⚠️Can you spot the critical errors in this tourniquet application?
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- Опубліковано 28 жов 2022
- ⚠️for educational purposes, fake wound and blood. Can you spot the critical error in this TQ application? To be honest, I missed it too because I was filming with one hand and pressing the syringe with the other. I only caught it when I reviewed the video before posting about teaching our youth. So shame on me for missing this as an instructor. The learning point here is that we get so focused on stopping the bleeding with the TQ and forget about the last final details of correct TQ application. Can you spot the mistake? Let’s save lives together and I will personally learn from this💪 #traumapak #bethedifference #tourniquet #savelives
Thank you to all of you for being vulnerable and commenting on what you see as the mistake. All your comments are truly appreciated A So there is a difference between the following: Critical…important...
recommended…preference...and situation dependent. There are always a few variations on how to treat the same injury or respond to the same incident but there are also times where things are black and white and there is a standard of care. Those would be what I consider "Critical" (as in if they are not done, someone will die or get seriously hurt). With that, the critical error in this video is that the strap was accidentally routed the wrong direction and any second the Velcro would give causing rapid and immediate failure of the tourniquet.
The other things mentioned in the comments fall under all the other categories like Important(gloves, too many turns on the rod or even trying a pressure bandage first depending on other circumstances like other patients or multiple injuries to this patient). As far as the gloves they don't fall under critical error in my opinion because failure to apply them has no impact on the success or failure of the tourniquet. However if you're taking an EMT test you would fail if you didn't wear them. Under the recommended category and again not critical would be the example of where to apply a tourniquet. It's recommended 2-3" above the wound and not on a joint or high and tight when under a threat. In this case the joint is 2-3" above the wound and everyone perceives a threat differently depending on their training and experience.
When I was in the military I was taught this and they taught after 2 hours tourn needs to be loosened slightly. Is that still taught or has it been revised?
T Time and Date on the white strap lets medical personnel know when the tourniquet was applied (not used in a simulated situation).
@@ChristopherBellew I remember hearing somewhere in either my Stop The Bleed training or Red Cross First Aid certification, you can reassess the wound after a couple of hours if help hasn't arrived. _However_, wherever it was I heard that, they also said that you really shouldn't consider this, as the likelihood that the wound clotted on it's own is incredibly low (basically non-existant) if it was a true arterial bleed. The chances for permanent damage from tourniquet placement are low within the window of time that emergency response can generally get to you. Unless you're in the backwoods, you should leave a tourniquet in place until trained professionals can take over care.
Also worth noting: GET YOUR TRAINING. Many locales have good Samaritan laws, and part of that legal defense requires that you have undergone training and not performed care above your level of training. Stop The Bleed programs exist all across the nation and are FREE. CAT tourniquets cost $25-30.
@@TRowland223I got my training before the war on terror. I was taught basically not to use one except as a last resort. Crazy how wrong that was.
I carry one in my backpack, have put it on myself once to see how painful it is and hot damn they weren't kidding. Hurts like a bitch. Although if you need one you're probably immune to pain while applying. Gonna hurt like hell later but you'll be alive and almost always keep your limb.
Place the initial tourniquet as high as possible. Place secondaries lower and progressively closer to the injury (3 inches, not on a joint). NEVER.. EVER.. rely on a tourniquet only 3 inches above the injury!! You will kill someone. Jesus.
Before anyone gets snarky - direct experience in war and conflict on most continents. It's like when people try to tell you a bullet wound packed with a tampon is ineffective. Yeah, if it's arterial, of course; only use with a plastic applicator (on non-arterial).
Edit: the lower tourniquet(s) are so you can slowly release the one above it to save the limb. If bleeding resumes, tighten the higher one back up and leave it as is. This is mainly outside of the scope of most medics, however, if it will be hours, or longer, until the wounded individual is retrieved, this practice saves limbs, and lives.
he is putting it on a limb, gone from the body
you win 😂
Lol😂
😂😂
You’re crazy
@@jdog4usmc1😂😂😂😂😂
back in my day the comments had the answers 💀💀
It’s been posted a few times and the answer is pinned to the top 👍
I refuse to accept anyone old enough to say "back in my day", is too old for skull emojis.
Please present identification to your nearest post office. Thank you for your cooperation, kind regards the government I guess.
