Top 3 things to Consider When Applying a Tourniquet(s) to the Lower Extremities (legs)

MEDICAL MONDAY

By: Sean Barnette

In this #MedicalMonday we will discuss the top 3 things to consider when applying a tourniquet(s) to the lower extremities (legs).

1. Before applying the tourniquet to a leg, completely undo the tourniquet. This means that you need to ensure that the tourniquet is not routed through any buckle and the tourniquet is making a straight line with no loop. The next step is to grasp the backplate and windlass rod in your hand (this is what you will slide underneath the back of the knee first) and ensure that the Velcro and windlass rod portion of the tourniquet are facing the ground. If you do not follow this step, the tourniquet will end up inside out. Undoing the TQ completely actually leads to a faster application time because you aren’t having to navigate the TQ over the foot or move the limb unnecessarily. Also, if the patient has an open fracture in the leg, it would be less than ideal for the TQ loop to snag the end of the bone sticking out of the leg.

2. Utilize the leg lock method to restrict the patient from rolling around. It was formerly taught that the person applying the tourniquet should place their knee into the patient’s groin while getting the TQ ready. It was found that this is less than optimal for multiple reasons. Firstly, if the pelvis or the upper portion of the extremity had been damaged / broken, placing the knee in the groin could cause further injury, including laceration of major vessels from the jagged edge of the bone that may have been broken. Even if no injury in the groin / pelvis area was present, placing a knee in the groin is painful for the patient and it will be more challenging for you to get the TQ on effectively because they will be moving trying to get away from your knee. This results in a longer time for TQ application. One other consideration before actually applying the TQ is to MAKE SURE that the pockets are emptied before you begin your TQ application.

Lastly, if pressure WAS needed in the groin area to stem blood flow, it is much easier and safer to just use pressure with your or your partner’s hand. (Insert all of the dirty jokes here!)

3. Understand that you may need to use TWO tourniquets to stop the bleeding from lower extremities. From the common sense aspect of medicine, most of the time the legs are bigger than the arms. Because of this size difference approximately 60 percent of patients requiring tourniquet application in the lower extremities require TWO tourniquets to be placed. A couple of points in the event you find yourself needing to place two TQs. Firstly, place the second TQ DIRECTLY next to the first one. As in the tourniquets must be touching. If there is a space between the tourniquets, that can lead to a complication called compartment syndrome which is bad for a multitude of reasons. The second point about multiple TQ application is on the first TQ go from the outside of the extremity to the inside. When you place your second TQ, go from the inside of the extremity to the outside. My suggestion is to use the natural void behind the knee to slide the TQ underneath the leg and then slide the TQ in a back-and-forth motion until the TQ is as high as you can get it. Don’t forget as mentioned last week to get any TQ that you place as tight as you can before twisting the windlass rod. Getting ALL of the initial slack out of the TQ is a common failure point of TQ application.

One last point that I want to mention before closing out this Medical Monday is that the majority of duty pants worn by law enforcement can hold a significant amount of blood before spilling onto the ground. Make sure you do a thorough assessment before dismissing the need to apply a TQ.