Here are the points to remember about using atourniquet:1. Use a tourniquet only as a last resort! Don’tuse a tourniquet unless you can’t control thebleeding by any other means.2. Don’t use a tourniquet for bleeding from thehead, face, neck, or trunk. Use it only on thelimbs.3. Always apply a tourniquet above the woundand as close to the wound as possible. As ageneral rule, do not place a tourniquet below theknee or elbow except for complete amputations.In certain distal areas of the extremities, nerveslie close to the skin and may be damaged by thecompression. Furthermore, rarely does oneencounter bleeding distal to the knee or elbowthat requires a tourniquet.4. Be sure you draw the tourniquet tight enough tostop the bleeding, but don’t make it any tighterthan necessary. The pulse beyond the tourniquetshould disappear.5. Don’t loosen a tourniquet after it has beenapplied.Transport the victim to a medicalfacility that can offer proper care.6. Don’t cover a tourniquet with a dressing. If it isnecessary to cover the injured person in someway, make sure that all the other peopleconcerned with the case know about thetourniquet. Using crayon, skin pencil, or blood,mark a large “T” and the time the tourniquet wasapplied on the victim’s forehead or on a medicaltag attached to the wrist.MANAGEMENT OF INTERNALSOFT-TISSUE INJURIESInternal soft-tissue injuries may result from deepwounds, blunt trauma, blast exposure, crushingaccidents, bone fracture, poison, or sickness. Theymay range in seriousness from a simple contusion tolife-threatening hemorrhage and shock.Visible IndicationsVisible indications of internal soft-tissue injuryinclude the following:Hematemesis (vomiting bright red blood)Hemoptysis (coughing up bright red blood)Melena (excretion of tarry black stools)Hematochezia (excretion of bright red bloodfrom the rectum)Hematuria (passing of blood in the urine)Nonmenstrual (vaginal bleeding)Epistaxis (nosebleed)Pooling of the blood near the skin surfaceOther SymptomsMore often than not, however, there will be novisible signs of injury, and the Corpsman will have toinfer the probability of internal soft-tissue injury fromother symptoms such as the following:Pale, moist, clammy skinSubnormal temperatureRapid, feeble pulseFalling blood pressureDilated, slowly reacting pupils with impairedvisionTinnitusSyncopeDehydration and thirstYawning and air hungerAnxiety, with a feeling of impending doom4-34Figure 4-28.—Applying a tourniquet.
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