ isn't tightened, wouldn't the blood start gushing back out the wound even if it's packed? (Assuming the artery is why they're losing so much blood)
@@2averagenoobs108 The point of a conversion is really to remove the tourniquet if it wasn’t required, if you applied a tourniquet and there was arterial bleeding, then leave it. If you put the tq on and it was just capillary or minor venous bleeding then you could convert it, that’s why he said you just fill the cavity, not pack the gauze against an artery, because again, if there is arterial bleeding, the tq stays on.
With so many disclaimers of not doing what "some guy on the internet" tells you maybe the video should be monetized just like the COVID videos or antivacination with none other numbers than simple 0s to show the dedication to the cause.
That comment didn’t make sense.
Hi. What about loosening the tourniquet?
Don’t loosen the tourniquet.
I thought you couldn't leave a tourniquet on for more than 15 minutes before limb loss. Can you clarify?
You can leave a tourniquet on for more then 6 hours before limb loss.
Please . . . . .what is happening to a person when they go into shock . . .
ruclips.net/video/C9Nng0PPyjs/видео.html
What if there is not medical help available within 6 hrs?
Leave it on
What happens after six hours?
The limb dies...probably
There’s basically no chance to save it, since there was no blood circulation for such a long time. Not sure, but I think there’s like a shot that they may give in a hospital environment to try to save it, but can’t tell for sure
There have been limb recoveries after this timeframe. The issue is that there is a large amount of cellular waste that will circulate through the body if the TQ is released which can cause cardiac arrest and at the very least acid base imbalance. These patients need a surgeon and will also get a cocktail of calcium, sodium bicarbonate, albuterol, insulin, and dextrose to counteract these effects.
@@melissasmess2773 the limb is fine. The US Army did a field study and proved a tourniquet can be left on for extended amounts of time
pubmed.ncbi.nlm.nih.gov/17414556/
I don’t see the point of two TQ’s. Just bandage and retighten the one if needed.
TQs are one time use and can break after they have already been applied and loosened
Why can't you do this on a patient in a shock state?
Ok bro I'm in Ukraine training infantry skills to troops and volunteers. I'm not a medic but I'm not completely ignorant of how things on the medical side work... The current "rule of thumb" being taught is to throw a tourniquet on anything and everything that has a red spot on it. ... Get shot in the leg? No problem! We've got a tourniquet for that.... It's not bleeding very much? Don't worry bro, we are going to put a tourniquet on it anyway.... Getting you to a "real" hospital is going to take a MINIMUM of 8 hours if you are EXTREMELY lucky? ... No problem the doctors know what to do! ... (they just cut the arm or leg off) ... So I'm TRYING to get it through as many thick skulls as possible that not every teeny tiny bullet hole or shrapnel wound or compound fracture needs a tourniquet.
I'm afraid there's way too many guys here having their arms and legs amputated when it's completely unnecessary.
So I try to advise those in my circle to tell their troops to only apply a tourniquet on the battlefield when the sleeve or pant leg is SOAKED in blood... not 1/4 soaked... Not 1/2 soaked.... completely soaked.
I tell them I have plenty of friends who have been shot, but didn't have a tourniquet slapped on them and they are just fine now.
If a guy has his foot blown off I don't understand why I should put a tourniquet up next to his balls and say "good luck buddy" ... I further advise those around me that if I'm not gushing blood like a garden hose that they are putting their own lives at risk if they even think about putting a tourniquet on me because I won't hesitate to activate their life insurance policy.
Thoughts?
Thank you for training and helping Ukraine!!! I appreciate that very much! I agree that many people still think that TQ is a qure for everything. It's a huge problem. But we teach them according to protocol and are changing that vision to how it has to be. Big problem that there are many people that do not keep themselves up to date. I mean that they do not renew knowledges of protocol and new demands of UA Ministry of Defense and Ministry of Health. There are numerous changes for ASM /CLS/ CMC and will be more soon ;) that are very important to know to instructors that teach / train troops and also train civil people, volunteers here.
and if it happens after zombies come, cauterize. jk sort of
How to remove a TK:
(1) go to medical school
(2) enter an EM or Trauma Surgery residency
(3) do what your Attending says or, when away from adult supervision, or act according to your training
This is gold!! #1 subs provider -> P R O M O S M.
Thank you!