Tourniqueting: Key points
=========================

Indications
-----------

- [Causal and circumstational; see slides.]

Urgency
-------

- Trumps everything except for own safety

Location
--------

- 5cm (palm width) proximal to wound
- Prefer distally to joint if possible

Techniques
----------

Prefabricated
~~~~~~~~~~~~~

- XXX

Russian
~~~~~~~

- Tie a granny knot
- Fasten
- [XXX no need to: Wrap rope ends around organ's cylinder]
- Tie a second granny knot with a [strong enough] stick in the knot
- Twist stick to fasten knot
- Apply remaining rope to stick's ends to dissuade it from unspooling
- Tie ends

Dutch
~~~~~

- Fold rope in two
- Pass two ends around organ's cylinder then through the U's bottom
- Pull hard
- Twist ends around each other once
- Wrap them around organ's cylinder in opposite directions
- Tie ends

Follow-up
---------

- Verify bleeding has stopped
  + If not, tighten

- Write down time of application
  + Accurate and precise to the minute

- Downgrade if:
  + was circumstational and circumstantions have changed
  + has been in place for not more than 20 minutes

- Pre-notify A&E

APPENDIX: regular bandage application
-------------------------------------

- Direct pressure onto wound

- If bleeding continues:
  + "חבישה לוחצת": use a cloth triangle to tie a granny knot on top of the bandage

- Check distal pulse
  + arm: brachial, radial
  + leg: popliteal, posterior tibial, dorsalis pedis
  + NOTE: brachial, popliteal are upstream of the distal ones; thus, e.g., ∃radial⇒∃brachial