2024-01-30 17:30 編輯
名詞縮寫
PT 充氣式止血帶
剛剛搜尋uptodate上面關於止血帶的介紹.
Severe upper extremity injury in the adult patient(最後更新2023-04-10)
重點整理
1. 止血帶可用於四肢受傷後無法以直接加壓控制出血的狀況(直接加壓還是首選)
2. 止血帶使用目的是為了提高外傷病患存活率
3. PT 打氣壓力不要超過 250mmHg
4. PT放置位置. 在傷口近端(靠心臟那一端), 距離傷口 5 公分處放置
(因此腋下出血使用一般止血帶. 無法達到良好止血的目的)
(腋下止血處理可以參考這裡 嚴重外傷出血處置-腋下出血處置)
5. PT 不宜使用超過兩小時, 不需要間隔性鬆開. 因為不會提高肢體截肢率
(多數傷患送醫時間不長, PT 如果使用超過兩小時, 需要諮詢當地醫療指導醫師)
(台灣的醫療指導醫師是有法條規範的: 醫療指導醫師實施辦法)
http://www.uptodate.com/contents/severe-extremity-injury-in-the-adult-patient?source=see_link§ionName=Control+of+hemorrhage&anchor=H151199357#H151199357
可以使用止血帶止血, 或直接將受損血管夾住, 如果無法明確區分是哪一條血管斷裂冒血, 不要亂夾, 氣壓式止血帶通常使用於上下肢手術止血, 目前ATLS高級外傷救命術鼓勵在嚴重肢體受傷動脈出血病患使用止血帶止血.
Bleeding can also be controlled using a tourniquet [20,21], or direct clamping of visible vessels. Clamping vessels that cannot be clearly identified shouldnot be performed. Pneumatic tourniquets are commonly used to lessen bleeding during the course of upper and lower extremity surgery. There is renewed interest in the civilian community in the use of tourniquets for control of extremity hemorrhage. The current version of Advanced Trauma Life Support (ATLS) endorses the judicious use of a tourniquet for major extremity arterial hemorrhage, and several civilian guidelines now include tourniquet application as a temporary adjunct to control extremity hemorrhage when direct pressure is unsuccessful [22,23], or during tactical civilian events, which are situations where ballistic or explosive wounds are possible (eg, an active shooter standoff) [24]. (See "Prehospital care of the adult trauma patient", section on 'Hemorrhage control'.)
目前有各種制式化的止血帶(多數用於戰場). 可以有效阻斷 80% 以上的血流
A variety of tourniquets have been developed to manage combat-related extremity hemorrhage with a low risk of ischemia and neurologic complications [25,26]. The Combat Application Tourniquet (CAT), Emergency and Medical Tourniquet (EMT), and Special Operations Forces Tactical Tourniquet (SOFTT) meet the effectiveness standard of the United States military and occlude distal flow in >80 percent of subjects [25,26]. The relative effectiveness of these tourniquets has been evaluated in human volunteers with each shown to attenuate the distal arterial pulse in upper and lower extremities [27]. The benefits of tourniquet application are illustrated in the following studies in combat casualty populations:
下面兩個試驗顯示出止血帶的好處
第一個實驗, 165 個病患, 67名在到院前使用止血帶, 83.3% 有效止血, 沒有用止血帶的 60.7% 能有效止血. 之後的截肢機率相等.
第二個實驗, 232 戰場傷患, 到院前或在急診室使用止血帶, 存活率顯著上升 77% 比 0% . 這項實驗中, 沒有因為使用止血帶造成需要截肢的問題. 但有四名傷患出現神經麻痺.
●In a study that evaluated 165 patients, 67 of whom had a prehospital tourniquet applied, control of bleeding was significantly improved with tourniquet application versus no tourniquet (83.3 versus 60.7 percent), and there were no differences in secondary amputation rates [25].
●A prospective study of 232 combat casualties found a significantly improved survival rate (77 percent versus 0 percent) when using a tourniquet (prehospital or emergency department) versus no tourniquet [26]. In this study, no amputations were required due to tourniquet use, but four transient nerve palsies were reported.
