Setting (medicine)

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In emergency medicine, when ligating , the blood supply in an arm or leg is cut off with a circular bandage with strong pressure on the arteries of the extremity .

Tying with the Spanish winch
Military tourniquet

The purpose of tying it off (using a blood pressure cuff or tourniquet ) is to prevent life-threatening bleeding and the associated hemorrhagic shock . It is therefore only used when a pressure bandage or manual compression does not provide adequate hemostasis. Immediate action is indicated in the event of life-threatening bleeding or multiple injuries to the extremity, the inability to reach the source of the bleeding or a mass casualty .

The pressure should be applied evenly around the extremity to the skin and the underlying tissue. Once an extremity has been tied, it can only be opened by a doctor due to the risk of thrombus formation. The time of the binding is to be recorded and can be written on the extremity above the binding.

risk

One risk is that if the limb is tied for too long, it will die and then have to be amputated. However, given the expected benefit in the context of life-threatening bleeding, this risk is negligible. Setting times up to 3 hours are z. B. regularly performed as part of planned knee operations in operating theaters in order to keep blood loss low during an operation ( tourniquet ). Experience from vascular surgery shows that extremities can even survive for up to 6 hours without a blood supply. Only after 6 hours without a blood supply is an amputation considered inevitable. Further risks are nerve damage when using improperly narrow binding materials such as wire or cord. Too little pressure when tying can lead to venous congestion and even increase the bleeding.

Use in the military

In Tactical Combat Casualty Care (TCCC) developed by the US military, tying is recommended for rapid hemostasis, especially in the so-called Care Under Fire phase, in which the patient and rescuer are under enemy fire.

Even outside the line of fire, but before reaching medical resources ( tactical field care ), the bleeding can be stopped by tying off. Insatiable bleeding from extremities is the main cause (approx. 60%) of avoidable deaths on the battlefield.

Wound statistics from the US armed forces in Iraq and Afghanistan show that bleeding to death leads the statistics with over 80% of the preventable causes of death. 1/3 of this fatal bleeding is localized on the extremities and can therefore be controlled with a tourniquet. The remaining 2/3 of the bleeding is found on the trunk and is difficult to stop immediately.

Soldiers of the German Federal Armed Forces on the ISAF mission in Afghanistan are equipped with tourniquets.

literature

  • C. Madler, K.-W. Jauch, K. Werdan, J. Sigrist, F.-G. Pajonk (ed.): The NAW book. 3. Edition. Urban & Fischer at Elsevier, 2005, ISBN 3-437-22510-3 .

proof

  1. ↑ S3- guideline for multiple trauma / treatment of seriously injured persons of the DGU . In: AWMF online (as of 07/2011)
  2. ↑ M. Storck, PK Modic: German Society for Vascular Surgery S2 guideline for vascular injuries. AWMF online www.leitlinien.net 2008.
  3. ↑ NAEMT (ed.): Preclinical trauma management: The PHTLS concept. Urban & Fischer Verlag / Elsevier, 2009, ISBN 978-3-437-48620-3 .
  4. ^ Joseph F. Kelly, Amber E. Ritenour, Daniel F. McLaughlin, Karen A. Bagg, Amy N. Apodaca, Craig T. Mallak, Lisa Pearse, Mary M. Lawnick, Howard R. Champion, Charles E. Wade, John B. Holcomb: Injury Severity and Causes of Death From Operation Iraqi Freedom and Operation Enduring Freedom: 2003 ??? 2004 Versus 2006. In: The Journal of Trauma . 64, 2008, pp. S21-S27, doi: 10.1097 / TA.0b013e318160b9fb .

Web links

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