@@RJay_Mac what
@@astrovical sigh okay fine... me think u not old, think you maybe be younger than old.
Me also think u take ID to post office. Me no understand why me say this, but me commited now. Thank :)
@@RJay_Mac how old do u think i am
You also need to write the time it was applied on to the little white tag that says time because a tourniquet should only be applied for up to two hours because of necrosis.
That’s turned out to act not be true. That is no longer the advice given. You can have a tourniquet on for a really long time before you have problems. Even if it’s on for days, it’s better to lose the limb than take of the tourniquet and bleed to death.
If you are within range of a hospital then it's pointless. It would never take multiple hours to get it treated otherwise you'll be dead anyway
For starters he forgot to put on gloves. Then you only need to tighten as needed to stop the bleeding. This student stopped the bleeding and wound that sucker even more. Too much dude. Depending on what course this is, he might have to do more talking to the imaginary patient and start the MARCH process, ask some basic questions to assess alertness and orientation. It's also sometimes protocol to apply pressure first and if that doesn't work you then you move to the tourniquet. It's very important for students to follow the outline protocol to learn everything first. If they want to go straight to a tourniquet let them do so when they have more experience as a first responder.
There goes that arm.
U won’t have time for gloves when someone bleeding out
To creator: you need to have the answer somewhere, people have no clue what the "critical mistake" is. There is no point in this video if people won't learn from whatever this mistake is.
Sorry about that.
First off thank you to all of you for being vulnerable and commenting on what you see as the mistake. All your comments are truly appreciated A So there is a difference between the following: Critical…important...
recommended…preference...and situation dependent. There are always a few variations on how to treat the same injury or respond to the same incident but there are also times where things are black and white and there is a standard of care. Those would be what I consider "Critical" (as in if they are not done, someone will die or get seriously hurt). With that, the critical error in this video is that the strap was accidentally routed the wrong direction and any second the Velcro would give causing rapid and immediate failure of the tourniquet A.
The other things mentioned in the comments fall under all the other categories like Important(gloves, too many turns on the rod or even trying a pressure bandage first depending on other circumstances like other patients or multiple injuries to this patient). As far as the gloves they don't fall under critical error in my opinion because failure to apply them has no impact on the success or failure of the tourniquet. However if you're taking an EMT test you would fail if you didn't wear them. Under the recommended category and again not critical would be the example of where to apply a tourniquet. It's recommended 2-3" above the wound and not on a joint or high and tight when under a threat. In this case the joint is 2-3" above the wound and everyone perceives a threat differently depending on their training and experience.
@@Traumapak thanks a lot for that answer!
@@Traumapak awesome 👍🏽thank you for that lesson and explanation. Good upload
Which tourniquet do u recommend?
There are many great ones. The one you train most with and have on you is the one you will be best with. The CAT, SAM XT and SOF tourniquet are all great and we use them all the time.
The true critical error is telling the trainee it's FINE when there are a few errors. They won't learn if you don't tell them what they're doing wrong. Time on applying your tourniquet is the biggest error.
That's because people nowadays can't handle criticism, everything has to be positive otherwise they will feel insecure and cry or have a tantrum.
This is the biggest problem in healthcare
Not in Africa sierra leone to be specific
Your supervisor will instantly shout wrong wrong. Maybe they will even add their stupid, but we handling it here.
That's because our country has been taken over by snowflakes that think they shouldn't have to work for anything.
this is the most true statement. It is disturbing how kids these days are completely neurotic and absolutely nuts and I can't take criticism. This next generation is going to be a scary one. When you and I become old men it will be terrifying to go to a hospital because everybody will have mental illness to a point where it will be too late to undo it unless all of them are eliminated. Which obviously cannot happen. We are strong men and we created easy times. But now these weak men are going to create very hard times@@mnmlst1
This would be good enough, but ideally you get the velcro strap to finish the same direction as you start. (He doubled back.) Also, better to be too tight than to continue to lose blood. But too tight can also cause nerve and tissue damage, especially as time goes on (>120 minutes). He could have stopped cranking 1/2 turn after the blood stops. If applied properly, it can always be cranked tighter later if bleed resumes. No reason to torture somebody beyond necessity.
Old former trauma nurse here. First, grab a dressing and apply pressure over the artery spurting. Then, if you must apply a tourniquet, time of application is essential for ER to know. Any tourniquet must be secured firmly whether velcro or in a barn with a belt and a stick. Yes, patients have come in with all kinds of makeshift tourniquets. Again, "how long has it been on?" was the question asked first.
