Last posts on tourniquet2024-03-29T07:09:22+01:00All Rights Reserved blogSpirithttps://www.hautetfort.com/https://www.hautetfort.com/explore/posts/tag/tourniquet/atom.xmlMédecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlGarrot: Moins de 2h OK mais pb après 4htag:citerahiadesgenettes.hautetfort.com,2023-01-19:64234082023-01-19T19:12:00+01:002023-01-19T19:12:00+01:00 Impact of Time and Distance on Outcomes Following Tourniquet Use in...
<p style="text-align: center;"><strong><span style="font-family: arial, helvetica, sans-serif; font-size: 14pt;">Impact of Time and Distance on Outcomes Following Tourniquet Use in Civilian and Military Settings: a Scoping Review</span></strong></p><p style="text-align: center;"><span style="font-size: 10pt;"><strong><span style="font-family: arial, helvetica, sans-serif;">Joarder M et Al. </span></strong><strong><span style="font-family: arial, helvetica, sans-serif;"><a class="doi" title="Persistent link using digital object identifier" href="https://doi.org/10.1016/j.injury.2023.01.031" target="_blank" rel="noreferrer noopener" aria-label="Persistent link using digital object identifier">https://doi.org/10.1016/j.injury.2023.01.031</a></span></strong></span></p><p style="text-align: justify;"> </p><p style="text-align: justify;"> </p><div id="abstracts" class="Abstracts u-font-serif"><div id="abs0002" class="abstract author"><div id="abss0002"><p id="spara006" style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><u>Background:</u> The last two decades have seen the reintroduction of tourniquets into guidelines for the management of acute limb trauma requiring haemorrhage control. Evidence supporting tourniquet application has demonstrated low complication rates in modern military settings involving rapid evacuation timeframes. It is unclear how these findings translate to patients who have prolonged transport times from injury in rural settings. This scoping review investigates the relationship between time and distance on metabolic complications, limb salvage and mortality following tourniquet use in civilian and military settings.</span></p><p id="spara007" style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><u>Methods:</u> A systematic search strategy was conducted using PubMed, Embase, and SafetyLit databases. Study characteristics, setting, mechanism of injury, prehospital time, tourniquet time, distance, limb salvage, metabolic response, mortality, and tourniquet removal details were extracted from eligible studies. Descriptive statistics were recorded, and studies were grouped by ischemia time (< 2 hours, 2-4 hours, or > 4 hours).</span></p><p id="spara008" style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><u>Results:</u> The search identified 3103 studies, from which 86 of studies were included in this scoping review. Of 86 studies, 55 studies were primarily civilian environments and 32 were based in military settings. One study included both settings. Blast injury was the most common mechanism of injury sustained by patients in military settings (72.8% [5968/8200]) followed by penetrating injury (23.5% [1926/8200]). In contrast, in civilian settings penetrating injury was the most common mechanism (47.7% [1633/3426]) followed by blunt injury (36.4% [1246/3426]).</span></p><p id="spara009" style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Tourniquet time was reported in 66/86 studies. T<span style="background-color: #ffff99;"><strong>ourniquet time over four hours was associated with reduced limb salvage rates (57.1%) and higher mortality rates (7.1%)</strong></span> compared with a tourniquet time of less than two hours. The overall limb salvage and mortality rates were 69.6% and 6.7% respectively. Metabolic outcomes were reported in 28/86 studies with smaller sample sizes and inconsistencies in which parameters were reported.</span></p><p id="spara010" style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><u>Conclusion:</u> This scoping review presents literature describing comparatively safe tourniquet application when used for less than two hours duration. However, there is limited research describing prolonged tourniquet application or when used for protracted distances, such that the impact of tourniquet release time on metabolic outcomes and complications remains unclear. Prospective studies utilising the development of an international database to provide this dataset is required.</span></p></div></div></div><div class="Keywords u-font-serif"><div id="keys0001" class="keywords-section"></div></div>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlConversion de garrot: Le concept Tourniquet +1tag:citerahiadesgenettes.hautetfort.com,2020-08-16:62579202020-08-16T17:37:00+02:002020-08-16T17:37:00+02:00 Tourniquet Conversion. A Recommended Approach in the Prolonged Field Care...
<p style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 14pt;">Tourniquet Conversion. A Recommended Approach in the Prolonged Field Care Setting</span></p><p style="text-align: center;"><a href="https://pdfs.semanticscholar.org/57f9/913fe1531e12e06db148b2668df46465d4b2.pdf" target="_blank" rel="noopener"><span style="font-family: arial, helvetica, sans-serif; font-size: 10pt;">Brendon D. et Al. J Spec Oper Med . Fall 2015;15(3):81-5.</span></a></p><p style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">-----------------------------</span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Les auteurs de ce document proposent le concept du tourniquet +1 lors de la réévaluation d'un garrot posé en contexte tactique. Ceja consiste à oser un second garrot au dessous du premier avant de desserrer le premier garrot. Ils s'appuie sur la fréquence d'après eux de rupture de garrot lors de cette manoeuvre. Cette manoeuvre est à proscrire si le garrot est en place depuis plus de 6 heures. Elle est systématique si ce dernier est en place depuis moins de 2 heures. Entre les deux elle peut être réalisée. Leurs recommandations ne sont pas très claires. </span></p><p style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">-----------------------------</span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Life-saving interventions take precedence over diagnostic maneuvers in the Care Under Fire stage of Tactical Combat Casualty Care. The immediate threat to life with an actively hemorrhaging extremity injury is addressed with the liberal and proper use of tourniquets. The emphasis on hemorrhage control has and will continue to result in the application of tourniquets that may not be needed past the Care Under Fire stage. As soon as tactically allowable, all tourniquets must be reassessed for conversion. Reassessment of all tourniquets should occur as soon as the tactical situation permits, but no more than 2 hours after initial placement. This article describes a procedure for qualified and trained medical personnel to safely convert extremity tourniquets to local wound dressings, using a systematic process in the field setting. </span></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlFormation au Tourniquet: Il faut mieux fairetag:citerahiadesgenettes.hautetfort.com,2019-10-08:61814352019-10-08T21:05:00+02:002019-10-08T21:05:00+02:00 High Tourniquet Failure Rates Among Non-Medical Personnel Do...
<h1 style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 14pt;"><span class="highlight">High</span> <span class="highlight">Tourniquet</span> <span class="highlight">Failure</span> <span class="highlight">Rates</span> Among <span class="highlight">Non-Medical</span> <span class="highlight">Personnel</span> Do Not Improve with <span class="highlight">Tourniquet</span> Training, Including Combat Stress Inoculation: A Randomized Controlled Trial.</span></h1><div class="afflist" style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif;"><a href="https://www.ncbi.nlm.nih.gov/pubmed/31043185" target="_blank" rel="noopener"><span style="font-size: 10pt;">Tsur AM, et Al <span role="menubar">Prehosp Disaster Med.</span> 2019 Jun;34(3):282-287.</span></a><a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Binyamin%20Y%5BAuthor%5D&cauthor=true&cauthor_uid=31043185"><br /></a></span><div class="ui-helper-reset" aria-live="assertive"> </div></div><div class="abstr"><p style="text-align: justify;"> </p><div class=""><p style="text-align: justify;"><strong><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">BACKGROUND:</span></strong></p><p style="text-align: justify;"><span style="background-color: #ffff99;"><strong><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; background-color: #ffff99;">The rate of failing to apply a <span class="highlight">tourniquet</span> remains <span class="highlight">high</span>.</span></strong></span></p><p style="text-align: justify;"><strong><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">HYPOTHESIS:</span></strong></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">The study objective was to examine whether early advanced training under conditions that approximate combat conditions and provide stress inoculation improve competency, compared to the current educational program of <span class="highlight">non-medical</span> <span class="highlight">personnel</span>.</span></p><p style="text-align: justify;"><strong><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">METHODS:</span></strong></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">This was a randomized controlled trial. Male recruits of the armored corps were included in the study. During Combat Lifesaver training, recruits apply The <span class="highlight">Tourniquet</span> 12 times. This educational program was used as the control group. The combat stress inoculation (CSI) group also included 12 <span class="highlight">tourniquet</span> applications, albeit some of them in combat conditions such as low light and physical exertion. <span style="background-color: #ffff99;"><strong>Three parameters defined success, and these parameters were measured by The Simulator: (1) applied pressure ≥ 200mmHg; (2) time to stop bleeding ≤ 60 seconds; and (3) placement up to 7.5cm above the amputation</strong></span>.</span></p><p style="text-align: justify;"><strong><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">RESULTS:</span></strong></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Out of the participants, 138 were assigned to the control group and 167 were assigned to the CSI group. T<strong>he overall <span class="highlight">failure</span> rate was 80.33%</strong> (81.90% in the control group versus 79.00% in the CSI group; P value = .565; 95% confidence interval, 0.677 to 2.122). Differences in pressure, time to stop bleeding, or placement were not significant (95% confidence intervals, -17.283 to 23.404, -1.792 to 6.105, and 0.932 to 2.387, respectively). </span></p><p style="text-align: center;"><img id="media-6041872" style="margin: 0.7em 0;" title="" src="http://citerahiadesgenettes.hautetfort.com/media/00/00/1825849374.jpeg" alt="Tourniquet failure.jpeg" width="273" height="257" /></p><p style="text-align: justify;"> </p><p style="text-align: justify;"><span style="background-color: #ffff99;"><strong><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt; background-color: #ffff99;"><span class="highlight">Tourniquet</span> placement was incorrect in most of the applications (62.30%).</span></strong></span></p><p style="text-align: justify;"><strong><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">CONCLUSIONS:</span></strong></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">This study found <span class="highlight">high</span> <span class="highlight">rates</span> of <span class="highlight">failure</span> in <span class="highlight">tourniquet</span> application immediately after successful completion of <span class="highlight">tourniquet</span> training. <strong><span style="background-color: #ffff99;">These</span> <span class="highlight">rates</span> did not improve with <span class="highlight">tourniquet</span> training</strong>, including CSI. The results may indicate that better <span class="highlight">tourniquet</span> training methods should be pursued.</span></p></div></div>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlGarrot tactique: Oui, mais avec une réévaluation PRECOCEtag:citerahiadesgenettes.hautetfort.com,2019-08-06:61688072019-08-06T20:03:00+02:002019-08-06T20:03:00+02:00 Tactical tourniquet : Surgical management must be within 3 hours....