Swan KG Jr, Wright DS, Barbagiovanni SS, et al. Tourniquets revisited. J Trauma 2009; 66:672.
Arrillaga A, Bynoe R, Frykberg ER, Nagy K. EAST Practice Management Guidelines for Penetrating Trauma to the Lower Extremity (2002). http://www.east.org/content/documents/lower_extremity_isolated_arterial_injuries_from_penetrating_trauma.pdf (Accessed on October 22, 2013).
Fox N, Rajani RR, Bokhari F, et al. Evaluation and management of penetrating lower extremity arterial trauma: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 2012; 73:S315.
Committee for Tactical Emergency Medical Care. Tactical Emergency Casualty Care Guidelines: Direct Threat Care. http://c-tecc.org/tactical-emergency-casualty-care-guidelines (Accessed on October 22, 2013).
Beekley AC, Sebesta JA, Blackbourne LH, et al. Prehospital tourniquet use in Operation Iraqi Freedom: effect on hemorrhage control and outcomes. J Trauma 2008; 64:S28.
Kragh JF Jr, Walters TJ, Baer DG, et al. Survival with emergency tourniquet use to stop bleeding in major limb trauma. Ann Surg 2009; 249:1.
Walters TJ, Wenke JC, Kauvar DS, et al. Effectiveness of self-applied tourniquets in human volunteers. Prehosp Emerg Care 2005; 9:416.
US Department of Health and Human Services Centers for Disease Control and Prevention. Tetanus. www.cdc.gov/vaccines/pubs/pinkbook/downloads/tetanus.pdf (Accessed on May 06, 2011).
Swan KG Jr, Wright DS, Barbagiovanni SS, et al. Tourniquets revisited. J Trauma 2009; 66:672.
Arrillaga A, Bynoe R, Frykberg ER, Nagy K. EAST Practice Management Guidelines for Penetrating Trauma to the Lower Extremity (2002). http://www.east.org/content/documents/lower_extremity_isolated_arterial_injuries_from_penetrating_trauma.pdf (Accessed on October 22, 2013).
Fox N, Rajani RR, Bokhari F, et al. Evaluation and management of penetrating lower extremity arterial trauma: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 2012; 73:S315.
Committee for Tactical Emergency Medical Care. Tactical Emergency Casualty Care Guidelines: Direct Threat Care. http://c-tecc.org/tactical-emergency-casualty-care-guidelines (Accessed on October 22, 2013).
Beekley AC, Sebesta JA, Blackbourne LH, et al. Prehospital tourniquet use in Operation Iraqi Freedom: effect on hemorrhage control and outcomes. J Trauma 2008; 64:S28.
Kragh JF Jr, Walters TJ, Baer DG, et al. Survival with emergency tourniquet use to stop bleeding in major limb trauma. Ann Surg 2009; 249:1.
Walters TJ, Wenke JC, Kauvar DS, et al. Effectiveness of self-applied tourniquets in human volunteers. Prehosp Emerg Care 2005; 9:416.
US Department of Health and Human Services Centers for Disease Control and Prevention. Tetanus. www.cdc.gov/vaccines/pubs/pinkbook/downloads/tetanus.pdf (Accessed on May 06, 2011).
Swan KG Jr, Wright DS, Barbagiovanni SS, et al. Tourniquets revisited. J Trauma 2009; 66:672.
Arrillaga A, Bynoe R, Frykberg ER, Nagy K. EAST Practice Management Guidelines for Penetrating Trauma to the Lower Extremity (2002). http://www.east.org/content/documents/lower_extremity_isolated_arterial_injuries_from_penetrating_trauma.pdf (Accessed on October 22, 2013).
Fox N, Rajani RR, Bokhari F, et al. Evaluation and management of penetrating lower extremity arterial trauma: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 2012; 73:S315.
