immobilization of sharp bone ends reduces fur- ther tissue trauma and allows lacerated blood vessels to clot. In addition, the gentle pressure ex- erted by the splint helps the clotting process by giving additional support to compresses or dress- ings already in place over open fracture sites.
Later in this chapter we will go into the sub- ject of splinting in greater detail.
Figure 4-22.Applying a tourniquet.
A tourniquet is a constricting band that is used to cut off the supply of blood to an injured limb. Use a tourniquet only if the control of hemorrhage by other means proves to be difficult or impossi- ble. A tourniquet must always be applied ABOVE the wound, i.e., towards the trunk, and it must be applied as close to the wound as practical.
Basically, a tourniquet consists of a pad, a band, and a device for tightening the band so that the blood vessels will be compressed. It is best to use a pad, compress, or similar pressure object, if one is available. It goes under the band. It must be placed directly over the artery or it will actually decrease the pressure on the artery and thus allow a greater flow of blood. If a tourniquet placed over a pressure object does not stop the bleeding, there is a good chance that the pressure object is in the wrong place. If this occurs, shift the ob- ject around until the tourniquet, when tightened, will control the bleeding. Any long flat material may be used as the band. It is important that the band be flat: belts, stockings, flat strips of rub- ber, or neckerchief maybe used; but rope, wire, string, or very narrow pieces of cloth should not be used because they cut into the flesh. A short stick may be used to twist the band, tightening the tourniquet. Figure 4-22 shows how to apply a tourniquet.
To be effective, a tourniquet must be tight enough to stop the arterial blood flow to the limb, so be sure to draw the tourniquet tight enough to stop the bleeding. However, do not make it any tighter than necessary.
After you have brought the bleeding under control with the tourniquet, apply a sterile com- press or dressing to the wound and fasten it in position with a bandage.
Here are the points to remember about using a tourniquet:
1. Dont use a tourniquet unless you cant control the bleeding by any other means.
2. Dont use a tourniquet for bleeding from the head, face, neck, or trunk. Use it only on the limbs.
3. Always apply a tourniquet ABOVE THE WOUND and as close to the wound as possible. As a general rule, do not place a tourniquet below the knee or elbow ex- cept for complete amputations. In certain distal areas of the extremities, nerves lie close to the skin and may be damaged by the compression. Furthermore, rarely does one encounter bleeding distal to the knee or elbow that requires a tourniquet.
4. Be sure you draw the tourniquet tight enough to stop the bleeding, but dont make it any tighter than necessary. The pulse beyond the tourniquet should disappear.
5. Dont loosen a tourniquet after it has been applied. Transport the victim to a medical facility that can offer proper care.
6. Dont cover a tourniquet with a dressing. If it is necessary to cover the injured per- son in some way, MAKE SURE that all the other people concerned with the case know about the tourniquet. Using crayon, skin pencil, or blood, mark a large T on the victims forehead or on a medical tag at- tached to the wrist.