<h1 id="result_action_bar" class="results_settings one_setting" style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 14pt;">Tactical <span class="highlight">tourniquet</span>: Surgical management must be within 3 hours.</span></h1><div class="rprt_all"><div class="rprt abstract"><div class="auths" style="text-align: center;"><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6611996/pdf/main.pdf" target="_blank" rel="noopener">Caubère A et Al. <span role="menubar">Trauma Case Rep.</span> 2019 Jul 3;22:100217. doi: 10.1016/j.tcr.2019.100217. eCollection 2019 Aug.</a><h3 style="text-align: center;"> </h3><h3 style="text-align: center;">------------------------------------------</h3></div><div class="afflist"><div class="ui-helper-reset" style="text-align: justify;" aria-live="assertive"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">L'usage précoce et libéral des garrot a prouvé son bien fondé. Encore faut il que ce que l'on appelle le garrot tactique soit bien on, mis en oeuvre. En effet ce garrot sauve la vie au prix de certaines complications dès lors que sa durée dépasse 02h00 (<a href="http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.914.6478&rep=rep1&type=pdf" target="_blank" rel="noopener">1</a>). Cette stratégie libérale repose sur quelques éléments fondamentaux (une pose bien indiquée et réalisée interrompant le flux artériel ET une réévaluation précoce systématique visant à établir le besoin et la mise en oeuvre éventuelle d'alternatives. Ceci n'est pas toujours parfaitement fait. C'est ce que montre cette publication qui rappelle quelques fondamentaux. Curieusement certaines leçons du passé ont été oubliées notamment celles qui portent sur les alternatives au garrot quand les durées d'évacuations sont longues (<a href="https://apps.dtic.mil/dtic/tr/fulltext/u2/a444895.pdf" target="_blank" rel="noopener">2</a>)</span></div></div><div class="abstr"><h3 style="text-align: center;">------------------------------------------</h3><div class=""><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Despite longstanding controversy, <span class="highlight">tourniquets</span> are widely used in tactical combat casualty care, with undisputed benefits for recent conflicts in Iraq and Afghanistan. Increased time delays are a particular issue in large areas, such as the Sahel-Saharan band. <strong><span style="background-color: #ffff99;">Complications associated with <span class="highlight">tourniquet</span> use are predominantly related to acute ischemia with risk of amputation and ischaemia-reperfusion injury</span></strong>, as shown in the first clinical case. Often stated but poorly described, misuse of <span class="highlight">tourniquet</span> and subsequent failure to interrupt arterial blood flow is also a clinical scenario that should be recognized. In the case of misuse of the <span class="highlight">tourniquet</span>, more significant blood loss may be expected because of venous compression (« venous <span class="highlight">tourniquet</span> », second clinical case). <span style="background-color: #ffff99;"><strong>Early medical re-evaluation of the <span class="highlight">tourniquet</span> is an essential component in prolonged field care</strong></span>. This includes reassessment of the <span class="highlight">tourniquet</span>'s ability to achieve hemostasis, abolish the downstream pulse and the relevance of the <span class="highlight">tourniquet</span> altogether. This combat tool requires training to be successful and complications are time dependent. <span class="highlight">T<span style="background-color: #ffff99;"><strong>ourniquet </strong></span></span><span style="background-color: #ffff99;"><strong>use requires appropriate application, re-evaluation and triage of wounded personnel within 3 h towards more structured surgical management.</strong></span></span></p></div></div></div></div>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlHémorragie: Garrot, mais aussi COMPRESSIONtag:citerahiadesgenettes.hautetfort.com,2019-05-16:61513362019-05-16T09:05:00+02:002019-05-16T09:05:00+02:00 Bleeding control in combat fields with extreme transfer time Ratnayake...
<h1 style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 14pt;">Bleeding control in combat fields with extreme transfer time</span></h1><div class="auths"><a href="https://jramc.bmj.com/content/early/2019/02/04/jramc-2018-001120.extract.jpg" target="_blank" rel="noopener"><span style="font-family: arial, helvetica, sans-serif; font-size: 10pt;">Ratnayake AS et Al <span role="menubar">J R Army Med Corps.</span> 2019 Feb 6. pii: jramc-2018-001120. doi: 10.1136/jramc-2018-001120.</span></a></div><div class="auths"> </div><div class="auths" style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Cette lettre à l'éditeur émane d'une équipe srilankaise qui a l'expertise de prise en charge de plaies vasculaires avec des délais de prise en charge de près de 04heures (<a href="https://link.springer.com/article/10.1007%2Fs00068-012-0228-4" target="_blank" rel="noopener">1</a>) Ceci se rapproche des conditions dans lesquelles opèrent nos équipes. Les auteurs y rappellent tout l'intérêt lors de la révision du bien fondé de la pose d'un garrot du packing de plaies ET des compressions sélectives par des pansements adaptés dont un exemple est proposé<a href="http://ctoms.ca/Mission-Essential-Equipment/Hemorrhage-Control/AirWrap-Compression-Bandage.html" target="_blank" rel="noopener"> ici.</a></span></div><div class="auths"><p style="text-align: center;"><img id="media-5992062" style="margin: 0.7em 0;" title="" src="http://citerahiadesgenettes.hautetfort.com/media/00/00/2647528026.jpeg" alt="Balloon tamponnade.jpeg" /></p></div>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlApprendre à poser un garrot: En fait, pas si simpletag:citerahiadesgenettes.hautetfort.com,2019-05-02:61481632019-05-02T22:42:00+02:002019-05-02T22:42:00+02:00 Can they stop the bleed ? Evaluation of tourniquet application by...
<p style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 14pt;">Can they <span class="highlight">stop</span> the <span class="highlight">bleed</span>? <span class="highlight">Evaluation</span> of <span class="highlight">tourniquet</span> <span class="highlight">application</span> by <span class="highlight">individuals</span> with <span class="highlight">varying</span> <span class="highlight">levels</span> of <span class="highlight">prior</span> <span class="highlight">self-reported</span> <span class="highlight">training</span>.</span></p><p class="afflist" style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif;"><a href="https://www.google.fr/url?sa=t&rct=j&q=&esrc=s&source=web&cd=57&cad=rja&uact=8&ved=2ahUKEwjw8Nug1_3hAhVL1eAKHRNkBI84MhAWMAZ6BAgCEAE&url=https%3A%2F%2Fwww.injuryjournal.com%2Farticle%2FS0020-1383(18)30545-X%2Fpdf&usg=AOvVaw1pG2dmkKBIe3DAZ-HbiMJ-" target="_blank" rel="noopener"><span style="font-size: 10pt;"><span style="background-color: #ffffff;">McCarty et Al. </span><span style="background-color: #ffffff;"><span role="menubar">Injury.</span> 2019 Jan;50(1):10-15. doi: 10.1016/j.injury.2018.09.041.</span></span></a><a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=McCarty%20JC%5BAuthor%5D&cauthor=true&cauthor_uid=30274758"><br /></a></span></p><div class="ui-helper-reset" style="text-align: center;" aria-live="assertive">--------------------------------------------------------</div><div class="abstr"><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">1 garrot sur 3 posé correctement malgré une formation ad-hoc.<br /></span></p><p style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">--------------------------------------------------------</span></p><div class=""><h4 style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">BACKGROUND:</span></h4><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><span class="highlight">Application</span> of extremity tourniquets is a central tenet of multiple national initiatives to empower laypersons to provide hemorrhage control (HC). However, the <span style="background-color: #ffff99;"><strong>efficacy of the general population who self-report <span class="highlight">prior</span> first-aid (FA) or HC <span class="highlight">training</span> on individual's ability to control bleeding with a <span class="highlight">tourniquet</span> remains unknown</strong></span>. Therefore, the objective of this study was to assess the effectiveness of laypeople with <span class="highlight">self-reported</span> <span class="highlight">prior</span> FA or HC <span class="highlight">training</span> to control bleeding with a <span class="highlight">tourniquet</span>.</span></p><h4 style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">STUDY DESIGN:</span></h4><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Employees of a stadium were assessed via simulation in their ability to apply a Combat <span class="highlight">Application</span> <span class="highlight">Tourniquet</span>. As a subgroup analysis of a larger study, participants who <span class="highlight">self-reported</span>: 1) No <span class="highlight">prior</span> <span class="highlight">training</span>, 2) FA <span class="highlight">training</span> only or 2) FA + HC <span class="highlight">training</span> were compared. Logistic regression adjusting for age, gender, education, willingness-to-assist, and comfort level in HC was performed.</span></p><h4 style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">RESULTS:</span></h4><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">317 participants were included. <span style="background-color: #ffff99;"><strong>Compared to participants with no <span class="highlight">prior</span> <span class="highlight">training</span> (14.4%,n = 16/111), those with FA <span class="highlight">training</span> only (25.2%,n = 35/139) had a 2.12-higher odds (95%CI:1.07-4.18) of correct <span class="highlight">tourniquet</span> <span class="highlight">application</span> while those with FA + HC (35.8%,n = 24/67) had a 3.50-higher odds (95%CI:1.59-7.72) of correct <span class="highlight">application</span></strong></span>. Participants with <span class="highlight">prior</span> FA + HC were more willing-to-assist and comfortable performing HC than those without <span class="highlight">prior</span> <span class="highlight">training</span> (p < 0.05). </span></p><p style="text-align: center;"><img id="media-5986288" style="margin: 0.7em 0;" title="" src="http://citerahiadesgenettes.hautetfort.com/media/02/01/3054967469.jpeg" alt="Tourniquet.jpeg" /></p><p style="text-align: justify;"> </p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">However, reporting being very willing-to-assist [OR0.83,95%CI:0.43-1.60] or very comfortable [OR1.11,95%CI:0.55-2.25] was not associated with correct <span class="highlight">tourniquet</span> <span class="highlight">application</span>.</span></p><h4 style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">CONCLUSION:</span></h4><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><span class="highlight">Self-reported</span> <span class="highlight">prior</span> FA + HC <span class="highlight">training</span>, while associated with increased likelihood to correctly apply a <span class="highlight">tourniquet</span>, results in <span style="background-color: #ffff99;"><strong>only 1/3 of <span class="highlight">individuals</span> correctly performing the skill</strong>.</span> As work continues in empowering and <span class="highlight">training</span> laypeople to act as immediate responders, these findings highlight the importance of effective layperson education techniques.</span></p></div></div>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlBande de compression: Ne pas les vouer aux gémoniestag:citerahiadesgenettes.hautetfort.com,2019-04-26:61466482019-04-26T21:19:00+02:002019-04-26T21:19:00+02:00 Comparison of Two Tourniquets on a Mid-Thigh Model : The Israeli...