Committee for Tactical Emergency Medical Care. Tactical Emergency Casualty Care Guidelines: Direct Threat Care. http://c-tecc.org/tactical-emergency-casualty-care-guidelines (Accessed on October 22, 2013).
Beekley AC, Sebesta JA, Blackbourne LH, et al. Prehospital tourniquet use in Operation Iraqi Freedom: effect on hemorrhage control and outcomes. J Trauma 2008; 64:S28.
Kragh JF Jr, Walters TJ, Baer DG, et al. Survival with emergency tourniquet use to stop bleeding in major limb trauma. Ann Surg 2009; 249:1.
Walters TJ, Wenke JC, Kauvar DS, et al. Effectiveness of self-applied tourniquets in human volunteers. Prehosp Emerg Care 2005; 9:416.
US Department of Health and Human Services Centers for Disease Control and Prevention. Tetanus. www.cdc.gov/vaccines/pubs/pinkbook/downloads/tetanus.pdf (Accessed on May 06, 2011).
1. 止血帶可用於四肢受傷後無法以直接加壓控制出血的狀況(直接加壓還是首選)
2. 止血帶使用目的是為了提高外傷病患存活率
3. PT 打氣壓力不要超過 250mmHg
4. PT放置位置. 在傷口近端(靠心臟那一端), 距離傷口 5 公分處放置
(因此腋下出血使用一般止血帶. 無法達到良好止血的目的)
(腋下止血處理可以參考這裡 嚴重外傷出血處置-腋下出血處置)
5. PT 不宜使用超過兩小時, 不需要間隔性鬆開. 因為不會提高肢體截肢率
(多數傷患送醫時間不長, PT 如果使用超過兩小時, 需要諮詢當地醫療指導醫師)
(台灣的醫療指導醫師是有法條規範的: 醫療指導醫師實施辦法)
6. 傷患應該送手術室控制出血
google中文翻譯
控制四肢出血 — 對於直接加壓無法充分控制的上肢出血，回顧性研究表明，四肢止血帶可減少出血，且併發症發生率較低[ 6-8 ]。
氣動止血帶 (PT) 通常用於減少擇期上肢手術期間的出血。它們也可用於急診室控制四肢出血，以提高病患的存活率[ 9,10 ]。標準 PT 可用於控制腋窩遠端上肢的出血。 PT 的充氣壓力應小於 250 mmHg，如果可能，PT 袖套應放置在開放性傷口至少 5 cm 的位置。 PT連續充氣時間不應超過2小時，以避免缺血性併發症[ 6-8 ]。患者應前往手術室快速控制出血。
在院前或軍事環境中，最常用的止血帶是無風式戰鬥止血帶 (CAT) 或特種部隊戰術止血帶（SOFT-T 寬型）。如有必要，可以用一隻手快速塗抹。在一項回顧性研究中，94%的上肢應用CAT的軍人實現了出血的絕對控制，並且沒有死亡報告[ 11 ]。美國軍方戰術戰鬥傷亡護理委員會定期檢視商用止血帶的性能[ 12 ]。對於腋窩交界處的傷口，建議包紮傷口，最好使用止血敷料，並持續加壓[ 13 ]。市面上有一些連接性止血帶，但目前沒有足夠的證據推薦使用它們。另外，在戰場上，據報道，在腋窩上使用專門的止血帶可以控制腋窩（交界處）出血[ 14 ]。
Control of extremity hemorrhage — For upper extremity hemorrhage that is not adequately controlled with direct pressure, retrospective studies have shown that extremity tourniquets reduce bleeding with a low rate of complications [6-8].
Pneumatic tourniquets (PTs) are commonly used to reduce bleeding during elective upper extremity surgery. They can also be used in the emergency department setting to control extremity hemorrhage to improve patient survival [9,10]. Standard PTs can be used to control hemorrhage in the upper extremity distal to the axilla. The inflation pressure of the PT should be less than 250 mmHg, and the PT cuff should be placed at least 5 cm proximal to the open wound, if possible. The PT should not be inflated continuously for more than two hours to avoid ischemic complications [6-8]. The patient should proceed to the operating room for rapid hemorrhage control.