1. No gloves, 2. Need to apply direct and firm pressure
Où se faire la pression ? Est ce que avant de sérrez ?
@@ImenChouabbi-rd4wlwhere you bleed
Looped the velcro the wrong way, its gunna loosen. Also talk to your who youre helping and keep them coherent. Keep them stimulated or they'll go into shock.
"Keep them stimulated or they'll go into shock" did you make that up?
I think you need to look up shock. It's caused when your body isn't getting enough oxygen so stimulating them would have the opposite effect. They should lie down, raise their legs and keep them warm. Things to increase the blood flow.
What do you think shock is? Like when they act emotionally "shocked", or maybe electrocuted. Loss of coherency is an indication shock is in process (not enough O2 delivery to the brain). Will talking to them increase O2 delivery to the brain.
I have gone into shock before after an accident with a band saw. The wound from the band saw was relatively minor but I still went into shock, I remained coherent while I was in shock but I felt physically unwell.
@@craigpater6278 being shocked and going into shock are two different things
Shouldn’t the strap be over the other side to secure it properly to prevent it from giving out?
The initial pull on the strap is what matters most, you mist have the red tip towards you when applying to maximize the firt pull, if you do not pull hard enough in the beginning you can tun the handle 20 times and will still not be affective.
No PPE, but probably most importantly, he didn't apply direct pressure.
Go ahead a apply direct pressure and see how hard it is to apply the TQ with on of your hands busy
Who tf needs ppe?
@@nuknuk1237if you need to use your hands and no one else is there, apply pressure with your knee instead.
@@okamitsu1212Yeah, that’s what we were taught.
@@thisiconisactuallygoofysfa9960 have fun with a bunch of diseases
he velcroed the strap the same way it was put on at the end, causing the tourniquet to come off/loosen if the strap were to be pulled any
So was he supposed to tuck it under the arm all the way and wrap it around?
@@landonjackson9377YES
@@landonjackson9377Yes, so it doesn’t rip open
We need this in our country for practical work honestly. This model should be in my school!!!!!
TraumaPAK / High Threat Innovations, Subscribed because your videos are always awesome!
The biggest error is trying to stop the bleeding on a severed limb.
😂
😂
i commend your level of stupidity. the limb shown here is a rubber model which we use to practice different techniques and develop skill. and also that is artificial blood flowing through a pressure regulated tube used to replicate a human artery.
It’s ok, it won’t be bleeding for long anyway
😂
People are upset at him saying it’s fine at small errors but y’all gotta realize they’re practicing for a real event and you don’t want to nit pick small errors since it’ll cause them to hesitate making sure things are perfect when someone’s bleeding out, the strap was a little loose at the beginning and that’s fine since it’s faster to just twist to tighten it to stop that bleeding as fast as possible so the patient has the best survivability instead of hesitating and loosing the strap to try to re adjust and tighten it before hand those few seconds of hesitation could mean life or death,
TLDR. Yes doing this right is important in medicine but being confident and not hesitating when I’m emergency situations is just as important
Pull as tightly as possible to minimize the amount of cinch turns you need, and going either high and tight or as proximal to the hemorrhage would be based on how close the wound is to a junctional area, so if you wanna save more of the arm, you would have to get closer to the wound, which isn't really possible here.
I was going to say that the trainee did not write (or verbalize that he/she would write) the time of TQ application on the white velcro - which would count as a fail for this skill. But having read the answer, it definitely makes more sense that the white velcro strip should've been moved to expose more of the windlass clip's male-velcro surface to allow a better securing of the loose strap.
Excellent demonstration of an easily overlooked misstep. This is why we must train continually.
I would say to lower the tourniquet, have someone hold pressure while another is tightening the tourniquet
Dang is he trying to kill the arm??? Too tight
Your supposed to start with a pressure dressing. Also you tighten it just enough to stop the bleeding. After the bleeding stopped, the person continued to tighten the torquenoquet.
Exactly they should be screaming about how tight the TQ is
Everything you said is good, however, if you have a tourniquet that should be used first to stop the bleeding. If you have no tourniquet, then you use pressure and utilize dressings to stop the bleed. Check out Stop the Bleed, they have nice kits with dressings, scissors, and a tourniquet, etc. It would be great for everyone to have one or every household etc.
