Tourniquet
A tourniquet is a device that is used to apply pressure to a limb or extremity in order to create ischemia or stopping the flow of blood.
During Alexander the Great’s military campaigns in the fourth century BC, tourniquets were used to stanch the bleeding of wounded soldiers.
[2] In 1718, French surgeon Jean Louis Petit developed a screw device for occluding blood flow in surgical sites.
In 1785, Sir Gilbert Blane advocated that, in battle, each Royal Navy sailor should carry a tourniquet: It frequently happens that men bleed to death before assistance can be procured, or lose so much blood as not to be able to go through an operation.
If it be objected, that this, from its solemnity may be apt to intimidate common men, officers at least should make use of some precaution, especially as many of them, and those of the highest rank, are stationed on the quarter deck, which is one of the most exposed situations, and far removed from the cockpit, where the surgeon and his assistants are placed.
This was the cause of the death of my friend Captain Bayne, of the Alfred, who having had his knee so shattered with round shot that it was necessary to amputate the limb, expired under the operation, in consequence of the weakness induced by loss of blood in carrying him so far.
As the Admiral on these occasions allowed me the honour of being at his side, I carried in my pocket several tourniquets of a simple construction, in case that accidents to any person on the quarter deck should have required their use.
It has been found to be a safe alternative method for most orthopedic limb procedures, but it does not completely replace the use of contemporary tourniquet devices.
al. reported two cases of pulmonary embolism after silicon ring exsanguination tourniquet application in patients with traumatic injuries.
[4] In one case of exsanguination tourniquet induced bilateral pulmonary emboli, after rapid intervention a 65-year-old woman was discharged in good condition 7 days after surgery.
[4] In a second case with multiple pulmonary emboli, despite extensive efforts of intervention a 53-year-old man’s condition quickly deteriorated after surgery, and was declared brain dead 2 days after.
al. discuss the potential risk of DVT for various types of tourniquets and exsanguination methods, the authors recommend extreme caution and suggest avoiding the use of an exsanguination tourniquet in patients with risk factors for DVT, including patients with traumatic injury of the extremities.
Since the beginning of the 21st century, US authorities have resuscitated its use in both military and non-military situations because treatment delays have been dramatically reduced.
[32] However, such evidence (meta-analyses and reviews) often omit the analysis of key tourniquet parameters and their correlation to outcomes leading to limited, inconclusive, and conflicting results.
Surgical tourniquets prevent blood flow to a limb and enable surgeons to work in a bloodless operative field.
[39] LOP may also be measured automatically using a photoplethysmography distal sensor applied to the patient’s finger or toe of the operative limb to detect volumetric changes in blood in peripheral circulation as cuff pressure is gradually increased.
[51] The tourniquet can be used for limb procedures in the operating room, or in emergency medicine as a means to stabilize a patient until further treatment can be applied.
[55] Concerns over quality control of distributed manufactured tourniquets was partially addressed with an open source testing apparatus.
[56] Recently, pneumatic tourniquets have been successfully used for a technique called Personalized Blood Flow Restriction Training (PBFRT) to accelerate the rehabilitation of orthopedic patients, injured professional athletes, and wounded soldiers.
[57] Typically, to increase muscle size and strength, a person needs to lift loads at or above 65% of their one repetition maximum.
[57] Low-load resistance exercise combined with blood flow restriction (BFR) has been shown in literature to increase both muscle strength and size across different age groups.
[59] For load compromised populations, this reduces the pain during the exercise protocol and leads to overall improvements in physical function.