In the prehospital or military setting, the most commonly used tourniquets are the windless style Combat Application Tourniquet (CAT) or Special Forces Tactical Tourniquet (SOFT-T wide). These can be applied rapidly with one hand, if necessary. In a retrospective study, 94 percent of the service personnel who had applied a CAT to the upper extremity achieved absolute control of hemorrhage, and no deaths were reported [11]. The Tactical Combat Casualty Care Committee of the United States military routinely reviews the performance of commercial tourniquets [12]. For junctional wounds at the axilla, wound packing, ideally with a hemostatic dressing, along with continuous pressure is recommended [13]. There are some junctional tourniquets on the market, but there is insufficient evidence to recommend their use at this time. Also, in the battlefield, application of a specialized tourniquet to the axilla has been reported to control axillary (junctional) hemorrhage [14].
下面是舊的內容.
以往認為止血帶可能造成肢體缺血壞死或神經受損. 後來醫學研究發現, 其實只有0.4% 病患會因為止血帶造成肢體壞死需要截止, 1.5% 造成永久性神經受損.
Unlike civilian EMS, military medicine practices have long called for tourniquet application much earlier in the treatment for blood loss. Recent research in military hospitals in Iraq and Afghanistan has shown that, contrary to popular belief, using a tourniquet doesn’t guarantee limb amputation or even nerve loss. In fact, researchers found that among patients who had a tourniquet applied to a limb before arriving to the hospital, only 0.4% of them underwent an amputation and usually the reason they got an amputation had nothing to do with the tourniquet. On the nerve damage front, only 1.5% of tourniquetted patients suffered any kind of permanent nerve damage. Based on this newfound knowledge, many civilian EMS teachers and practitioners are starting to encourage tourniquet use much sooner.
Necrosis of muscle tissue doesn’t onset until after 2 hours without blood flow, and can even last 5-8 hours without consequences resulting in amputation; so you can keep the tourniquet on for awhile–but you want to get the victim help as soon as possible.
http://www.artofmanliness.com/2012/03/21/how-to-save-lives-like-an-army-medic-using-a-tourniquet-to-control-major-bleeding/
新的醫學證據顯示, 止血帶使用之後不需要間歇性鬆開. 因為無法減少肢體存活率. 反而會讓出血更嚴重.
止血帶建議每 45 分鐘需要鬆開一下
http://www.uptodate.com/contents/initial-evaluation-and-management-of-shock-in-adult-trauma?source=see_link§ionName=Hemostatic+agents&anchor=H18#H18
Use of a tourniquet is acceptable to stop hemorrhage in cases of amputation or severe extremity injury when other measures have not successfully controlled bleeding. Tourniquets must be released periodically (eg, every 45 minutes) to avoid prolonged ischemia and possible tissue loss. (See "Severe extremity injury in the adult patient", section on 'Control of hemorrhage'.)
google中文翻譯
控制四肢出血 — 對於直接加壓無法充分控制的上肢出血，回顧性研究表明，四肢止血帶可減少出血，且併發症發生率較低[ 6-8 ]。
氣動止血帶 (PT) 通常用於減少擇期上肢手術期間的出血。它們也可用於急診室控制四肢出血，以提高病患的存活率[ 9,10 ]。標準 PT 可用於控制腋窩遠端上肢的出血。 PT 的充氣壓力應小於 250 mmHg，如果可能，PT 袖套應放置在開放性傷口至少 5 cm 的位置。 PT連續充氣時間不應超過2小時，以避免缺血性併發症[ 6-8 ]。患者應前往手術室快速控制出血。
在院前或軍事環境中，最常用的止血帶是無風式戰鬥止血帶 (CAT) 或特種部隊戰術止血帶（SOFT-T 寬型）。如有必要，可以用一隻手快速塗抹。在一項回顧性研究中，94%的上肢應用CAT的軍人實現了出血的絕對控制，並且沒有死亡報告[ 11 ]。美國軍方戰術戰鬥傷亡護理委員會定期檢視商用止血帶的性能[ 12 ]。對於腋窩交界處的傷口，建議包紮傷口，最好使用止血敷料，並持續加壓[ 13 ]。市面上有一些連接性止血帶，但目前沒有足夠的證據推薦使用它們。另外，在戰場上，據報道，在腋窩上使用專門的止血帶可以控制腋窩（交界處）出血[ 14 ]。
Control of extremity hemorrhage — For upper extremity hemorrhage that is not adequately controlled with direct pressure, retrospective studies have shown that extremity tourniquets reduce bleeding with a low rate of complications [6-8].
