Prolonged Field Care Podcast

PFC Podcast: Tourniquet Conversion

Jan 15, 2026
Explore the critical nuances of tourniquet management in trauma care, including the vital distinction between tourniquet conversion and replacement. Discover the importance of patient resuscitation prior to conversion, and the physiological risks associated with prolonged tourniquet use. The discussion highlights techniques for safe conversions, potential complications like reperfusion injury, and the challenges of assessing limb salvageability in high-stress situations. Gain practical insights on preparing for adverse outcomes and ensuring optimal patient care.
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ADVICE

Resuscitate First, Then Convert

  • If the tactical situation allows and the patient is resuscitated, convert the tourniquet rather than leaving it indefinitely.
  • Aim to resuscitate within ~30 minutes and be thinking about conversion in the next 30 minutes.
INSIGHT

Why The Two-Hour Guideline Exists

  • The two-hour tourniquet threshold is based on tissue metabolic debt and limited field resources, not a strict physiological cliff.
  • Beyond two hours you create metabolic problems (acidosis, hyperkalemia) the field often can't manage.
ADVICE

Prioritize Patient And Prepared Options

  • Focus on the patient and your resources rather than a fixed "how-to" protocol when reducing a tourniquet.
  • Ensure alternative hemorrhage control and be prepared for reperfusion injury when you take it off.
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