<h1 style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 14pt;"><span class="highlight">Comparison</span> of <span class="highlight">Two</span> <span class="highlight">Tourniquets</span> on a <span class="highlight">Mid-Thigh</span> <span class="highlight">Model</span>: The <span class="highlight">Israeli</span> <span class="highlight">Silicone</span> <span class="highlight">Stretch</span> and <span class="highlight">Wrap</span> <span class="highlight">Tourniquet</span> <span class="highlight">vs</span>. The <span class="highlight">Combat</span> <span class="highlight">Application</span> <span class="highlight">Tourniquet</span>.</span></h1><div class="afflist" style="text-align: center;"><a href="https://academic.oup.com/milmed/article/183/suppl_1/157/4959953" target="_blank" rel="noopener"><span style="font-size: 10pt;"><span style="font-family: arial, helvetica, sans-serif;">Glick CPTY et Al.</span><span style="font-family: arial, helvetica, sans-serif;"><span role="menubar"> Mil Med.</span> 2018 Mar 1;183(suppl_1):157-161. doi: 10.1093/milmed/usx169.</span></span></a><div class="ui-helper-reset" style="text-align: center;" aria-live="assertive"> </div><div class="ui-helper-reset" style="text-align: center;" aria-live="assertive"><span style="font-family: arial, helvetica, sans-serif;">-----------------------------------</span></div><div class="ui-helper-reset" style="text-align: justify;" aria-live="assertive"><br /><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Le succès des garrots artériels tels que le SOFT-T et le CAT ne doit pas occulter l'intérêt des bandes de compression élastiques (Bande d'Esmach, SWAT-Tourniquet, IDF Silicone Tourniquet) préconisées en médecine rurale lors d'explosion de mines antipersonnelles (<a href="https://www.researchgate.net/profile/Johan_Pillgram-Larsen/publication/235023783_Compression_Bandage_Not_Tourniquet_Experience_in_68_Patients_With_Traumatic_Amputation_after_Mine_Injuries/links/02e7e52c11c63d7685000000/Compression-Bandage-Not-Tourniquet-Experience-in-68-Patients-With-Traumatic-Amputation-after-Mine-Injuries.pdf?origin=publication_detail" target="_blank" rel="noopener">1</a>). Ce travail met en avant leur efficacité. </span></div></div><div class="abstr"><p style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">-----------------------------------</span></p><div class=""><h4 style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Introduction:</span></h4><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Experience from recent conflicts underlines the dramatic impact of effective <span class="highlight">tourniquet</span> use on <span class="highlight">combat</span> casualty mortality. <strong><span style="background-color: #ffff99;">Although the <span class="highlight">Combat</span> <span class="highlight">Application</span> <span class="highlight">Tourniquet</span> (CAT) is replacing the <span class="highlight">silicone</span> band <span class="highlight">tourniquets</span> (IST; "<span class="highlight">Israeli</span> <span class="highlight">Silicone</span> <span class="highlight">Tourniquet</span>") in the <span class="highlight">Israeli</span> Defense Forces, no direct <span class="highlight">comparison</span> was made between them</span>.</strong> The purpose of this study is to compare the performance of the <span class="highlight">two</span> <span class="highlight">tourniquets</span> on a <span class="highlight">mid-thigh</span> <span class="highlight">model</span>.</span></p><h4 style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Methods:</span></h4><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Participants were <span style="color: #000000; background-color: #ffff99;"><strong><span class="highlight">Israeli</span> military recruits</strong></span> who previously had the military first aid course. Each participant applied both the CAT and the IST. Applications were assessed by the HapMed Leg <span class="highlight">Tourniquet</span> Trainer, which measured the applied pressure and the time required to reach it.</span></p><p style="text-align: center;"><img style="float: left; margin: 0.2em 1.4em 0.7em 0;" src="https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/milmed/183/suppl_1/10.1093_milmed_usx169/3/m_usx169f02.png?Expires=1578650501&Signature=IaEAwHrShRj7-LgLEXEfPOtB~1FNEkbwFVxWLLfTuuzQZWEco-nkcAOMYBXiTZWLWNHMhG245izn3SRI3masPzOGXUiRxtbonvDE4PTEEBMKSf6C5EXi8s8v1tKLCsTWXg-DK82RALTylzvfxq0GM~3IBbWo9sRLCkL48DBTUGBH0O7rHimr3Dw2tFDQxN6rG-9IgaQMY4pOtm89UpppuX2UE4urzPfPwapi-7EBa~XIuArt29meTqTMtpZHBBK6NUjeJd6vQpIeHljgOyA4WA4ULQo-rC2Oy8KNK~4BkjuG1G9~JayMe~gg7v58lRH0MXzsx3DN8Ep5HyjnbuQjNA__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" alt="m_usx169f02.png?Expires=1578650501&Signature=IaEAwHrShRj7-LgLEXEfPOtB~1FNEkbwFVxWLLfTuuzQZWEco-nkcAOMYBXiTZWLWNHMhG245izn3SRI3masPzOGXUiRxtbonvDE4PTEEBMKSf6C5EXi8s8v1tKLCsTWXg-DK82RALTylzvfxq0GM~3IBbWo9sRLCkL48DBTUGBH0O7rHimr3Dw2tFDQxN6rG-9IgaQMY4pOtm89UpppuX2UE4urzPfPwapi-7EBa~XIuArt29meTqTMtpZHBBK6NUjeJd6vQpIeHljgOyA4WA4ULQo-rC2Oy8KNK~4BkjuG1G9~JayMe~gg7v58lRH0MXzsx3DN8Ep5HyjnbuQjNA__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" width="334" height="412" /></p><h4 style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Results:</span></h4><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><span style="background-color: #ffff99;"><strong>I</strong><strong><span style="background-color: #ffff99;">S</span>T <span class="highlight">application</span> resulted in higher rates of effective occlusion pressure</strong> </span>compared with the CAT (91% <span class="highlight">vs</span>. 73.1%, p < 0.01), and a higher mean occlusion pressure (41 mmHg, p < 0.01) was recorded using the IST. Among effective attempts, <span class="highlight">application</span> time did not differ significantly between the <span class="highlight">tourniquets</span>.</span></p><div id="usx169TB2" class="table-wrap-title" data-id="usx169TB2"><div class="caption"><p style="text-align: center;">Effect of Elapsed Time Since First Aid Course on Success Rate</p></div></div><div class="table-overflow"><table><thead align=""><tr><th> </th><th>Experience More Than 1 mo (<em>n</em> = 15) </th><th>Experience Equal to or Less Than 1 mo (<em>n</em> = 63) </th><th><em>p</em>-Value </th></tr></thead><tbody><tr><td>Succeeded with CAT, <em>n</em> (%) </td><td><span style="background-color: #ff6600;">7 (46.7) </span></td><td><span style="background-color: #ff6600;">50 (79.4) </span></td><td><strong>0.01</strong> </td></tr><tr><td>Succeeded with IST, <em>n</em> (%) </td><td><span style="background-color: #00ff00;">14 (93.3) </span></td><td><span style="background-color: #00ff00;">57 (90.5) </span></td><td>0.5</td></tr></tbody></table></div><h4 style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Conclusion:</span></h4><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><strong><span style="background-color: #ffff99;">The IST was superior to the CAT in producing effective occlusion pressure while not prolonging</span> <span class="highlight">application</span> time.</strong> These results may indicate that the IST remains a valid option for controlling <span class="highlight">mid-thigh</span> bleeding.</span></p></div></div>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.html+ d'1 Tourniquet et 1/4 convertitag:citerahiadesgenettes.hautetfort.com,2018-07-21:60677712018-07-21T23:34:41+02:002018-07-21T23:34:41+02:00 Point of injury tourniquet application during Operation Protective...
<p style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 14pt;">Point of injury tourniquet application during Operation Protective Edge-What do we learn?</span></p><div class="auths" style="text-align: center;"><a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Shlaifer%20A%5BAuthor%5D&cauthor=true&cauthor_uid=28230629">Shlaifer A et Al </a><a title="The journal of trauma and acute care surgery." href="https://www.ncbi.nlm.nih.gov/pubmed/28230629">J Trauma Acute Care Surg.</a><a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Shlaifer%20A%5BAuthor%5D&cauthor=true&cauthor_uid=28230629"> 2017 Aug;83(2):278-283<sup><br /></sup></a></div><div class="abstr"><br /><div class=""><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">BACKGROUND:</span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Hemorrhage is a leading cause of preventable death on the battlefield. Timely tourniquet application to massively bleeding extremity wounds is critical for casualty survival albeit with reported adverse effects to extremity integrity. The aim of this study was to describe the immediate- and short-term outcomes of point of injury (POI) tourniquet applications during "Operation Protective Edge" (OPE).</span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">METHODS:</span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">A case series study regarding tourniquet application at the POI during OPE was collected. The data gathered included reports by medical providers at the POI, aerial and land evacuation vehicles, and receiving hospitals. Variables collected included, the number of tourniquet applications, caregiver level, tourniquet type, limb characters, tourniquet effectiveness, in-hospital procedures, complications, and short-term limb outcome.</span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">RESULTS:</span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">During OPE, the Israeli Defense Forces Medical Corps treated 7<span style="background-color: #ffff99;"><strong>04 casualties. Of these, 90 casualties were treated with 119 tourniquets of which 79 survived</strong></span>. Penetrating trauma was the mechanism of injury in 97.8% (88 of 90) of the casualties. <span style="background-color: #ffff99;"><strong>Injuries sustained from <span class="highlight">improvised</span> <span class="highlight">explosive</span> devices and shrapnel were related to the use of more than one tourniquet per casualty and per limb (p = 0.034)</strong></span>. The success rate of the first tourniquet was reported to be 70% (84 of 119), regardless of caregiver level (p = 0.56), tourniquet type (p = 0.16), or limb characters (p = 0.48). Twenty-seven <span style="background-color: #ffff99;"><strong>(25.7%) of 105 of the tourniquets were converted to direct pressure dressings enroute to receiving hospitals two of the conversions failed and thus a new tourniquet was applied.</strong></span> Fasciotomy was performed on eight casualties (a single limb in each). Vascular injury was presumed to be the indication for fasciotomy in three of these cases, in the other five limbs (6%, 5 of 85), no vascular involvement was discovered during surgery, and the fasciotomy is suspected as tourniquet related. 7%) 6 of 85) suffered from neurological sequela that could not be explained by their primary injury. Total complication rate was 11.7% (10 of 85) (one patient had both fasciotomy and neural complication without vascular injury).</span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">CONCLUSION:</span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Tourniquet use on the battlefield is a simple method of eliminating preventable death, we believe that clinical practice guidelines should <span style="background-color: #ffff99;"><strong>promote liberal use of tourniquets by trained combatants and medical personnel with abilities to convert to direct pressure hemorrhage control when possible</strong></span> since an unjustified tourniquet application risks low rates minor morbidity, whereas a justifiable tourniquet not applied may be lethal.</span></p></div></div>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlTourniquet: Une vieille histoiretag:citerahiadesgenettes.hautetfort.com,2018-05-01:60479482018-05-01T20:18:21+02:002018-05-01T20:18:21+02:00 A brief history of the tourniquet Welling DR et Al. Vasc Surg...
