Stopping of a external bleeding with a hemostatic tourniquet

Authors: Rednenko VV, Poplavets E.V.

Editor: Rednenko V.V.

Equipment for the practical skill:

• gloves
• rubber tourniquet

• bandages
• cotton-cushion pad
• sterile gauze
• blanket

Clinical situation:      

• You see a person with a bleeding. Stop the bleeding with tourniquet

Order of the skill performance:

Preparatory stage:

• Put on gloves
• Visualize the wound (either take off clothes if it’s possible or cut off clothes if it’s necessary).
• Verify a bleeding.
• Identify a type of the external bleeding and choose a way to stop the bleeding: 
  • Severe, life-threatening bleeding that cannot be controlled using direct pressure (Limb amputation)
  • A physical location that makes it impossible to apply direct pressure to control the bleeding (e.g., the injured person or the person's limb is trapped in a confined space) (Crush limb injury)

Main stage:

• Take a comfortable position for this manipulation, If it's possible, use the help of an assistant.
• If the victim is in consciousness, calm him, explain your actions
  
• Press the vessel at the set point proximal from the wound, using either a thumb or join together 2-5 fingers or a clenched fist, achieving a stop of bleeding
• Select the exact place for the tourniquet:
  • 10-20 centimeters proximally from the wound (a tourniquet never applied distally from the wound)
  • Never applied a tourniquet too close to the wound. Further, the tourniquet must not be covered by the bandage of the wound
• Prepare the place for the tourniquet:
  
  • Put some clothes or some bandage rounds on this place
• Use the tourniquet
  • Take the tourniquet by one hand (left) so that the short end of the tourniquet is not less than 10 cm.
  • With your other hand, put a tourniquet above the surface of the limb at the selected place.
  • Stretch the tourniquet with both hands.
  • Form the first turn around the limb.
  • Increase gradually the effort of the stretch until the bleeding stop.
  • Hold down the first turn of the tourniquet with the other turns applying them without the additional stretch. The other turns of the tourniquet should overlap of lower ones about 70%
  • Fasten two ends of the tourniquet with locking elements (buckles) or tie ends of the tourniquet.
• Check the tourniquet (no bleeding from the wound).
• Note the time of a tourniquet application (write the note with the marked and put it under the upper tourniquet turn).
• Apply an aseptic bandage on the wound, without any covering the tourniquet.
• Immobilize the damaged area

Main stage:

• In the cold season, protect the damaged limb from cold.