You’re all missing it. He doubled back on the Velcro instead of going around the arm. That TQ is about to come completely off
The tourniquet was set up for self application. Note the buckle... it was only thread through once (allowing for an individual to quickly apply to themselves in an emergency)
If applying to others, I'd apply looping the band through both parts of the buckle creating a secure 'bite' preventing the whole thing coming off if the velcro gives way.
Clearly seen at 9 seconds in
I only tighten to the point the bleed stops. There were extra turns made. Also, document when the tourniquet was placed. It could also have been placed nearer to the elbow and not mid bicep.
No PPE, No gauze first, you need to use the gauze and if it keeps bleeding then use the tourniquet, he needs to keep the dressing or gauze on while the tourniquet is going, he locked it in but he only needs to do ot until yhe bleeding stops, he didn't write the date and time on the tourniquet and get ready for transportation. Trust me i took EMR class
No PPE, protocol least where I’m from is to turn the handle at least 2 or 3 times, and when someone is injured like this you need to speak to them keep their mind occupied. Air Force!
1. No gloves
2. Time stamp is faced inward towards body (needs to be staged outward)
3. Tourniquet is very high above wound
Those are a few errors we see in this video
Remember, after you place your tourniquet, the job isn't done; sanitize & pack that wound!
Being high above the wound is the current practice AFAIK because it is just as effective and because the tourniquet goes in the same place every time (increases application speed, muh standardz). We're not nearly as scared for the total loss of the limb because of the cut-off circulation as we once were. It's unlikely that someone would have to have it on for long enough.
Once you get to that time somehow and you're thinking the limb is a goner, I guess you could apply a second tourniquet farther down before removing the first to possibly save a little more of the arm. I personally wouldn't want to remove any tourniquet at all until I've got more advanced medical treatment available.
(First responder/First aid perspective. No clue on what the military practices)
Yeah I know nobody asked but hopefully somebody finds it interesting. If y'all have the arguments in favor of placement closer to the wound shoot em at me.
@@MaxDefense101 thanks for the response, like the in depth answer.
You can place a tourniquet just a few inches above the wound to save it, so long as you have enough flesh to compress the arteries.
The main reasons we prefer to place them closer to the wound are:
It saves as much of the limb as possible
Provides more blood flow throughout the body
Gives you leeway to add a 2nd tourniquet if necessary
US military branches and the US govt both (we understand it's the same organization, but the recommendation is across the board, from the military to the DHS) recommend placing a tourniquet only a few inches above the wound.
Again thanks for the long reply, we love the engagement!
God bless, hope this helps
🙏✝️
I got out of the army almost a year ago. We were always taught high and tight as a general rule of thumb, for just about any actual injury on the limbs.
Obviously, a combat scenario is very different from a civilian.. but either way, it's high stress. It's easier to have a standard that can immediately be applied by whoever. TQ is not going to be enough no matter what.
But doing it high and tight stops blood flow and allows time for medic/ems to reasses.. from my understanding, it's generally 8hrs before permanent damage starts happening to the limb. If it's been 8hrs before assessment after gunshot(s) wounds, you probably have bigger concerns than just losing a limb..
@@hextacy1464 better than what we've heard from "professionals"
We went to a state-sponsored medical event where instructors literally told students they could leave a TQ on a limb for over 24 hours...
Cough, hemoconcentration, cough
It is high above the would but from what I can see they did that to make sure there was 2-3 inches above the joint. As far as military applications go if it’s high and tight it’ll be above the clothes and as far up as possible. Directly on the skin means it’s a deliberate at that point, so do the 2-3 inches above the wound or joint. As long as the bleeding is controlled you can always convert to a pressure bandage or just place another tq in the correct spot and loosen the first one (only if you know what you’re doing)
😮كنت ادرس والآن رآيت هذا بارك الله فيكم
Tourniquet is ideally meant to be applied as close to the wound as possible, although it would've been close to the elbow in this case i think i may still have been possible, meaning the person or limb in this case wouldn't of been left a stub and rather lost at the elbow. (For example) The white tag with the T on it is the TIME that the Tourniquet was applied. Not for other people.
“Scene safe, BSI”
The arm is detached and tourniquet is useless?