<h1 style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 14pt;">A brief history of the tourniquet</span></h1><p style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 10pt;"><a href="https://www.jvascsurg.org/article/S0741-5214(11)02470-0/pdf" target="_blank" rel="noopener noreferrer">Welling DR et Al. Vasc Surg 2012;55:286-90</a></span></p><p style="text-align: center;"> </p><p style="text-align: center;"><img id="media-5808625" style="margin: 0.7em 0;" title="" src="http://citerahiadesgenettes.hautetfort.com/media/01/00/572124227.jpg" alt="Matas Cmpressor.jpg" width="375" height="135" /></p><p style="text-align: center;">Le compresseur de Matas</p><p style="text-align: center;"><a href="https://www.jvascsurg.org/article/S0741-5214(11)02470-0/pdf" target="_blank" rel="noopener noreferrer">Clic ici pour accéder à l'article</a></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlGarrot: Pas si simple sans formationtag:citerahiadesgenettes.hautetfort.com,2017-12-03:60051292017-12-03T22:23:00+01:002017-12-03T22:23:00+01:00 The Tourniquet Gap: A Pilot Study of the Intuitive Placement of Three...
<header class="article-header"><div class="ng-scope"><div class="ng-scope"><h1 style="text-align: center;"><span class="ng-binding" style="font-family: arial, helvetica, sans-serif; font-size: 14pt;">The Tourniquet Gap: A Pilot Study of the Intuitive Placement of Three Tourniquet Types by Laypersons</span></h1><p class="article-in-press ng-scope" style="text-align: center;"><a href="http://www.jem-journal.com/article/S0736-4679(17)30867-3/fulltext" target="_blank" rel="noopener noreferrer">Ross EM et Al. http://dx.doi.org/10.1016/j.jemermed.2017.09.011</a></p><p class="article-in-press ng-scope" style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">--------------------------</span></p><p class="article-in-press ng-scope" style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">La pose de garrot par l'intervenant le plus proche d'une victime blessé semble être une évidence. Pourtant ce travail met en évidence un taux relativement important d'échec. Ceci milite pour la conduite de campagne de formation avant toute mise à disposition de garrot industriel</span></p><p class="article-in-press ng-scope" style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">--------------------------</span></p><div class="articleSharebookmark"><strong><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Background</span></strong></div></div></div></header><div class="s-content ng-scope early-item"><div data-once-html="item"><section id="hl0000574" class="abstract ng-scope"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">The “Stop the Bleed” campaign in the United States advocates for <span style="background-color: #ffff99;"><strong>nonmedical personnel to be trained in basic hemorrhage control and that “bleeding control kits” be available in high-risk areas</strong></span>. However, it is not clear which tourniquets are most effective in the hands of laypersons.</span><p id="hl0000580" style="text-align: justify;"><span style="font-size: 12pt;"><strong><span style="font-family: arial, helvetica, sans-serif;">Objectives</span></strong></span></p><p id="hl0000581" style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">The objective of this pilot study was to determine which tourniquet type was the most intuitive for a layperson to apply correctly.</span></p><p id="hl0000583" style="text-align: justify;"><span style="font-size: 12pt;"><strong><span style="font-family: arial, helvetica, sans-serif;">Methods</span></strong></span></p><p id="hl0000584" style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">This project is a randomized study derived from a “Stop the Bleed” education initiative conducted between September 2016 and March 2017. Novice tourniquet users were randomized to apply one of three commercially available tourniquets (Combat Action Tourniquet [CAT; North American Rescue, LLC, Greer, SC], Ratcheting Medical Tourniquet [RMT; m2 Inc., Winooski, VT], or Stretch Wrap and Tuck Tourniquet [SWAT-T; TEMS Solutions, LLC, Salida, CO]) in a controlled setting. Individuals with formal medical certification, prior military service, or prior training with tourniquets were excluded. The primary outcome of this study was successful tourniquet placement.</span></p><p id="hl0000586" style="text-align: justify;"><span style="font-size: 12pt;"><strong><span style="font-family: arial, helvetica, sans-serif;">Results</span></strong></span></p><p id="hl0000587" style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Of 236 p<span style="background-color: #ffff99;"><strong>ossible participants, 198 met the eligibility criteria. Demographics were similar across groups. The rates of successful tourniquet application for the CAT, RMT, and SWAT-T were 16.9%, 23.4%, and 10.6%, respectively</strong></span> ( <em>p </em>= 0.149). T<span style="background-color: #ffff99;"><strong>he most common causes of application failure were: inadequate tightness (74.1%</strong></span>), improper placement technique (44.4%), and incorrect positioning (16.7%).</span></p><p id="hl0000590" style="text-align: justify;"><span style="font-size: 12pt;"><strong><span style="font-family: arial, helvetica, sans-serif;">Conclusion</span></strong></span></p><p id="hl0000591" style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Our pilot study on the intuitive nature of applying commercially available tourniquets found <span style="background-color: #ffff99;"><strong>unacceptably high rates of failure</strong></span>. Large-scale community education efforts and manufacturer improvements of tourniquet usability by the lay public must be made before the widespread dissemination of tourniquets will have a significant public health effect.</span></p></section></div></div>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlTourniquet: Bien en contexte civil AUSSItag:citerahiadesgenettes.hautetfort.com,2017-08-31:59756562017-08-31T22:05:11+02:002017-08-31T22:05:11+02:00 The trauma center is too late: Major limb trauma without a pre-hospital...
<h1 style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 14pt;">The trauma center is too late: Major limb trauma without a pre-hospital tourniquet has increased death from hemorrhagic shock</span></h1><p style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Scerbo MH et Al. Journal of Trauma and Acute Care Surgery,10.1097/TA.0000000000001666</span></p><p> </p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><strong>Background:</strong> To date, <span style="background-color: #ffff99;"><strong>no civilian studies have demonstrated that pre-hospital (PH) tourniquets improve survival</strong></span>. We hypothesized that late, trauma center (TC) tourniquet use would increase death from hemorrhagic shock compared to early (PH) placement. </span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><strong>Methods:</strong> All patients arriving to a Level-1, urban TC between 10/2008 and 01/2016 with a tourniquet placed prior to (T-PH) or after arrival to the TC (T-TC) were evaluated. Cases were assigned the following designations: indicated [absolute indication (vascular injury requiring repair/ligation, operation within 2 hours for extremity injury, or traumatic amputation), or relative indication (major musculoskeletal/soft-tissue injury requiring operation 2-8 hours after arrival, documented large blood loss)], or non-indicated. Outcomes were death from hemorrhagic shock, physiology upon arrival to the TC and massive transfusion requirements. Following univariate analysis, logistic regression was carried out to assess independent predictors of death from hemorrhagic shock. </span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><strong>Results:</strong> 306 patients received 326 tourniquets for injuries to 157 upper and 147 lower extremities. 281 (92%) had an indication for placement. 70% of patients had a blunt mechanism of injury. <span style="background-color: #ffff99;"><strong>T-TC patients arrived with a lower systolic blood pressure [101 (86, 123) versus 125 (100, 145)mmHg, p<0.001], received more transfusions in the first hour of arrival (55% versus 34%, p=0.02) and had a greater mortality from hemorrhagic shock</strong></span> (14% vs. 3.0%, p=0.01). When controlling for year of admission, mechanism of injury and shock upon arrival (SBP ≤90mmHg or HR ≥120 bpm or base deficit ≤ 4), indicated <span style="background-color: #ffff99;"><strong>T-TC had a 4.5-fold increased odds of death compared to T-PH</strong></span> [OR 4.5, 95% CI 1.23-16.4, p=0.02)]. </span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><strong>Conclusions:</strong> <span style="background-color: #ffff99;"><strong>Waiting until TC arrival to control hemorrhage with a tourniquet was associated with worsened blood pressure and increased transfusion within the first hour of arrival</strong></span>. In routine civilian trauma patients, delaying to T-TC was associated with 4.5-fold increased odds of mortality from hemorrhagic shock</span></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlSOFT-Tourniquet: Du nouveautag:citerahiadesgenettes.hautetfort.com,2017-07-21:59650412017-07-21T19:01:00+02:002017-07-21T19:01:00+02:00 Tactical Médical Solutions qui est le fabricant du SOFT-Tourniquet, garrot...
<p>Tactical Médical Solutions qui est le fabricant du SOFT-Tourniquet, garrot en dotation dans l'armée française, propose une nouvelle version de son garrot Wide. Sa nouvelle boucle est d'emploi bien plus aisé que la précédente et positionne ce garrot parmi les tous meilleurs(<a href="http://www.combattourniquet.com" target="_blank" rel="noopener noreferrer">CAT</a>, <a href="https://www.emd-pro.com/materiel-medical-materiel-premiers-secours/86-garrot-sof-tactical-tactical-medical-solutions-utilise-par-les-forces-francaises.html" target="_blank" rel="noopener noreferrer">SOFT-T</a>, <a href="http://pc-equipment.fr/wp-content/uploads/2015/06/Garrot-TK4-GOHH-FR.pdf" target="_blank" rel="noopener noreferrer">TK4</a>,...)</p><p> </p><p style="text-align: center;"><img style="margin: 0.7em 0;" src="https://www.tacmedsolutions.com/media/images/productimage-picture-sof-tactical-tourniquet-wide-new-buckle-1502.png" alt="productimage-picture-sof-tactical-tourniquet-wide-new-buckle-1502.png" width="306" height="175" /></p><p style="text-align: center;">Clic sur l'image pour accéder au <a href="https://www.tacmedsolutions.com/product/sof-tactical-tourniquet-wide-next-generation/" target="_blank" rel="noopener noreferrer">site</a>. Le <a href="https://www.emd-pro.com/66-materiel-medical-materiel-premiers-secours" target="_blank" rel="noopener noreferrer">distributeur en France</a>.</p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlUne ceinture pour tourniquet ? Plutôt l'inverse.tag:citerahiadesgenettes.hautetfort.com,2017-04-29:59381692017-04-29T10:23:06+02:002017-04-29T10:23:06+02:00 Belts Evaluated as Limb Tourniquets: BELT Study Comparing Trouser...
