Managing Penetrating Wounds and Tourniquet Application

Contributor: Ricky Dhaliwal, MD

Educational Pearls:

What can you do to control bleeding in a penetrating wound?

• Apply direct pinpoint pressure on the wound as well as proximal to the wound.

• Build a compression dressing.

How do you build a compression dressing?

• Think about building an upside-down pyramid with the gauze.

• Consider coagulation agents such as an absorbent gelatin sponge material, microporous polysaccharide hemispheres, oxidized cellulose, fibrin sealants, topical thrombin, or tranexamic acid.

What are the indications to use a tourniquet?

• The Stop The Bleed campaign recommends looking for the following features of "life-threatening" bleeding.

• Pulsatile bleeding.

• Blood is pooling on the ground.

• The overlying clothes are soaked.

• Bandages are ineffective.

• Partial or full amputation.

• And if the patient is in shock.

How do you put on a tourniquet?

• If using a Combat Application Tourniquet (C-A-T) tourniquet, apply it proximal to the wound, then rotate the plastic rod until the bleeding stops. Then secure the plastic rod with a clip and make sure the Velcro is in place.

• Mark the time - generally, there is a spot on the tourniquet to write.

• Have a plan for the next steps. Does the patient need emergent surgery? Do they need to be transfered?

How long can you leave a tourniquet on?

• Less than 90 minutes.

What are the risks?

• Nerve injury.

• Ischemia.

References

1. Latina R, Iacorossi L, Fauci AJ, Biffi A, Castellini G, Coclite D, D'Angelo D, Gianola S, Mari V, Napoletano A, Porcu G, Ruggeri M, Iannone P, Chiara O, On Behalf Of Inih-Major Trauma. Effectiveness of Pre-Hospital Tourniquet in Emergency Patients with Major Trauma and Uncontrolled Haemorrhage: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2021 Dec 6;18(23):12861. doi: 10.3390/ijerph182312861. PMID: 34886586; PMCID: PMC8657739.

2. Martinson J, Park H, Butler FK Jr, Hammesfahr R, DuBose JJ, Scalea TM. Tourniquets USA: A Review of the Current Literature for Commercially Available Alternative Tourniquets for Use in the Prehospital Civilian Environment. J Spec Oper Med. 2020 Summer;20(2):116-122. doi: 10.55460/CT9D-TMZE. PMID: 32573747.

3. Resources poster booklet. (n.d.). Stop the Bleed. https://www.stopthebleed.org/resources-poster-booklet/

Summarized by Jeffrey Olson MS2 | Edited by Meg Joyce & Jorge Chalit, OMSII