😐
Sorry, but that is a demo
The most basic error first of all put pressure on the wound and put any clothes or gauze available inside the wound with pressure. Then apply tourniquet, period.
The student took the long way instead of the short cut. It went straight to the hand instead of the severed end 😅 did I passed the test!
I see a few errors, one that would be problematic assuming the rest are ignored until they're at the hospital is he didn't write down the time on it nor even pretended to
You need to feed the red tabbed side of the Velcro through the windlass channel to prevent it from coming undone if the patient is moving or being moved. Also without the strap in the channel the time tag has no access to the Velcro on the outside of the windlass channel
If you don't have a fancy one like this, you can use a stick or something ridged to twist whatever you can find to wrap around the injured area, always above the injury site. A good hands length above should suffice. Second, always write the time of application somewhere close to the tourniquet. Once on, do not remove unless you're the dr taking it off. In the event you can not make one, a properly applied pressure dressing can buy you the time needed in an injury of this nature. If it's a Severed appendage, only a tourniquet will work. Unless you can find something to clamp or tie off the artery. Fyi any length of fabric can be used to make one. Most of us have shoe laces, and that will work well. Rule of thumb: Once the patient starts complaining, the tourniquet is hurting more than the injury. You're on the right track of stopping the flow of blood. When applied right, it's going to hurt like hell.
Medic here: The mistake is, perhaps, where he put the tail of the belt. It’ll unvelcro the way it was placed this undoing the whole apparatus. Instead, continue to wrap the tail around the limb in the direction of pull so that Velcro self-adheres and bring it around that direction to secure. As soon as that Velcro pops loose the hemorrhage begins again.
Apply direct pressure first, if it continues to bleed add more gauze still bleeding, add another gauze, still bleeding, remove the gauze you’ve placed on add a quick clot which you can do so due to a puncture or penetration wound to stop bleeding, now if the quick clot fails which they can apply the TQ high and right never on a joint or apply 2-3in above the wound, high and tight is usually the way to go. Once that’s done and bleeding is controlled, use saline solution or antiseptic to clean it the wound to prevent infections, then cover it up with gauze and a pressure bandage.
In the first step you are going to be holding direct pressure for about 5-10min usually bleeding stop within 5 minutes or less just by direct pressure. Quick colt and TQ are only used for bleeding that can be controlled by direct pressure. If there’s a chest wound don’t just use quick clot cause that’s not going to work and cause more harm than good. If there’s a neck wound or chest injuries you are going to use a chest seal or an occlusive dressing this is not a complete fix these are temporary fixes same as a chest needle decompression. Anything trauma medicine the main purpose is to by time before the patient ends up in a body bag. If you really want to help someone out and know the signs take an EMT course or go to a trauma class. I highly recommend going through the EMT course yes it’s expensive but everything that you learned that’ll stick with you from here on and you can watch out for and notice the signs. Trauma course are good to but they only teach you how to do not teach you how, why, pros and cons, and even what’s good and bad basic on medical kits.
She didnt wash her hands 🤔 didnt even ask if i have insurance, what if im not covered? 😝
"The leading extremity of the velcro band must not be folded back. It must be wrapped and pressed down so that the hook and loops of the velcro remain enagaged and cannot come undone on its own. "
*No ppe
* No pressure directly at wound first.
And strap is to high from the wound when we have more space below to do it
honestly, didn't spot any errors... tq was high and tight, bleeding stopped, windlass secured... only the time was not written in this vid.. its not supposed to be pretty, its not supposed to be sanitary.. only thing its supposed to be is effective and thats what it was
Yup ! Blood flow stopped ! Total success !
paramedic here, idk what he meant by wrongly routed i couldn't see properly in the video,
he didnt have gloves, and in this situation you wouldn't use torniquet, instead a medical pad (its called wundauflage in german) and create a pressure point with pressure bandage and fixate it with a gauze roll (mullbinde) or trianular bandage then if it doesn't stop then use the torniquet because it cuts the bloodflow to the whole limb so there is risk of necrosis after a while
He stopped turning the windlass when the bleeding stopped instead of turning it until it couldn’t go anymore. He didn’t wrap the strap around the windlass to secure it. He didn’t write the time. He didn’t check the pulse. All I can think of.