<h1 class="cit" style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 14pt;">Belts Evaluated as Limb Tourniquets: BELT Study Comparing Trouser Supporters Used as Medical Devices in a Manikin Model of Wound Bleeding.</span></h1><p class="auths" style="text-align: center;"><a href="https://www.ncbi.nlm.nih.gov/pubmed/28433364" target="_blank"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Bequette BW et Al Wilderness Environ Med. 2017 Apr 19. pii: S1080-6032(17)30060-1. </span></a></p><div class="afflist"> </div><div class="abstr"><div class=""><h4 style="text-align: center;">--------------------------------</h4><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Une idée, qui n'est pas nouvelle de même que celui de pantalon intégrant un garrot (<a href="https://www.cnet.com/news/stop-the-bleeding-with-tourniquet-pants/" target="_blank">1</a>), mais on devrait plutôt dire un tourniquet pour ceinture. Ce travail est par ailleurs intéressant car il aborde la problématique des garrots insuffisamment serrés.</span></p><h4 style="text-align: center;">--------------------------------</h4><p style="text-align: justify;"><strong><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">OBJECTIVE:</span></strong></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">The purpose of the present study is to compare several models of commercially designed belts as used as a tourniquet.</span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><strong>METHODS</strong>:</span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">In the Belts Evaluated as Limb Tourniquets (BELT) study, an experiment was designed to <span style="background-color: #ffff99;"><strong>test the effectiveness of pants belts as non improvised medical devices to control hemorrhage in a manikin</strong></span>. Models of belts included Tourni-belt, Tourniquet Belt, ParaBelt, and Battle Buddy. Data collected included effectiveness, time to stop bleeding, total time of application, pressure, blood loss, and composite results (score count of good results; composite outcome good if every component was good).</span></p><p style="text-align: justify;"><strong><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">RESULTS:</span></strong></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Differences in effectiveness percentages among models were not statistically significant. The difference in mean between users was statistically significant for stop time, total time, pressure, blood loss, composite score, and composite outcome. Mean time to stop bleeding differed for only 1 pair of models after the Tukey-Kramer adjustment; <span style="background-color: #ffff99;"><strong>ParaBelt was faster than Tourniquet Belt</strong></span>. Mean total time of application differed between ParaBelt-Tourniquet Belt and Tourni-belt-Tourniquet Belt; the former model in both pairs was faster. No significant difference in mean blood loss measured by model was found. For composite outcome score, no pairwise difference between models was significant. For composite outcome (good-bad), <span style="background-color: #ffff99;"><strong>ParaBelt had good results in 75% of tests; the other 3 models had significantly worse results</strong></span>.</span></p><p><strong><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">CONCLUSIONS:</span></strong></p><p><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">In a preliminary laboratory analysis of belt tourniquet models using a manikin, performance differed by model. ParaBelt performed better than other models for the composite outcome.our tourniquet ?</span></p></div></div>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlTourniquet: Les israéliens, pour +++tag:citerahiadesgenettes.hautetfort.com,2017-04-11:59320262017-04-11T22:31:00+02:002017-04-11T22:31:00+02:00 Point of injury tourniquet application during Operation Protective Edge -...
<h1 class="cit" style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 14pt;">Point of injury tourniquet application during Operation Protective Edge - what do we learn?</span></h1><div class="auths" style="text-align: center;"><a href="https://www.ncbi.nlm.nih.gov/pubmed/28230629" target="_blank"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Shlaifer A et Al. J Trauma Acute Care Surg. 2017 Feb 23.</span></a></div><div class="auths" style="text-align: center;"> </div><div class="auths" style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">------------------------------------</span></div><div class="auths" style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Un point récent sur l'emploi du garrot dans un contexte de combat mixte zone urbaine mais aussi hors de la ville. Disons immédiatement que ce travaille CONFIRME l'intérêt du garrot, qui doit pouvoir être rapidement converti. Le contexte de pose du garrot est avant tout tactique (exposition au feu, plusieurs blessés, nuit complète). L' efficacité du premier garrot est de 70%. Près d'1/4 nécessitent au moins 2 garrots et encore 1/4 sont convertis pendant la medevac. Sur 13% des blessés sont réalisés des gestes de sauvetage: décompression thoracique /Intubation ou Cricothyrotomie. Ce document exprime parfaitement l'importance de la maîtrise et partant de l'entraînement à la réalisation des gestes de la procédure du sauvetage au combat.</span></div><div class="auths" style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">------------------------------------</span></div><div class="abstr"><div class=""><h4 style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">BACKGROUND:</span></h4><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Hemorrhage is a leading cause of preventable death on the battlefield. Timely tourniquet application to massively bleeding extremity wounds is critical for casualty survival albeit with reported adverse effects to extremity integrity. The aim of this study was to describe the immediate and short term outcomes of point of injury (POI) tourniquet applications during 'Operation Protective Edge' (OPE).</span></p><h4 style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">METHODS:</span></h4><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">A case series study regarding tourniquet application at the POI during OPE was collected. The data gathered included <span style="background-color: #ffff99;"><strong>reports by medical providers at the POI, aerial and land evacuation vehicles, and receiving hospitals</strong></span>. Variables collected included, the number of tourniquet applications, caregiver level, tourniquet type, limb characters, tourniquet effectiveness, in-hospital procedures, complications and short term limb outcome.</span></p><h4 style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">RESULTS:</span></h4><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">During OPE, the Israeli Defense Forces Medical Corps (IDF-MC) treated <span style="background-color: #ffff99;"><strong>704 casualties. Out of these, 90 casualties were treated with 119 tourniquets out of which 79 survived</strong></span>. P<span style="background-color: #ffff99;"><strong>enetrating trauma was the mechanism of injury in 97.8%</strong></span> (88/90) of the casualties. Injuries sustained from Improvised explosive devices (IED) and shrapnel were related to the use of more than one tourniquet per casualty and per limb (p=0.034).<span style="background-color: #ffff99;"><strong> The success rate of the first tourniquet was reported to be 70% (84/119), regardless of caregiver leve</strong></span>l (P=0.56), tourniquet type (P=0.16) or limb characters (p=0.48). two of the conversions failed and thus a new tourniquet was applied. <span style="background-color: #ffff99;"><strong>Fasciotomy was performed on 8 casualties</strong></span> (a single limb in each). Vascular injury was presumed to be the indication for fasciotomy in three of these cases, in the other five limbs (6%, 5/85) no vascular involvement was discovered during surgery and the fasciotomy is suspected as tourniquet related. 7%) 6/85) suffered from neurological sequela that could not be explained by their primary injury. <strong><span style="background-color: #ffff99;">Total complication rate was 11.7%</span></strong> (10/85) (one patient had both fasciotomy and neural complication without vascular injury) </span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;"><strong>CONCLUSION:</strong> </span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Tourniquet use on the battlefield is a simple method of eliminating preventable death,<span style="background-color: #ffff99;"><strong> we believe that clinical practice guidelines should promote liberal use of tourniquets by trained combatants and medical personnel with abilities to convert to direct pressure hemorrhage control when possible since an unjustified tourniquet application risks low rates minor morbidity whereas a justifiable tourniquet not applied may be lethal.</strong></span></span></p></div></div>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlTourniquet: La nouveauté de SamMedicaltag:citerahiadesgenettes.hautetfort.com,2017-03-17:59222882017-03-17T00:26:00+01:002017-03-17T00:26:00+01:00 SAM Tourniquet XT Un garrot, dont l'intérêt apparaît être d'une...
<h1 style="text-align: center;"><a href="https://www.dropbox.com/sh/bosrj2kfk1gquco/AAAniiRITWZhpDJNLxNF3Nzza/_sale-sheet/samxt-m-ss-02.pdf?dl=0" target="_blank">SAM Tourniquet XT</a></h1><p><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Un garrot, dont l'intérêt apparaît être d'une part sur sa largeur et d'autre part sur sa boucle de serrage innovante. </span></p><p style="text-align: center;"><a href="https://www.youtube.com/watch?v=-Cb91ZcFcK0" target="_blank"><img style="margin: 0.7em 0;" src="https://samxt.com/images/lookbook-1.jpg" alt="lookbook-1.jpg" width="280" height="383" /></a></p><p style="text-align: center;"> Clic sur l'image pour accéder à une vidéo</p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlTourniquet: Attentiontag:citerahiadesgenettes.hautetfort.com,2017-03-14:59213032017-03-14T12:44:00+01:002017-03-14T12:44:00+01:00 Cat on a Hot Tin Roof: Mechanical Testing of Models of Tourniquets After...
<div class="cit" style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 14pt;">Cat on a Hot Tin Roof: Mechanical Testing of Models of <span class="highlight">Tourniquets</span> After Environmental Exposure.</span></div><div class="auths" style="text-align: center;"><a href="https://www.ncbi.nlm.nih.gov/pubmed/28285478" target="_blank">O'Conor DK et Al. J Spec Oper Med. 2017 Spring;17(1):27-35.</a><br /><h1><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">------------------- </span></h1><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">La pose d'un garrot est essentiel à la survie d'un blessé présentant une hémorragie sévère des membres. Encore faut-il qu'il soit de bonne qualité. Les autorités sanitaires américaines insistent sur l'importance de ne se fournir qu'auprès de distributeurs connues distribuant des garrots éprouvés plutôt que de céder aux sirènes de la copie chinoise de basse qualité. En effet même ces garrots voient leur efficacité réduite après exposition aux conditions de combat. C'est ce que met une fois de plus en évidence ce travail.</span></p><h1 style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">------------------- </span></h1></div><div class="abstr"><div class=""><h4 style="text-align: justify;"><span style="font-size: 12pt; font-family: arial, helvetica, sans-serif;">BACKGROUND:</span></h4><p style="text-align: justify;"><span style="font-size: 12pt; font-family: arial, helvetica, sans-serif;">The purpose of the present study was to mechanically assess models of emergency <span class="highlight">tourniquet</span> <span style="background-color: #ffff99;"><strong>after 18 months of environmental exposure to weather</strong></span> to better understand risk of component damage.</span></p><h4 style="text-align: justify;"><span style="font-size: 12pt; font-family: arial, helvetica, sans-serif;">MATERIALS AND METHODS:</span></h4><p style="text-align: justify;"><span style="font-size: 12pt; font-family: arial, helvetica, sans-serif;">An experiment was designed to test <span class="highlight">tourniquet</span> performance on a manikin thigh. Three <span class="highlight">tourniquet</span> models were assessed: <span style="background-color: #ffff99;"><strong>Special Operations Forces Tactical <span class="highlight">Tourniquet</span> Wide, Ratcheting Medical <span class="highlight">Tourniquet</span>, and Combat Application <span class="highlight">Tourniquet</span></strong></span>. Unexposed <span class="highlight">tourniquets</span> formed a control group stored in a laboratory; exposed <span class="highlight">tourniquets</span> were placed outdoors on a metal roof for 18 months in San Antonio, Texas. Two users, a military cadet and a scientist, made 300 assessments in total. Assessment included major damage (yes-no), effectiveness (hemorrhage control, yes-no), casualty survival (alive-dead), time to stop bleeding, pressure, and blood loss. Time, pressure, and blood loss were reported in tests with effectiveness.</span></p><h4 style="text-align: justify;"><span style="font-size: 12pt; font-family: arial, helvetica, sans-serif;">RESULTS:</span></h4><p style="text-align: justify;"><span style="font-size: 12pt; font-family: arial, helvetica, sans-serif;"><span style="background-color: #ffff99;"><strong>Exposed devices had worse results than unexposed devices</strong></span> for major damage (3% [4/150] versus 0% [0/150]; &rho; = .018), effectiveness (89% versus 99%; &rho; = .002), and <span style="background-color: #ffff99;"><strong>survival of casualties</strong></span> (89% versus 100%; &rho; &lt; .001). In tests for effectiveness, exposed devices had worse results than unexposed devices for time to stop bleeding (29 seconds versus 26 seconds; &rho; = .01) and pressure (200mmHg versus 204mmHg; &rho; = .03, respectively), but blood loss volume did not differ significantly.</span></p><h4 style="text-align: justify;"><span style="font-size: 12pt; font-family: arial, helvetica, sans-serif;">CONCLUSION:</span></h4><p style="text-align: justify;"><span style="font-size: 12pt; font-family: arial, helvetica, sans-serif;">Compared with unexposed control devices, environmentally exposed <span class="highlight">tourniquets</span> had worse results in tests of component damage, effectiveness, and casualty survival.</span></p></div></div>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlTMT tourniquet: Un nouveau venutag:citerahiadesgenettes.hautetfort.com,2017-02-16:59118892017-02-16T23:52:00+01:002017-02-16T23:52:00+01:00 Un nouveau venu qui fait aussi bien que la référence US, à savoir le CAT,...