Pneumatic tourniquets (PTs) are commonly used to reduce bleeding during elective upper extremity surgery. They can also be used in the emergency department setting to control extremity hemorrhage to improve patient survival [9,10]. Standard PTs can be used to control hemorrhage in the upper extremity distal to the axilla. The inflation pressure of the PT should be less than 250 mmHg, and the PT cuff should be placed at least 5 cm proximal to the open wound, if possible. The PT should not be inflated continuously for more than two hours to avoid ischemic complications [6-8]. The patient should proceed to the operating room for rapid hemorrhage control.
In the prehospital or military setting, the most commonly used tourniquets are the windless style Combat Application Tourniquet (CAT) or Special Forces Tactical Tourniquet (SOFT-T wide). These can be applied rapidly with one hand, if necessary. In a retrospective study, 94 percent of the service personnel who had applied a CAT to the upper extremity achieved absolute control of hemorrhage, and no deaths were reported [11]. The Tactical Combat Casualty Care Committee of the United States military routinely reviews the performance of commercial tourniquets [12]. For junctional wounds at the axilla, wound packing, ideally with a hemostatic dressing, along with continuous pressure is recommended [13]. There are some junctional tourniquets on the market, but there is insufficient evidence to recommend their use at this time. Also, in the battlefield, application of a specialized tourniquet to the axilla has been reported to control axillary (junctional) hemorrhage [14].
下面是舊的內容.
以往認為止血帶可能造成肢體缺血壞死或神經受損. 後來醫學研究發現, 其實只有0.4% 病患會因為止血帶造成肢體壞死需要截止, 1.5% 造成永久性神經受損.
Unlike civilian EMS, military medicine practices have long called for tourniquet application much earlier in the treatment for blood loss. Recent research in military hospitals in Iraq and Afghanistan has shown that, contrary to popular belief, using a tourniquet doesn’t guarantee limb amputation or even nerve loss. In fact, researchers found that among patients who had a tourniquet applied to a limb before arriving to the hospital, only 0.4% of them underwent an amputation and usually the reason they got an amputation had nothing to do with the tourniquet. On the nerve damage front, only 1.5% of tourniquetted patients suffered any kind of permanent nerve damage. Based on this newfound knowledge, many civilian EMS teachers and practitioners are starting to encourage tourniquet use much sooner.
Necrosis of muscle tissue doesn’t onset until after 2 hours without blood flow, and can even last 5-8 hours without consequences resulting in amputation; so you can keep the tourniquet on for awhile–but you want to get the victim help as soon as possible.
http://www.artofmanliness.com/2012/03/21/how-to-save-lives-like-an-army-medic-using-a-tourniquet-to-control-major-bleeding/
新的醫學證據顯示, 止血帶使用之後不需要間歇性鬆開. 因為無法減少肢體存活率. 反而會讓出血更嚴重.
http://www.uptodate.com/contents/initial-evaluation-and-management-of-shock-in-adult-trauma?source=see_link§ionName=Hemostatic+agents&anchor=H18#H18
Use of a tourniquet is acceptable to stop hemorrhage in cases of amputation or severe extremity injury when other measures have not successfully controlled bleeding. Tourniquets must be released periodically (eg, every 45 minutes) to avoid prolonged ischemia and possible tissue loss. (See "Severe extremity injury in the adult patient", section on 'Control of hemorrhage'.)
