Prolonged Field Care Podcast

Prolonged Field Care Podcast: Tourniquet Conversion

4 snips
May 2, 2025
This discussion focuses on the nuances of tourniquet management in trauma care. It highlights the critical difference between conversion and replacement, emphasizing resuscitation's role. The physiological implications of prolonged tourniquet use are explored, particularly the risks of reperfusion injury and managing acidosis. Listeners learn about the vital assessment for limb salvageability and the challenges medics face in high-pressure scenarios. The importance of preparation and confidence in decision-making is underscored to improve patient outcomes.
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ADVICE

Replace Bad Or High Tourniquets

  • Replace a failing or poorly placed tourniquet with a better one positioned a couple inches proximal to the wound.
  • Expose the injury by removing layers and place the new tourniquet 2–3 inches above the bleeding source.
ADVICE

Resuscitate Before Conversion

  • Prioritize resuscitation before attempting tourniquet conversion and aim to have blood products within ~30 minutes.
  • Convert as soon as the patient is warm, not coagulopathic, and clinically stable rather than waiting on exact numbers.
INSIGHT

Why The Two-Hour Threshold Exists

  • The two-hour guideline reflects field physiology and limits to treating reperfusion metabolic load in austere settings.
  • Longer tourniquet times increase acidosis, hyperkalemia, and other metabolic burdens you'll eventually have to manage.
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