Tourniquet pain and injury

This is one for my brass testicled Polish/UK friend Aleksander Hepner (but not directed at him).

Sometimes I hear versions of “tourniquets hurt, but it’s better to be alive than dead right?” My blood boils hearing this because it’s a cop out. I’m in medicine to save lives AND to diminish pain. If there are ways to make things hurt less, I choose those.

Tourniquet pain and injury come from five sources (and there could be more):
1. Skin pinch
2. Deep tissue compression
3. Ischemia
4. Venous engorgement
5. Psyche … because “I’m going to put this tourniquet on and it will hurt, but it will save your life” is far from soothing.

Each of these can be lessened with a direct pressure first approach. Some of you will be thinking, “this Slishman guy doesn’t know a thing about warfare”. And you’re right. If you’re a soldier getting shot at, then use what you know. However, if you are a first responder, medic, nurse, doctor, officer, teacher or any human being caring for patients in the full sense of the word CARING, then pain matters.

The attached graph shows how I think of pain and tissue damage when using tourniquets vs. widely applied direct pressure. And wide is key because of this limb occlusion pressure equation:
LOP = 67 + C/(0.06W)

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