http://www.uptodate.com/contents/severe-extremity-injury-in-the-adult-patient?source=see_link§ionName=Control+of+hemorrhage&anchor=H151199357#H151199357
可以使用止血帶止血, 或直接將受損血管夾住, 如果無法明確區分是哪一條血管斷裂冒血, 不要亂夾, 氣壓式止血帶通常使用於上下肢手術止血, 目前ATLS高級外傷救命術鼓勵在嚴重肢體受傷動脈出血病患使用止血帶止血.
Bleeding can also be controlled using a tourniquet [20,21], or direct clamping of visible vessels. Clamping vessels that cannot be clearly identified shouldnot be performed. Pneumatic tourniquets are commonly used to lessen bleeding during the course of upper and lower extremity surgery. There is renewed interest in the civilian community in the use of tourniquets for control of extremity hemorrhage. The current version of Advanced Trauma Life Support (ATLS) endorses the judicious use of a tourniquet for major extremity arterial hemorrhage, and several civilian guidelines now include tourniquet application as a temporary adjunct to control extremity hemorrhage when direct pressure is unsuccessful [22,23], or during tactical civilian events, which are situations where ballistic or explosive wounds are possible (eg, an active shooter standoff) [24]. (See "Prehospital care of the adult trauma patient", section on 'Hemorrhage control'.)
目前有各種制式化的止血帶(多數用於戰場). 可以有效阻斷 80% 以上的血流
A variety of tourniquets have been developed to manage combat-related extremity hemorrhage with a low risk of ischemia and neurologic complications [25,26]. The Combat Application Tourniquet (CAT), Emergency and Medical Tourniquet (EMT), and Special Operations Forces Tactical Tourniquet (SOFTT) meet the effectiveness standard of the United States military and occlude distal flow in >80 percent of subjects [25,26]. The relative effectiveness of these tourniquets has been evaluated in human volunteers with each shown to attenuate the distal arterial pulse in upper and lower extremities [27]. The benefits of tourniquet application are illustrated in the following studies in combat casualty populations:
下面兩個試驗顯示出止血帶的好處
第一個實驗, 165 個病患, 67名在到院前使用止血帶, 83.3% 有效止血, 沒有用止血帶的 60.7% 能有效止血. 之後的截肢機率相等.
第二個實驗, 232 戰場傷患, 到院前或在急診室使用止血帶, 存活率顯著上升 77% 比 0% . 這項實驗中, 沒有因為使用止血帶造成需要截肢的問題. 但有四名傷患出現神經麻痺.
●In a study that evaluated 165 patients, 67 of whom had a prehospital tourniquet applied, control of bleeding was significantly improved with tourniquet application versus no tourniquet (83.3 versus 60.7 percent), and there were no differences in secondary amputation rates [25].
●A prospective study of 232 combat casualties found a significantly improved survival rate (77 percent versus 0 percent) when using a tourniquet (prehospital or emergency department) versus no tourniquet [26]. In this study, no amputations were required due to tourniquet use, but four transient nerve palsies were reported.
Swan KG Jr, Wright DS, Barbagiovanni SS, et al. Tourniquets revisited. J Trauma 2009; 66:672.
Arrillaga A, Bynoe R, Frykberg ER, Nagy K. EAST Practice Management Guidelines for Penetrating Trauma to the Lower Extremity (2002). http://www.east.org/content/documents/lower_extremity_isolated_arterial_injuries_from_penetrating_trauma.pdf (Accessed on October 22, 2013).
Fox N, Rajani RR, Bokhari F, et al. Evaluation and management of penetrating lower extremity arterial trauma: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 2012; 73:S315.
Committee for Tactical Emergency Medical Care. Tactical Emergency Casualty Care Guidelines: Direct Threat Care. http://c-tecc.org/tactical-emergency-casualty-care-guidelines (Accessed on October 22, 2013).