<p>Un nouveau venu qui fait aussi bien que la référence US, à savoir le CAT, sans apporter plus (<a href="https://www.ncbi.nlm.nih.gov/pubmed/27045491" target="_blank">1</a>). Ne pas confondre ce garrot dont le distributeur est connu et dont la fabrication parfaitement tracée. Sans aucune comparaison avec nombre de copies qui ne bénéficient pas des mêmes contrôle de qualité distribués à moins de 10 Euros et qui peuvent faire illusion.</p><p style="text-align: center;"><img src="https://www.spservices.co.uk/images/products/pics/1489769572INTMT2.jpg" alt="1489769572INTMT2.jpg" /></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlTourniquets contrefaits = DANGERtag:citerahiadesgenettes.hautetfort.com,2017-02-08:59065122017-02-08T07:19:00+01:002017-02-08T07:19:00+01:00 DANGER Les événements récents ont mis en avant l'importance de...
<p style="text-align: center;"><span style="font-size: 14pt;"><strong>DANGER</strong></span></p><p style="text-align: center;"> </p><p style="text-align: justify;">Les événements récents ont mis en avant l'importance de l'application précoce de garrot. L'approvisionnement en garrot est un véritable challenge et un marché où la guerre commerciale fait maintenant rage. Si le nombre de fabricants historiques de garrot était relativement restreint (CAT, SOFT-T, TK4, RATS, MAT, SWAT), on voit fleurir nombre de copies essentiellement chinoises dont il est relativement aisé de se procurer des exemplaires, notamment sur le marché de l'AIRSOFT. Deux fabricants sont particulièrement la cible de ces contrefacteurs <a href="http://www.combattourniquet.com/" target="_blank">CAT ressources</a> et <a href="https://www.tacmedsolutions.com" target="_blank">TACMED solutions,</a> car ce sont les deux garrots validés par les US dans le cadre du TCCC. Ces deux fabricants diffusent leurs produits pour une 20aines d'euros. Le garrot en service dans l'armée française depuis une dizaine d'année est le <a href="https://www.emd-pro.com/materiel-medical-materiel-premiers-secours/86-garrot-sof-tactical-tactical-medical-solutions-utilise-par-les-forces-francaises.html" target="_blank">SOFT-T</a> de la société TACMED, garrot dont il existe une <a href="https://www.emd-pro.com/materiel-medical-materiel-premiers-secours/1229-garrot-sof-tactical-enfant.html" target="_blank">version adaptée pour l'enfant</a>. Les contrefacteurs chinois affichent des tarifs parfois 10 fois moindres. Les produits proposés par ces sociétés ne peuvent pas disposer des qualités techniques de même niveau que ceux détenus par les originaux. Un aspect important des garrots est leur résistance au vieillissement, aux intempéries, au froid, aux UV. Il a été démontré que ces caractéristiques sont très importantes en terme d'efficacité après quelques mois de port du garrot en ambiance opérationnelle vraie. Il serait étonnant que ces copies de garrot, dont les matières premières et les circuits de fabrication sont pour le moins opaques offrent les mêmes garanties de sécurité que ceux de fabricants historiques maîtrisant tous les process de fabrication de leur production.</p><p style="text-align: justify;">Par ailleurs il semblerait que les conditions des certifications CE et ISO 134 (<a href="http://militarymedicine.amsus.org/doi/pdf/10.7205/MILMED-D-12-00491" target="_blank">1</a>,<a href="http://militarymedicine.amsus.org/doi/pdf/10.7205/MILMED-D-12-00454" target="_blank">2</a>,<a href="http://militarymedicine.amsus.org/doi/pdf/10.7205/MILMED-D-11-00212" target="_blank">3</a>)85 soit sujettes à caution car en partie relevant d'une autocertification.</p><p style="text-align: justify;">Les autorités américaines ne sont saisies de ce problème et rappellent l'importance de ne s'approvisionner que chez les forunisseurs des garrots validés dans le T3C, à savoir les garrots produits apr CAT ressources et TacMed Solutions en excluant toute autre production au prétexte de tarifs à première vue (tro) alléchants. Lire le <a href="http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm221752.htm" target="_blank">rapport de la FDA</a></p><p style="text-align: justify;">Je vous propose dans le lien suivant quelques exemples concernant le garrot SOFT-T</p><p style="text-align: center;"><a id="media-5559069" href="http://citerahiadesgenettes.hautetfort.com/media/00/01/2019053361.pdf">Matériel Tourniquet Contrefaçons.pdf</a></p><p style="text-align: justify;">Certains modèles de tourniquet s'inspirent très fortement de ces produits et en particulier du SOF-T (notamment le wide) mais avec une démarche d' innovation réelle. Aussi ces tourniquets sont ils différents de simples copies et très probablement de bonne qualité. Ils ne sont pas produits en chine mais dans des pays de l'Est européen, voire en Russie (<a href="http://srvv.store/catalog/1980/63604/" target="_blank">a</a>,b). On manque néanmoins de recul d'expertise technique de ces derniers. </p><p style="text-align: justify;">Dans l'état actuel des choses, à moins de s'équiper pour de l'airsoft, la prudence est de rester à l'écart des ces garrots et de continuer à utiliser les produits distribués par les fournisseurs reconnus des fabricants historiques (<a href="https://www.emd-pro.com" target="_blank">4</a>, <a href="http://www.cirmedical.fr" target="_blank">5</a>,<a href="http://www.welkit.com" target="_blank">6</a>)</p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.html15 ans d'emploi du tourniquet: Que dire ?tag:citerahiadesgenettes.hautetfort.com,2016-11-11:58727442016-11-11T07:44:55+01:002016-11-11T07:44:55+01:00 Battlefield Tourniquets: Lessons Learned in Moving Current Care Toward...
<p style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 14pt;"> Battlefield Tourniquets: Lessons Learned in Moving Current Care Toward Best Care in an Army Medical Department at War</span></p><p style="text-align: center;"><a href="http://69citera.hautetfort.com/files/Apr-Sept%202016.35-42.pdf" target="_blank">Kragh JF Jr et Al. US <span class="highlight">Army</span> Med Dep J. 2016 Apr-Sep;(2-16):29-36.</a></p><p style="text-align: center;">------------------------------</p><p style="text-align: center;">Un point d'étape qui insiste sans surprise sur l'apport d'une pose précoce d'un garrot. Précoce mais aussi rapide: 25 secondes sont nécessaires aux plus entraînés mais c'est 20 secondes de trop. Plus on s'entraîne et plus vite ET mieux on pose ce garrot. </p><p style="text-align: center;">------------------------------</p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Bleeding prevention and control by tourniquet use by out-of-hospital caregivers is a major breakthrough in military medicine of current wars. The present review documents developments in tourniquet practices since 2001 among the US military services for aid in improving doctrine, policy, and especially care in wars to come. Tourniquets are an adjunct for resuscitation in self-care and buddy aid and today are issued to all military service persons who deploy into a combat zone. In the US Army, virtually every Soldier is trained in first aid tourniquet use; since 2009 they are instructed early and often to use them early and often. Despite substantial knowledge gains among the services in tourniquet use and resulting improvements in casualty survival, current evidence shows persistent diffi culties in achieving best care with tourniquet use for individual trauma patients. Nevertheless, contemporary tourniquet use incorporates key lessons learned over the last 14 years of war that include: (1) tourniquet use reliably stops bleeding from limb wounds and prevents mortality in prehospital settings; and (2) brief tourniquet use appears to be safe. These 2 lessons have become so evident that civilian emergency medical systems have begun using them, albeit unevenly. Collection and interpretation of data of casualties with tourniquet use have showed that such intervention has lifesaving benefit through 2 mechanisms: control of both ongoing hemorrhage and shock severity. The next generation of interventions in bleeding control involves developing the skill sets, education, and standards of tourniquet users which may improve hemorrhage control in wars to come</span></p><p> </p><p style="text-align: center;"><a href="http://citerahiadesgenettes.hautetfort.com/media/02/01/666612723.jpg" target="_blank"><img id="media-5499222" style="margin: 0.7em 0;" title="" src="http://citerahiadesgenettes.hautetfort.com/media/02/01/2197923017.jpg" alt="tourniquet" width="395" height="183" /></a></p><p style="text-align: center;"> </p><p style="text-align: center;"> </p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlTourniquet: Entretien 3/mois mieux qu'1/moistag:citerahiadesgenettes.hautetfort.com,2016-09-24:58518462016-09-24T07:23:00+02:002016-09-24T07:23:00+02:00 Does practice make perfect? Prospectively comparing effects of 2 amounts of...
