This is a three part series on how to save a life at point of injury. After years on a Special Mission Unit, I have developed a simplified check list that will be explained throughout this series.
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25 y.o. healthy ASA 1 diver is diving during mini lobster season in Key West, FL. He has just completed his first dive to 25’ for 45 minutes collecting lobsters. He completes a 3 minute safety stop and upon surfacing under the wrong boat, he is hit with a running motor prop that deeply lacerates his left upper arm. Bright red arterial blood is spurting out and the diver is pulled into your boat. Water temp is 82°F. Initial presentation. Patient is actively bleeding, screaming; you arrive to the divers side to help.
Here are the 3 musts that will be presented in this series:
- Blood must go round and round
- Air must to go in and out
- You must keep your patient warm.
Blood must go round and round!
Sounds easy… However, this gets to the crux of why early intervention with a tourniquet is so imperative.
Let us review oxygen carrying capacity of red blood cells (RBCs). RBCs carry oxygen enriched blood to the tissue. As a patient begins to lose RBCs, the compensatory mechanisms of the body kick into gear. The body detects that there is a decrease of supply and stimulates the heart to pump faster (initial tachycardia). The body also detects a decrease supply of blood as it moves throughout the body (initial tachypnea). The patient is also cold and begins to shiver which ultimately increase O2 consumption and enhances the overall problem.
Therefore, early placement of a tourniquet can ensure that blood keeps moving throughout the circulation and sets up the best scenario for survival.
Remember that the body can only compensate for a period of time, you are literally racing against the clock at this point….. Do not delay and follow the guidelines for tourniquet placement. Special Operations Medical Association is a wealth of information, but here is a link specific to videos on tourniquet placement https://books.allogy.com/web/tenant/8/books/24235853-a054-4b29-8094-a37267cd458b/
Too learn more about resuscitation… check out this journal article for estimation of blood volume replacement: https://journals.sagepub.com/doi/abs/10.1177/1099800414555410
Check out part two of this series to follow this diver throughout his course of care. Coming soon.