The first thing you always do is put on PPE and then try to apply direct pressure. If direct pressure does not stop the bleeding, then you would apply a tourniquet as close to the bleeding as possible and turn it until fhe bleeding stops and not further, which this person kept turning it. It looks like there is enough room to place the tourniquet below the elbow. The reason for this is because applying a tourniquet almost always results in the limb below the tourniquet being amputated, so you must be careful about placement. If the bleeding was not stopped with the first tourniquette, then it would be appropriate to place a second tourniquet above the elbow.
Bro took a year to apply that TQ
He didn't write the time on the tourniquet. It's very important for who ever is treating them in the operating room to know when that tourniquet was applied. It's a determining factor on weather they should amputate the limb or not.
Exactly
Exactly my point too. Had to scroll a bit before i found someone who also noticed. If you dont train for it you gonna forget it in a real situation. ..... And iant that tq very high? Could be a a bit lower.
We always wrote T and time on forehead.
No pressure
No pressure on the wound
No action taken to cover the wound
This is a live demonstration of my arm when they don’t put the gauze like I ask them to and just use a bandaid 😂
He didn’t wrap the Velcro strap all the way around the limb. They double backed.
Initial tightening was too loose.
Is it bad if its too tight?
@@K1ng_ibno, the tourniquet should hurt worse than the wound
Yeah, broke a practice TQ that way. The initial ratchet of the strap must be significant. Typically you shouldn't have to turn it more than 3 if you hit the strap well.
@@michaelmoncur7678 You're absolutely correct, the tourniquet will hurt more than the wound when placed properly.
Ultimately the metric used for determining the tightness of the tourniquet though is "Has the wound stopped bleeding?" If the answer is no, you need to keep winding. If you can't wind anymore and the wound is still bleeding, place a second tourniquet where it will fit, and cinch down the strap tighter on initial placement. If you don't have a second TQ, then consider undoing the first TQ and re-tightening the strap. Seconds count though.
HHAHAHAH NOT ME THINKING THAT WAS A REAL ARM 😂😂😂😂😂
My hand if I was there:💀
I thought it was supposed to be 2 inches above wound then secured and time written down
I think so 2-3 fingers (not 3-4 as I had thought).
You can not place tourniquets on joints. That's one of it's contraindications
A few, but I am not sure if it is critical or not. I am also not sure if it is simply left out of the clip.
1. No PPE
2. No pre & post assessment of distal CMS.
3. No time written.
Exactly
Time noting, while a good idea, is not required. Long term studies indicate extended TQ application does not cause damage. PPE all day tho.
i think its the fact that the wound isnt covered, bacteria and viruses can easily enter and cause infection and other health issues
Kis kis ne padhai ke liye search kraa tha or yhaa aa gye 😂
Not wearing gloves
Nope, wearing gloves is a waste of time when someone is bleeding out..
@@mikejayfilms5697 I would loose that 5 seconds than get HPV or HIV from that shit. they didn't teach you that your OWN safety comes first?
When you move your arm when you're having a blood test
Devin booker opening his eyes was crazy, 1st time for everything.
the tourniquet is applied correctly above the wound and it is tight enough. the critical error is that the time when the tourniquet was applied was not noted. Pressure from tourniquets must be relieved periodically to prevent damage to the tissue from lack of oxygen. therefore the time when you put the tourniquet is critical. use a post-it or hell even a piece of paper and write the time. it's important
Placement looks fine. Around a single bone (high and tight) only negative was not checking for pulse before and after. :)
Fine ! We got the trauma ! Thank god i didn't applied to Med school! I m fk greatful!!
Ein tornique sollte immer eine rückfallebene und keine primärmaßnahme sein.
Eine abbindung unterbindet die komplette Durchbutung auch für den Rest der Peripherie.
Solche verletztung sollte problemlos mit einem einfachen Druckverband beherrschbar sein.
So wird eine ischämie des unbeteiligten Bereiches vermieden
When she put the blue thing on, it did stop the bleeding, but it is causing circulation. That’s the error.
J thought it was a real person at first 😭
You need to try and stop the bleeding with direct pressure first and then wrap the open wound in gauze. Also use gloves when exposed to bodily fluids, preferably before adding the tourniquet if there's blood everywhere and you have gloves available.
