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Safe surgery
Diathermy
Tourniquet in the OT
Asepsis
Tourniquet in the OT
Types of tourniquet..Inflatable and non inflanflatable. One uses air to compresses and the other just compresses.
Indications ⇒ it's to stop bleeding or to create an a vascular field. In trauma it is not encouraged? But pressure at the site is?
Contraindications ⇒sickle cell diseases, diabetic neuropathy, PVD, severe artheramatous plaque, reynauds diseades
Why only forearm and thigh? Because it compresses the artery between itself and the bone.. So if two bones might not compress well. So hence can't be used in forearm and leg.
Systolic blood pressure plus 100 is the max. Anesthesia will tell what's the max. In thighs it's more.. Somewhere like 350 and forearm 250.
Usually will raise arm and then out. In. Lower limb might put bandage to drain blood down. And press and drain the blood and then apply.
Cuff can be put for 2-3 hours. Must plan and try to finish surgery before this. But if surgery is longer than can release pressure for 5 to ten minutes tonreoxygenate and stuff while pressing the wound to stop bleeding. Apply pressure. And then after ten minutes again make a vascular field. There after can put only for a max 1 hour. Otherwise can cause ischaemia. So 2/3 hours ⇒ 5 to ten minutes then max one hour afterwards.
Must do local anesthetist and lignocaine max dose. Bupivocaine cannot be used since will protein bind and can cause cardiac depression and arrest. Lignocaine also can have effects but it mainly has CNS affect and depression rather than depression at the heart.
Must know max dose of lignocaine and then how to calculate max volume of lignocaine based on the max dose and concentration. Sometimes it won't be enough to fill the arm so then can dilute to get required volume about 30 mils and then inject over the forearm.
Must be careful that won't inject into vessels so must always aspirate before injecting lignocaine in.
Biers block can be used as tourniquet in anesthesia. Where they used double tourniquet. Remember that purpose of tourniquet is to create a blood less field. And not for anesthesia only. But sometimes you can do what's called awake surgeries. It's usually done in old fragile women who can't tolerate GA but increasingly done in younger women. Where they put a touniqute and then anethsise the arm below it and then put a tourniquet on this site and remove the field touniqute. Then anethsia goes though the veins back into capillaries and anethsisis. So patient can be awake. But have to be extra careful about CNS and cardiac depression.
And can keep for a minimum of half an hour. Even if surgery finishes before that must keep for half an hour until it gets metabolised etc and bound to protein and then must release tourniquet slowly by slowly monitoring for cardiac and CNS depression.
Bupivocaine cannot be used.
Complications of tourniquet.
When applying tourniquet can cause overload. Like around 15% increase in blood volume. Especially when tourniquet put on both limbs.
When releasing tourniquet risks 1. Momentary drop in BP while releasing. That's cause the blood vessels aren't reactive and is dilated and so huge volume of blood can be tolerated. So therefore pressure might suddenly drop. 2. Ischemic repercussion all the metabolites and waste products in the area can go into the systemic circulation around the body and cause problems 3. Increased co2 can enter circulation and increased cerbreal vasculature and cause problems? 4 local skin effects (and that's why they put cotton wool first over the skin before applying touniqut) 5. Release of artheramatous plaque into the distal. Limb causing ischaemia and gangrene. 6. Nerve injury (injury to radial nerve and sciatic nerve is common
MAIN IDEA IS AVASCULAR FIELD BUT CAN GIVE ANESTHESIA ALSO!!!!!!!!!!!!!!!!
Tourniquet in trauma
https://www.realfirstaid.co.uk/tourniquets
