Combat application tourniquet (CAT) Rachel Keys

Uses To stop arterial blood flow in an extremity Can be applied one-handed or two-handed Military Stop blood flow if injured in battlefield Lightweight and easy to carry Emergency medicine Good for trauma scenes Helps with patient transfer – good adherence Rachel Keys 3rd Year Medical Student QUB

Adult Trauma Life Support (ATLS) The combat application tourniquet can be used in ATLS ATLS follows the CABCDE framework The first C stands for Catastrophic Haemorrhage Stop any obvious major bleeding sites – if a limb, the combat application tourniquet can be used Rachel Keys 3rd Year Medical Student QUB

Rod locking clip and self adhering band Tourniquet Friction buckle Band Rod locking clip and self adhering band Windlass rod Rachel Keys 3rd Year Medical Student QUB

Two Handed Application – Step 1 Place tourniquet proximal to bleeding site Wrap the band around the limb Pass the band through the inside opening of the buckle Pull the band tight Inside opening Rachel Keys 3rd Year Medical Student QUB

Step 2 Place the band through the outside opening of the buckle Pull the band tight Rachel Keys 3rd Year Medical Student QUB

Step 3 Secure the band back on itself Rachel Keys 3rd Year Medical Student QUB

Step 4 Twist the rod until the bleeding stops Check the distal pulse is eliminated Rachel Keys 3rd Year Medical Student QUB

Step 5 Lock the rod in place in the clip Check bleeding and distal pulse Tighten tourniquet or add a second one if bleeding is not controlled Rachel Keys 3rd Year Medical Student QUB

Final Step Secure the rod with the strap Record time of application 13:00 Rachel Keys 3rd Year Medical Student QUB

Complications Continuous application may result in ischemia and cause; Permanent nerve injury Muscle injury, including rhabdomyolysis Skin necrosis Vascular injury Compartment syndrome Due to increased pressure within the compartment If the tourniquet is not tightened enough and impedes only venous blood, arterial blood will be allowed into the area with no return, leading to compartment syndrome Rachel Keys 3rd Year Medical Student QUB

Complications Slow release Reperfusion injury may result from tourniquet use The restoration of circulation results in inflammation and oxidative damage Slow release A policy of periodic loosening of a tourniquet in an attempt to reduce limb ischemia has often led to incremental exsanguination and death Rachel Keys 3rd Year Medical Student QUB

In the Emergency Department The combat application tourniquet is kept in the bleeding drawer Rachel Keys 3rd Year Medical Student QUB

T-POD Pelvic Stabiliser Bleeding drawer In the bleeding drawer you can also find; Haemostatic gauze T-POD Pelvic Stabiliser Percutaneous sheath introducer Traction splint Ambu Perfit ACE collar Rachel Keys 3rd Year Medical Student QUB

Any Questions?