Tourniquet use for civilian extremity trauma

Inaba, Kenji; Siboni, Stefano; Resnick, Shelby; Zhu, J.; Wong, Monica; Haltmeier, Tobias; Benjamin, Elizabeth; Δημητριάδης, Δημήτριος

doi:10.1097/ta.0000000000000747

Cited by 125 publications

(109 citation statements)

References 17 publications

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“…A survival benefit was difficult to appreciate as the mortality for the group was low (3%). Inaba and colleagues 40 evaluated 87, young patients with predominant penetrating, isolated major limb trauma with improvised, CAT and pneumatic tourniquets placed in the field, ED or operating room. The investigators reported an overall vascular injury rate of 80% with an associated complication rate of 8% and amputation rate of 17% (only one of which was attributed to the actual tourniquet).…”

Section: Discussionmentioning

confidence: 99%

Safety and Appropriateness of Tourniquets in 105 Civilians

Scerbo¹,

Mumm²,

Gates³

et al. 2016

Prehospital Emergency Care

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Background The United States military considers tourniquets to be effective for controlling bleeding from major limb trauma. The purpose of this study was to assess whether tourniquets are safely applied to the appropriate civilian patient with major limb trauma of any etiology. Methods Following IRB approval, patients arriving to a level-1 trauma center between October 2008 and May 2013 with a prehospital (PH) or emergency department (ED) tourniquet were reviewed. Cases were assigned the following designations: absolute indication (operation within 2 hours for limb injury, vascular injury requiring repair/ligation, or traumatic amputation); relative indication (major musculoskeletal/soft-tissue injury requiring operation 2–8 hours after arrival, documented large blood loss); and non-indicated. Patients with absolute or relative indications for tourniquet placement were defined as indicated, while the remaining were designated as non-indicated. Complications potentially associated with tourniquets, including amputation, acute renal failure, compartment syndrome, nerve palsies, and venous thromboembolic events, were adjudicated by orthopedic, hand or trauma surgical staff. Univariate analysis was performed to compare patients with indicated versus non-indicated tourniquet placement. Results A total of 105 patients received a tourniquet for injuries sustained via sharp objects, i.e., glass or knives (32%), motor vehicle collisions (30%), or other mechanisms (38%). A total of 94 patients (90%) had indicated tourniquet placement; 41 (44%) of which had a vascular injury. Demographics, mechanism, transport, and vitals were similar between patients that had indicated or non-indicated tourniquet placement. 48% of the indicated tourniquets placed PH were removed in the ED, compared to 100% of the non-indicated tourniquets (p < 0.01). The amputation rate was 32% among patients with indicated tourniquet placement (vs. 0%; p = 0.03). Acute renal failure (3.2 vs. 0%, p = 0.72), compartment syndrome (2.1 vs. 0%, p = 0.80), nerve palsies (5.3 vs. 0%; p = 0.57), and venous thromboembolic events (9.1 vs. 8.5%; p = 0.65) and were similar in patients that had indicated compared to non-indicated tourniquet placement. After adjudication, no complication was a result of tourniquet use. Conclusion The current study suggests that PH and ED tourniquets are used safely and appropriately in civilians with major limb trauma that occur via blunt and penetrating mechanisms.

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Section: Discussionmentioning

confidence: 99%

Safety and Appropriateness of Tourniquets in 105 Civilians

Scerbo¹,

Mumm²,

Gates³

et al. 2016

Prehospital Emergency Care

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“…Clinical manifestations of DVT are not typical at early stages. Therefore, it is difficult to achieve accurate diagnosis and false-positive and -negative conditions become evident (24,25). Therefore, early observation and diagnosis of DVT has become a study hotspot and challenge.…”

Section: Discussionmentioning

confidence: 99%

The association between the levels of CRP, IL-10, PLA2, Fbg and prognosis in traumatic fracture of lower limb

Jiao

Wang

Xiao

et al. 2016

Experimental and Therapeutic Medicine

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The aim of the present study was to examine changes of sera levels of C-reactive protein (CRP), interleukin-10 (IL-10), phospholipase A2 (PLA2) and fibrinogen β polypeptide chain gene (Fbg) in patients with traumatic fracture of lower limb, and to evaluate their association with prognosis. The changes in sera levels of CRP, IL-10, PLA2 and Fbg were observed at the time of injury, 24 h, and 5 and 7 days after surgery in 90 patients with traumatic fracture of lower limb. In addition, 50 cases, who presented for health examination, were included as the normal controls. The expression of sera levels of CRP, IL-10, PLA2 and Fbg in patients with traumatic fracture of lower limb, was markedly higher than that in the normal controls prior to surgery (P<0.05). The concentration of CRP significantly increased within 24 h after emergency, but decreased gradually as the wound healed, compared to the controls. Pre- and postoperative IL-10 levels increased within 24 h and then decreased gradually. The level of PLA2 in patients before and after surgery was increased, and then decreased gradually. The level of Fbg in patients with trauma was increased after 24 h and then decreased, and increased gradually. The correlation of serum CRP and IL-10 levels (r=0.634, P<0.05), and that of PLA2 and IL-10 levels (r=0.617, P<0.05) were positive. In conclusion, the expression of CRP, IL-10, PLA2 and Fbg levels in traumatic fracture of lower limb markedly increased and was closely associated with prognosis. CRP, IL-10, PLA2 and Fbg levels may therefore serve as useful indexes in determining the progression and prognosis of patients with traumatic fracture of lower limb.

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“…Because of the easy and quick access to specialist care, in case of massive hemorrhage in case of civil casualties, assistance is provided in stages, the last of which is the tourniquet application. [20,21] During the bombing attack in Boston, two explosives filled with bearing balls were detonated, killing three people and injuring 264. Eservices decided to apply tourniquets for 27 victims in a form of improvised bands.…”

Section: Discussionmentioning

confidence: 99%