Beekley AC, Sebesta JA, Blackbourne LH, et al. Prehospital tourniquet use in Operation Iraqi Freedom: effect on hemorrhage control and outcomes. J Trauma 2008; 64:S28.
Kragh JF Jr, Walters TJ, Baer DG, et al. Survival with emergency tourniquet use to stop bleeding in major limb trauma. Ann Surg 2009; 249:1.
Walters TJ, Wenke JC, Kauvar DS, et al. Effectiveness of self-applied tourniquets in human volunteers. Prehosp Emerg Care 2005; 9:416.
US Department of Health and Human Services Centers for Disease Control and Prevention. Tetanus. www.cdc.gov/vaccines/pubs/pinkbook/downloads/tetanus.pdf (Accessed on May 06, 2011).
Swan KG Jr, Wright DS, Barbagiovanni SS, et al. Tourniquets revisited. J Trauma 2009; 66:672.
Arrillaga A, Bynoe R, Frykberg ER, Nagy K. EAST Practice Management Guidelines for Penetrating Trauma to the Lower Extremity (2002). http://www.east.org/content/documents/lower_extremity_isolated_arterial_injuries_from_penetrating_trauma.pdf (Accessed on October 22, 2013).
Fox N, Rajani RR, Bokhari F, et al. Evaluation and management of penetrating lower extremity arterial trauma: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 2012; 73:S315.
Committee for Tactical Emergency Medical Care. Tactical Emergency Casualty Care Guidelines: Direct Threat Care. http://c-tecc.org/tactical-emergency-casualty-care-guidelines (Accessed on October 22, 2013).
Beekley AC, Sebesta JA, Blackbourne LH, et al. Prehospital tourniquet use in Operation Iraqi Freedom: effect on hemorrhage control and outcomes. J Trauma 2008; 64:S28.
Kragh JF Jr, Walters TJ, Baer DG, et al. Survival with emergency tourniquet use to stop bleeding in major limb trauma. Ann Surg 2009; 249:1.
Walters TJ, Wenke JC, Kauvar DS, et al. Effectiveness of self-applied tourniquets in human volunteers. Prehosp Emerg Care 2005; 9:416.
US Department of Health and Human Services Centers for Disease Control and Prevention. Tetanus. www.cdc.gov/vaccines/pubs/pinkbook/downloads/tetanus.pdf (Accessed on May 06, 2011).
Swan KG Jr, Wright DS, Barbagiovanni SS, et al. Tourniquets revisited. J Trauma 2009; 66:672.
Arrillaga A, Bynoe R, Frykberg ER, Nagy K. EAST Practice Management Guidelines for Penetrating Trauma to the Lower Extremity (2002). http://www.east.org/content/documents/lower_extremity_isolated_arterial_injuries_from_penetrating_trauma.pdf (Accessed on October 22, 2013).
Fox N, Rajani RR, Bokhari F, et al. Evaluation and management of penetrating lower extremity arterial trauma: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 2012; 73:S315.
Committee for Tactical Emergency Medical Care. Tactical Emergency Casualty Care Guidelines: Direct Threat Care. http://c-tecc.org/tactical-emergency-casualty-care-guidelines (Accessed on October 22, 2013).
Beekley AC, Sebesta JA, Blackbourne LH, et al. Prehospital tourniquet use in Operation Iraqi Freedom: effect on hemorrhage control and outcomes. J Trauma 2008; 64:S28.
Kragh JF Jr, Walters TJ, Baer DG, et al. Survival with emergency tourniquet use to stop bleeding in major limb trauma. Ann Surg 2009; 249:1.
Walters TJ, Wenke JC, Kauvar DS, et al. Effectiveness of self-applied tourniquets in human volunteers. Prehosp Emerg Care 2005; 9:416.
US Department of Health and Human Services Centers for Disease Control and Prevention. Tetanus. www.cdc.gov/vaccines/pubs/pinkbook/downloads/tetanus.pdf (Accessed on May 06, 2011).
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