1. Combat application tourniquet (CAT)
Rachel Keys

2. 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

3. 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

4. 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

5. 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

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

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

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

9. 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

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

11. 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

12. 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

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

14. 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

15. Any Questions?