Texas Dan Mosby wrote:Extremity wounds get the tourniquet if needed, are packed with kurlix, wrapped with kurlix, and finished up with an ace wrap. Thorax / ab wounds don't get packed, but can still be dressed and wrapped in conjunction with the use of an occlusive dressing.
I have a whole bunch of experience treating gunshot patients, all though it was many moons past; but there are four things you have to be very careful about when treating a gunshot wound to an extremity.
- Not all gunshot extremities require a tourniquet.
- A tourniquet will do more harm than good if it is not needed.
- Direct pressure to the wound in an extremity can be very effective in controlling bleeding where a tourniquet is not necessary.
- An ace bandage, applied too tightly, is a tourniquet.
The point of the lesson is that you may have a limb that would be harmed by a tourniquet, and if you apply the ace bandage too tightly in order to effect pressure on the wound, you'll do more harm than good because you have just created a de facto tourniquet. Even an obvious arterial bleed can often be controlled by pressure without cutting off the blood supply to the distal extremity. First, do no harm. Use tourniquets wisely.