<h1 style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 14pt;">Does practice make perfect? Prospectively comparing effects of 2 amounts of practice on tourniquet use performance</span></h1><div class="auths" style="text-align: center;"><a href="http://www.ncbi.nlm.nih.gov/pubmed/27614373" target="_blank"><span style="font-family: arial, helvetica, sans-serif; font-size: 10pt;">Baruch EN et al Am J Emerg Med. 2016 Aug 27. pii: S0735-6757(16)30540-X. doi: 10.1016/j.ajem.2016.08.048</span></a></div><div class="abstr"><div class=""><p style="text-align: center;">---------------------------------------------</p><p>L'entretien des compétences et en particulier des gestes apparaît fondamentale et nécessite un suivi chiffré pour garantir un niveau suffisant d'expertise pour une projection opérationnelle. Ceci est parfaitement mis en avant dans le travail de schaeur et Al. (1) qui porte sur des gestes de réanimation préhospitalière. Le document proposé à votre lecture porte sur un geste essentiel: La pose du garrot. Une pratique plus régulière limite le désapprentissage.</p><p style="text-align: center;">---------------------------------------------</p><p style="text-align: justify;">Although a lifesaving skill, currently, <strong><span style="background-color: #ffff99;">there is no consensus for the required amount of practice in tourniquet us</span>e</strong>. We compared the effect of 2 amounts of practice on performance of tourniquet use by nonmedical personnel.</p><h4 style="text-align: justify;">METHODS:</h4><p style="text-align: justify;">Israeli military recruits without previous medical training underwent their standard tactical first aid course, and their initial performance in use of the Combat Application Tourniquet (CAT; Composite Resources, Rock Hill, SC) was assessed. The educational intervention was to allocate the participants into<span style="background-color: #ffff99;"><strong> a monthly tourniquet practice program: either a single-application practice (SAP) group or a triple-application practice (TAP) group</strong></span>. Each group practiced according to its program. After 3 months, the participants' tourniquet use performance was reassessed. Assessments were conducted using the HapMed Leg Tourniquet Trainer (CHI Systems, Fort Washington, PA), a mannequin which measures time and pressure.</p><h4 style="text-align: justify;">RESULTS:</h4><p style="text-align: justify;">A total of 151 participants dropped out, leaving 87 in the TAP group and 69 in the SAP group. On initial assessment, the TAP group and the SAP group performed similarly. Both <span class="highlight">groups</span> improved their performance from the initial to the final assessment. <span style="background-color: #ffff99;"><strong>The TAP group improved more than the SAP group in mean application time (faster by 18 vs 8 seconds, respectively; P = .023) and in reducing the proportion of participants who were unable to apply any pressure to the mannequin</strong></span> (less by 18% vs 8%, respectively; P = .009).</p><h4 style="text-align: justify;">CONCLUSION:</h4><p style="text-align: justify;">T<span style="background-color: #ffff99;"><strong>hree applications per monthly practice session were superior to one</strong></span>. This is the first prospective validation of a tourniquet practice program based on objective measurements.</p></div></div>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlGarrot: Mais l'occlusion dans le temps ?tag:citerahiadesgenettes.hautetfort.com,2016-09-04:58435072016-09-04T06:39:00+02:002016-09-04T06:39:00+02:00 Different Width and Tightening System: Emergency Tourniquets on Distal...
<h1 style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 14pt;">Different Width and Tightening System: Emergency <span class="highlight">Tourniquets</span> on Distal Limb Segments</span></h1><div class="auths" style="text-align: center;"><a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=Wall%20PL%5BAuthor%5D&cauthor=true&cauthor_uid=26630093">Wall PL</a> et Al. <a title="Journal of special operations medicine : a peer reviewed journal for SOF medical professionals." href="http://www.ncbi.nlm.nih.gov/pubmed/26630093">J Spec Oper Med.</a> 2015 Winter;15(4):28-38</div><div class="auths" style="text-align: center;"> </div><div class="auths" style="text-align: center;">--------------------------------------</div><div class="auths" style="text-align: justify;">On s'interesse le plus souvent lors de la mise en place d'un tourniquet à son efficacité immédiate. Mais que se passe-t-il dans les minutes qui suivent ? Il est montré et notamment par ce travail que la pression sous le garrot diminue très rapidement. aussi le risque de resaignement est il grand et oblige à recontr^pler l'efficacité du garrot très régulièrement. C'est un des principes du garrot tactique. Ce travail suggère également que cette baisse de pression d'occlusion est moindre avec une bande de compression élastique. ceci milite pour l'adjonction d'une telle bande à peu près systématiquement soit du moins quand une réévaluation s'avère difficile à conduire dans de bonnes conditions. Ceci est connu (<a href="http://publications.amsus.org/doi/pdf/10.7205/MILMED.171.7.644" target="_blank">1</a>) mais souvent non appliqué; De telles bandes sont représentées par la <a href="http://www.swat-t.com/" target="_blank">SWAT tourniquet</a>, des bandes spécifiques, le pansement <a href="https://www.tacmedsolutions.com/product/olaes-modular-bandage/" target="_blank">OALES Modular bandage</a> et depuis peu par un produit très intéressant <a href="http://pc-equipment.fr/wp-content/uploads/2015/10/Pansement-Battlewrap-VF.pdf" target="_blank">le Battle Wrap</a></div><div class="auths" style="text-align: center;">--------------------------------------</div><div class="abstr"><div class=""><h4 style="text-align: justify;">BACKGROUND:</h4><p style="text-align: justify;"><span class="highlight">Tourniquets</span> are used on distal limb segments. We examined calf and forearm use of four thigh-effective, commercial <span class="highlight">tourniquets</span>with different widths and tightening systems: 3.8 cm windlass Combat Application <span class="highlight">Tourniquet</span>® (CAT, combattourrniquet.com) and Special Operations Forces® <span class="highlight">Tactical</span> <span class="highlight">Tourniquet</span>-Wide (SOFTTW, www.tacmedsolutions.com), 3.8 cm ratchet Ratcheting Medical <span class="highlight">Tourniquet</span> - Pediatric (RMT-P, www.ratchetingbuckles. com), and 10.4 cm elastic Stretch-Wrap-And-Tuck <span class="highlight">Tourniquet</span>® (SWATT, www.swattourniquet.com).</p><h4 style="text-align: justify;">METHODS:</h4><p style="text-align: justify;">From Doppler-indicated occlusion, windlass completion was the next securing opportunity; ratchet completion was one additional tooth advance; elastic completion was end tucked under a wrap.</p><h4 style="text-align: justify;">RESULTS:</h4><p style="text-align: justify;"><span style="background-color: #ffff99;"><strong>All applications on the 16 recipients achieved occlusion</strong></span>. Circumferences were calf 38.1±2.5 cm and forearm 25.1±3.0 cm (p<.0001, t-test, mean±SD). Pressures at Occlusion, Completion, and 120-seconds after Completion differed within each design (p<.05, one-way ANOVA; calf: CAT 382±100, 510±108, 424±92 mmHg; SOFTT-W 381±81, 457±103, 407±88 mmHg; RMT-P 295±35, 350±38, 301±30 mmHg; SWATT 212±46, 294±59, 287±57 mmHg; forearm: CAT 301±100, 352±112, 310±98 mmHg; SOFTT-W 321±70, 397±102, 346±91 mmHg; RMT-P 237±48, 284±60, 256±51 mmHg; SWATT 181±34, 308±70, 302±70 mmHg). Comparing designs, pressures at each event differed (p<.05, one-way ANOVA), and <span style="background-color: #ffff99;"><strong>the elastic design had the least pressure decrease over time</strong></span> (p<.05, one-way ANOVA). Occlusion losses differed among designs on the calf (p<.05, χ²; calf: CAT 1, SOFTT-W 5, RMT-P 1, SWATT 0; forearm: CAT 0, SOFTT-W 1, RMT-P 2, SWATT 0).</p><h4 style="text-align: justify;">CONCLUSIONS:</h4><p style="text-align: justify;">All four designs can be effective on distal limb segments, the SWATT doing so with the lowest pressures and least pressure losses over time. The pressure change from Occlusion to Completion varies by <span class="highlight">tourniquet</span> tightening system and can involve a pressure decrease with the windlass tightening systems. Pressure losses occur in as little as 120 seconds following Completion and so can loss of Occlusion. This is especially true for nonelastic strap <span class="highlight">tourniquet</span> designs.</p></div></div>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.html2 garrots: Côte à côte SVP, mais attentiontag:citerahiadesgenettes.hautetfort.com,2016-09-04:58435042016-09-04T06:16:00+02:002016-09-04T06:16:00+02:00 Pressures Under 3.8cm, 5.1cm, and Side-by-Side 3.8cm-Wide Tourniquets...
<h1 style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: 14pt;">Pressures Under 3.8cm, 5.1cm, and Side-by-Side 3.8cm-Wide <span class="highlight">Tourniquets</span></span></h1><div class="auths" style="text-align: center;"><a href="http://www.ncbi.nlm.nih.gov/pubmed/27450600" target="_blank"><span style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Wall PL et Al.J Spec Oper Med. 2016 Summer;16(2):28-35.</span></a></div><div class="abstr"><h3 style="text-align: center;">-----------------------------</h3><p>Plus un garrot est large et plus efficace il est. parmi les garrots en dotation le Garrot Delfi est le plus performant en terme d'occlusion. Néanmoins son emploi en première intention et hors un vecteur d'évacuation est difficilement envisageable. Aussi l'association de deux garrots apparaît elle très pertinente surtout si ces derniers sont posés côte à côte. Ce n'est pas pour autant une sécurité car en permettant l'obtention d'une pression d'occlusion plus basse, cette méthode expose à une occlusion insuffisante . Cette publication a par ailleurs comme intérêt de montrer que la pression d'occlusion baisse avec le temps et ce dès les premières minutes. Il est fondamental d'apprécier TRES régulièrement l'efficacité du garrot. Donc plutôt un garrot large d'emblée mais si l'on doit compléter poser le second à côté du premier. A noter que le garrot utilisé n'est pas en dotation dans l'armées US mais qu'il s'agit d'un des meilleurs garrots de dernière génération.</p><h3 style="text-align: center;">----------------------------- </h3><div class=""><h4>BACKGROUND:</h4><p>Applications of wider <span class="highlight">tourniquet</span> are expected to occlude arterial flow at lower pressures. We examined pressures under 3.8cm-wide, 5.1cm-wide, and side-by-side-3.8cm-wide nonelastic strap-based <span class="highlight">tourniquets</span>.</p><h4>METHODS:</h4><p>Ratcheting Medical <span class="highlight">Tourniquets</span> (RMT) were applied mid-thigh and mid-arm for 120 seconds with Doppler-indicated occlusion. The RMTs were a Single <span class="highlight">Tactical</span> RMT (3.8cm-wide), a Wide RMT (5.1cm-wide), and Paired <span class="highlight">Tactical</span> RMTs (7.6cm-total width). Tightening completion was measured at one-tooth advance past arterial occlusion, and paired applications involved alternating <span class="highlight">tourniquet</span> tightening.</p><h4>RESULTS:</h4><p>All 96 applications on the 16 recipients reached occlusion. <strong><span style="background-color: #ffff99;">Paired <span class="highlight">tourniquets</span> had the lowest occlusion pressures</span></strong> (ρ < .05). All pressures are given as median mmHg, minimum-maximum mmHg. Thigh application occlusion pressures were Single 256, 219-299; Wide 259, 203-287; Distal of Pair 222, 183-256; and Proximal of Pair 184, 160-236. Arm application occlusion pressures were Single 230, 189-294; Wide 212, 161-258; Distal of Pair 204, 193-254, and Proximal of Pair 168, 148-227. Pressure increases with the final tooth advance were greater for the 2 teeth/cm Wide than for the 2.5 teeth/cm Tacticals (ρ < .05). Thigh final tooth advance pressure increases were Single 40, 33-49; Wide 51, 37-65; Distal of Pair 13, 1-35; and Proximal of Pair 15, 0-30. Arm final tooth advance pressure increases were Single 49, 41-71; Wide 63, 48-77; Distal of Pair 3, 0-14; and Proximal of Pair 23, 2-35. <span style="background-color: #ffff99;"><strong>Pressure decreases occurred under all <span class="highlight">tourniquets</span> over 120 seconds</strong></span>. Thigh pressure decreases were Single 41, 32-75; Wide 43, 28-62; Distal of Pair 25, 16-37; and Proximal of Pair 22, 15-37. Arm pressure decreases were Single 28, 21-43; Wide 26, 16-36; Distal of Pair 16, 12-35; and Proximal of Pair 12, 5-24. <span style="background-color: #ffff99;"><strong>Occlusion losses before 120 seconds occurred predominantly on the thigh and with paired applications</strong> </span>(ρ < .05). Occlusion losses occurred in six Paired thigh applications, two Single thigh applications, and one Paired arm application.</p><h4>CONCLUSIONS:</h4><p><span style="background-color: #ffff99;"><strong>Side-by-side <span class="highlight">tourniquets</span> achieve occlusion at lower pressures than single <span class="highlight">tourniquets</span></strong></span>. Additionally, pressure decreases under<span class="highlight">tourniquets</span> over time; so all <span class="highlight">tourniquet</span> applications require reassessments for continued effectiveness.</p></div></div>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlTourniquet: Contrefaçons=Dangertag:citerahiadesgenettes.hautetfort.com,2015-12-22:57344022015-12-22T08:25:00+01:002015-12-22T08:25:00+01:00 Le regain d'intérêt pour la mise en place de garrot en cas d'hémorragie...
