Surgery of Modern Warfare III. (töredék) [antikvár]

section viii WOUNDS OF BLOOD VESSELSCHAPTER XXXIV TOURNIQUETS AND THEIR APPLICATION" TohehiquetA surgical instrument consisting essentially of a bandage, a pad and a screw, for stopping or checking by compression the flow of blood through an artery ; also a bandage tightened by tmsting a rigid bar put through it."Shorter Oxford Dictionary.T^HE tourniquet is a clumsy instrument which is applied as a gross ligature to a whole limb. Its use should be strictly limited to the control of arterial haemorrhage which is not stemmed by application of a firm pad and bandage combined with elevation of the limb. Its misuse is attended with many dangers, both from local pressure effects and from the devitalization of the limb which follows upon deprivation of the blood supply. This alone appears to predispose to infection of the limb.Par too great importance has been attached to this instrument. It is very seldom that its use is properly indicated. It is even more unusual to find a tourniquet properly applied ; rather it is more common to find that inadequate constriction of the limb increases the venous pressure and, therefore, the haemorrhage.The first-aid worker regards the tourniquet as his mainstay to control bleeding. He should be more adequately taught the fact tliat it is seldom that a really firm pad and bandage, with elevation of the limb, fails to control haemorrhage. The authors feel that this need for correcting the attitude of first-aid education is great. As this realization becomes more widespread, so will the use of the tourniquet diminish. They fear that, without this fundamental teaching, the mere removal of tourniquets from first-aid kits will result in an increased misuse of inadequate improvisations.INDICATIONS FOR THE USE OF A TOURNIQUET1.Primary arterial hsemorrhage, which cannot be controlled by the application of a firm pad and bandage to the wound or digital pressure over the main artery. In this case the tourniquet is the temporary substitute for urgent operative treatment, which is to be performed at the earliest possible moment.2.Reactionary and secondary hsemorrhageAfter an amputation a tourniquet should be at hand (usually tied to the bed rail) ready for immediate apphcation. In infected wounds and amputation stumps, when secondary hsemorrhage is threatened, a tourniquet should be in position on the limb, untightened, ready for instant fixation if profuse haemorrhage occurs.3.To render a field of operation bloodlessWell-known examples are for some amputations and for operations on joints.38329