154: Tourniquet Conversion with Jamie
In today’s episode, we’re diving into the topic of tourniquet conversion. With conflicts happening globally, it’s crucial to understand the difference between tourniquet conversion and replacement. Conversion means finding an alternative to control bleeding when the tourniquet is no longer needed. Replacement involves swapping a tourniquet for a more effective one. Conversion timing depends on the tactical situation and patient’s resuscitation status. You should consider…
resuscitating the patient before converting, ensuring they’re warm, non-coagulopathic, and ideally have a systolic blood pressure above 90. Science-wise, the two-hour rule may have originated from studies in cooler environments. Converting tourniquets in austere settings requires confidence and proper patient assessment. Crush syndrome, re-bleeding, and metabolic changes can be concerns when converting tourniquets. Use bicarb cautiously to mitigate potential acidosis. Calcium can also help, but pay attention to the specific calcium source and dosing. The goal is to save lives while minimizing limb loss.
Reperfusion syndrome, same as crush and suspension trauma
If the concern with replacing hasty TQ with a deliberate TQ is overloading the kidneys and the injury is distal, say a foot. Is there any research to show if maybe multiple replacements would be less risky? For example, repositioning multiple times by 25 cm increments over a given timeframe.