Wow amazing technique sir 💯👏🏽❤
Apply direct pressure with a gloved hand and when applying a tq it’s always red to the head 👌🏾
He had no gloves on but did a very good job
Lack of direct pressure (absolutely a critical, not sure why you aren’t making that a big deal), didn’t pull the Velcro all the way around the arm and doubled back, didn’t check for pulse even after application (even if bleeding seems controlled you still check for a pulse. Guys have died because of that misplaced confidence). PPE is technically a “critical” but personally I’ve cared much less about gloves than I do keeping my patient alive. The military has a bit of a different criteria of course so sorry if it seems like I’m nitpicking.
Time for putting tourniquet on is my best guess; that or not trying to plug the wound first by direct pressure
Everyone looking at his work
Meanwhile me: The boy's hads are looking good
this is a fake human hand bleeding, but i still get fainty looking at those red blood
1. no gloves -> your safety is the most important thing
2. didn't apply pressure to the wound
3. lousy tourniquet job
4. write the time on da white tag -> its for the surgeon so he knows what he's dealing with
Okay, Uhhh reading all the comments and I feel like I'm the only one who is realizing the most important thing here. APPLYING PRESSURE TO THE WOUND. You are litterly seeing someone bleeding, meaning whatever that had impaled the patient isn't blocking the bleeding. Apply pressure. Then see to the tourniquet, if the patient is conscious have them apply pressure until you can secure the tourniquet. Then remove the bandage check if the bleeding has stopped. Clean the wound and effected area and apply a clean bandage applying gentle pressure until able-bodied to seek further medical attention in an ER. Litterly letting the poor thing bleeding out all over.
I spot 4 errors. Not 1. She didn’t twist the Velcro before applying the the white loop for closure and also she didn’t do a final winch at first application causing her to have to turn the stick to many times. This can cause it to loosen when moving the patient. Also at the very beginning it looks like she might have went back the opposite direction with the Velcro instead of following through the same direction which could be fatal defeating the purpose of the tourniquet all together. Also she tried twisting with only one hand at first when she hand both hands free causing it to take longer potentially causing the trauma patient to lose to much blood and loss of motor skill or consciousness. Every second counts. Also a potential 5th error is not taking the whole CAT apart and applying in the natural crease of the high shoulder instead of dragging it across the arm it would have to depend on if there was broken bone or not. If there is no broken bone than there is no 5th error
Thankyou DOCTOR😢
It should be standard practice to train people to do this while you are screaming and crying at them to make them panicked. Anybody can do it with a soft spoken bob ross telling them about the happy little tourniquet.
They aren't wearing gloves, they didn't apply pressure to stop the wound first, the TQ was little to proximal to the wound, they didn't secure the windlass with the blue strap that last one may or may not be a error depending on where you go
As a trauma surgeon, If you decide to do a Torniquet. Right the hour down!!!
The idea was to locate the brachial artery and tie it really hard around it so as to cause occlusion of the brachial artery
apply pressure on the bleeding point to stop bleeding
and try to see where is bleeder if possible tie it
Try to put the tourniquet on as close as you can the wound to stop the bleeding with as much pressure as you can give the impact without doing more damage until the bleeding stops reassess
Dude I thought it was real arm at the start💀
He did not put it close enough to the wound because he could’ve saved some blood, but all of it passed the tourniquet fine but before the tourniquet is not fine, it will all come out the wound
You saved my arm, can i have it back now?
So I’m assuming this is a tourniquet exercise but all you should do for that sort of injury is apply pressure to the hinder the bleeding. If you put a tourniquet on for just a basic wound like that you’re adding an unnecessary chance to lose that limb
The velcro was not secure. Or was wrapped backwards.
Change the position so it’s in line. The white strap over the locking block. Time on it. The remaining material folds over the white strap.
"But would you not answer the question?"
"Nah, I'd give fully detailed advice."
Because I'm him, here's the steps:
Sterile gloves on.
Clean mask up.
Assess the bleed. This bleed appears to be arterial as the bleed is bright red and spurting rhythmically. A veinous bleed would be dark red and leak unrhythmically.
For an arterial bleed, your first objective, in my unprofessional opinion, would be to tourniquet. Arterial bleeds are next to impossible to clot with regular gauze. Secure the tourniquet on the muscle of the lower arm or the muscle of the upper arm. Your chances of successful occlusion are higher at those two points. Same with the leg. The muscle of the lower leg and the muscle of the upper leg provide much more to work with for successful occlusion. Never secure a tourniquet on a joint, you and their family will oftentimes be unhappy with the result. Write the time of application on the tourniquet and whatever you do, do not conceal the tourniquet. Whatever you do, do not loosen the tourniquet for comfortability. Restrain the patient from doing themselves, if need be. Do not remove a tourniquet for any reason after five to ten minutes time has passed or you could kill your patient with toxic blood reflowing back into the heart. Finally, bad medics tourniquet the neck. Don't be a bad medic.
Before I continue, I'd like to add that the guy's placement could have been a little lower. Any lower and he would have placed the tourniquet on a joint, which if we can all remember, is bad practice.
If you still have a pulse, and thus bleeding, your tourniquet must be reapplied quickly. If the tourniquet does not occlude blood flow after the second application, it is likely faulty. This could be for a number of reasons, like using a training tourniquet or accidentally purchasing a counterfeit. Do not take it off after the second application. Semi occlusion is better than zero occlusion, and can assist with clotting.
Now the steps for when handling a veinous bleed, or when your tourniquet fails for arterial occlusion.
Poke your fingers into the wound, check for the pulse of the damaged vein or artery. Your patient should barely feel this, however pain isn't your problem. Saving their life is your problem. Handle that first. Apply direct pressure to the vein or artery with the index finger of one hand. Clear excess blood of the wound so that when you pack the wound, you don't waste the absorption potential of your gauze. This is okay to do as you can't just bucket the blood back into your patient like in Team Fortress Two. Once it's gone, it's gone. Now with your free hand, open a packet of gauze. Make a small sized ball out of the end of the gauze with your free hand, and guide it along the hand that you're applying pressure with down to your index finger. Shove the gauze ball between your index finger and the pulsing artery or vein. Reapply pressure. Repeat process while ensuring you also fill up any other cavities within the wound, to minimise expansion of the gauze. Use as much gauze necessary to complete this step. Keep the packaging, or measurements and numbers of the gauze rolls you use. A paramedic or doctor will find this information vital later on, should your patient survive.
Once the wound is fully packed, apply multiple gauze pads or an additional roll of gauze on the surface of the wound. Apply pressure and keep watch for bleed-through. If bleed-through occurs, do not attempt to repack the wound. Apply an additional role of gauze or gauze pads and secure snuggly with a roll of gauze or elastic bandage for additional pressure. Do elevate the wound above the heart to slow any bleeding. Do attempt to get them warm to prevent shock and prevent hypothermia. Do attempt to hydrate them to replenish their blood supply. While applying as much pressure to the wound as possible, get a hold of any emergency services you can (nearly all carry medical equipment and are medically trained). If emergency services are inaccessible in your location and it is safe to move them, attempt to relocate them to emergency services or they could bleed out and die. While doing so, I repeat, keep the wound elevated above the heart and them warm and hydrated.
And if anyone was going to ask, for bleeding of the head and neck, it's direct pressure. For wounds to the groin and armpits, it's packing and then direct pressure. For non-fatal wounds to the chest or stomach, it's oftentimes direct pressure or clear seals, with direct pressure to control severe bleeding and clear seals to prevent lung collapses.
One last thing I'd like to add is that you shouldn't attempt to resuscitate your patient if they have polytrauma. Extreme examples of polytrauma include having multiple penetrating wounds to the sternum as if your patient took a gap year in England, or being in half with multiple lacerations as if they've vacationed in Mexico. Think to yourself when faced with diagnosing polytrauma: "Would I want to wake up from this?"
Alrighty I'm taking my leave here folks. If there are any medical professionals who'd love to comment here stating as much: don't. I don't trust faceless people without a following on the internet all that much to provide me with reliable information. While that sounds ironic coming from me, the key factor that facilitates my audacity to be that faceless person is indifference. I don't care. Take the information or leave it.
Bye for now!
He didn’t say “BSI , is the scene safe?” 😂
😭😭😭😂
Critical error,
1.) what happened to BSI AND Scene safety
2.)she needs to apply direct pressure first before tourniquet unless your in a combat zone
3.) when applying the tourniquet you need to wrap all the way around before turning your stick, than you place your strap over the stock
4) time when you applies the tourniquet
Put cloth onto the wound and press it.. That was a doctor told me when i accidently cut my pawn with a knife
At first I thought it was a real arm
I thought it was a real arm for a sec ☠️💀
Frr
great simulation !