<p style="text-align: justify;">Le regain d'intérêt pour la mise en place de garrot en cas d'hémorragie massive des membres ne doit pas faire oublier deux choses: Avoir appris correctement et utiliser un matériel adhoc.</p><p style="text-align: justify;">Concernant ce dernier point apparaissent sur le marché nombre de garrots qui soit n'ont pas été validés soit sont des contrefaçons de ce dernier, soit des garrots proposés dans le cadre d'activité de type Softball.</p><p style="text-align: justify;">Plutôt que d'utiliser un garrot de piêtre qualité, il vaut probablement mieux avoir recours à un garrot artisanal <a href="http://conovers.org/ftp/Improvised-Tourniquets.pdf" target="_blank">dont l'efficacité n'est pas remise en cause sous réserve d'une technique de pose maîtrisée.</a></p><p style="text-align: justify;">On rappelle que les 3 seuls garrots validés par l'armée américaine sont le CAT, le SOFTT et le Delfi EMT. Les SEULS garrots en service dans l'armée française sont le SOFTT et le Delfi EMT. Ces garrots sont produits par des industriels au terme de travaux de recherche et de démarche d'évolution et de politique qualité aboutis, toutes démarches absentes chez les copieurs et les contrefacteurs.</p><p style="text-align: justify;">Tous les autres garrots n'ont pas suivis les mêmes process de développement, ce qui ne permet pas de garantir ni leur efficacité dans le temps, ni leur fiabilité.</p><p style="text-align: justify;">Un exemple de copie du SOFTT est ici présenté</p><p style="text-align: center;"><a href="http://french.alibaba.com/product-gs/rotating-compression-tactical-black-tourniquet-for-hemorrhage-60068195340.html" target="_blank"><img style="margin: 0.7em 0;" src="http://g01.s.alicdn.com/kf/HTB1ALAeJVXXXXXbXFXXq6xXFXXXI/rotating-compression-tactical-black-tourniquet-for-hemorrhage.jpg" alt="rotating-compression-tactical-black-tourniquet-for-hemorrhage.jpg" width="237" height="237" /></a></p><p style="text-align: left;"> </p><p style="text-align: justify;">Un point d'alerte majeur aux USA</p><p style="text-align: center;"><br /><iframe width="270" height="152" src="https://www.youtube.com/embed/y9X1zhBQPhs?feature=oembed" frameborder="0" allowfullscreen="allowfullscreen"></iframe></p><p style="text-align: left;"> </p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlTourniquet et chaleur extrême ?tag:citerahiadesgenettes.hautetfort.com,2015-07-18:56589602015-07-18T22:58:00+02:002015-07-18T22:58:00+02:00 Laboratory testing of emergency tourniquets exposed to prolonged heat...
<h1 style="font-size: 1.231em; margin: 0.375em 0px; line-height: 1.125em; font-family: arial, helvetica, clean, sans-serif; text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: medium;">Laboratory testing of emergency tourniquets exposed to prolonged heat</span></h1><p style="text-align: center;"><a href="http://www.ncbi.nlm.nih.gov/pubmed/25770796" target="_blank"><span style="font-family: arial, helvetica, sans-serif; font-size: small;">Davidson JP et Al. <span style="line-height: 15.9565258026123px;"><span style="color: #660066;">J Spec Oper Med.</span></span><span style="line-height: 15.9565258026123px;"> 2015 Spring;15(1):34-8.</span></span></a></p><p style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: small;"><span style="line-height: 15.9565258026123px;">----------------------------------------------------------</span></span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: small;"><span style="line-height: 15.9565258026123px;">Il a été démontré que la fiabilité mécanique des tourniquets pouvait être altérée si ces derniers n'étaient pas protégés (<a href="http://publications.amsus.org/doi/pdf/10.7205/MILMED-D-12-00454" target="_blank">1</a>,</span></span><span style="font-family: arial, helvetica, sans-serif; font-size: small;"><span style="line-height: 15.9565258026123px;"><a href="http://publications.amsus.org/doi/pdf/10.7205/MILMED-D-11-00212" target="_blank">2</a>,<a href="http://publications.amsus.org/doi/pdf/10.7205/MILMED-D-12-00491" target="_blank">3</a></span></span><span style="font-family: arial, helvetica, sans-serif; font-size: small;"><span style="line-height: 15.9565258026123px;">). Le travail présenté porte sur l'effet de l'exposition prolongée à de hautes températures sur l'efficacité des garrots. Apparemment il n'y aurait pas d'effet propre.</span></span></p><p style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: small; line-height: 15.9565258026123px;">----------------------------------------------------------</span> </p><p><strong><span style="font-family: arial, helvetica, sans-serif; font-size: small;">BACKGROUND:</span></strong> </p><p><span style="font-family: arial, helvetica, sans-serif; font-size: small;">Environmental exposure of tourniquets has been associated with component damage rates, but the specific type of environmental exposure, such as heat, is unknown. Emergency-tourniquet damage has been associated with malfunction and loss of hemorrhage control, which may risk loss of life during first aid. The purposes of the study are to determine the damage rate of tourniquets exposed to heat and to compare the rate to that of controls.</span> </p><p><strong><span style="font-family: arial, helvetica, sans-serif; font-size: small;">METHODS:</span></strong> </p><p><span style="font-family: arial, helvetica, sans-serif; font-size: small;">Three tourniquet models (Combat Application Tourniquet®; SOF® Tactical Tourniquet; Ratcheting Medical Tourniquet®) were tested using a manikin (HapMed Leg Tourniquet Trainer; www.chisystems.com) that simulates extremity hemorrhage. The study group of 15 tourniquets (five devices per model, three models) was exposed to heat (oven at 54.4° C [130° F] for 91 days), and 15 tourniquets similarly constituted the control group (unexposed to heat). Damage, hemorrhage control, distal pulse stoppage, time to effectiveness, pressure (mmHg), and blood loss volumes were measured.</span> </p><p><strong><span style="font-family: arial, helvetica, sans-serif; font-size: small;">RESULTS:</span></strong> </p><p><span style="font-family: arial, helvetica, sans-serif; font-size: small;">Three tourniquets in both groups had damage not associated with heat exposure (p = 1). Heat exposure was not associated with change in effectiveness rates (p = .32); this lack of association applied to both hemorrhage control and pulse stoppage. When adjusted for the effects of user and model, the comparisons of time to effectiveness and total blood loss were statistically significant (p < .0001), but the comparison of pressure was not (p = .0613).</span> </p><p><strong><span style="font-family: arial, helvetica, sans-serif; font-size: small;">CONCLUSION:</span></strong> </p><p><span style="font-family: arial, helvetica, sans-serif; font-size: small;">Heat exposure was not associated with tourniquet damage, inability to gain hemorrhage control, or inability to stop the distal pulse.</span> </p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlTourniquet: Une histoire de pression pas si simpletag:citerahiadesgenettes.hautetfort.com,2015-07-17:56585932015-07-17T22:57:00+02:002015-07-17T22:57:00+02:00 Tourniquets and Occlusion: The Pressure of Design Wall PL et...
<p style="text-align: center;"><strong><span style="font-family: arial, helvetica, sans-serif; font-size: medium;">Tourniquets and Occlusion: The Pressure of Design</span></strong></p><p style="text-align: center;"><a href="http://publications.amsus.org/doi/pdf/10.7205/MILMED-D-12-00490" target="_blank"><span style="font-size: small;"><span style="font-family: arial, helvetica, sans-serif;">Wall PL et Al. </span><span style="font-family: arial, helvetica, clean, sans-serif; line-height: 15.9565258026123px;"><span style="color: #660066;">Mil Med.</span></span><span style="font-family: arial, helvetica, clean, sans-serif; line-height: 15.9565258026123px;"> 2013 May;178(5):578-87</span></span></a></p><p style="text-align: center;">-----------------------------------------------</p><p style="text-align: justify;">Un travail très intéressant qui exprime bien que l'efficacité d'un garrot nécessite un ensemble de gestes parfaitement réalisés, notamment un serrage suffisant qui doit être vérifié après la pose. Il existe en effet avec les garrots de type tourniquet ou pneumatique une chute plus ou moins importante de la pression d'occlusion donc de perte d'occlusion, ce d'autant qu'un relâchement musculaire peut apparaître réduisant d'autant plus cette pression d'occlusion. Les garrots élastiques n'aurait pas cet inconvénient.</p><p style="text-align: center;"><span style="text-align: center;">-----------------------------------------------</span></p><p style="text-align: justify;"><strong>Abstracts: </strong>Nerve injuries result from tourniquet pressure. The objective was to determine arterial occlusion and completion pressures with the 3.8-cm-wide windlass Combat Application Tourniquet (CAT) and the 10.4-cm-wide Stretch, Wrap, and Tuck Tourniquet (SWAT-T).</p><p style="text-align: justify;"><strong>Methods</strong>: Sixteen volunteers self-applied and had tourniquets applied to their thighs and arms (CAT and SWAT-T, random order, then blood pressure cuffs).</p><p style="text-align: justify;"><strong>Results</strong>: Occlusion (Doppler signal elimination) pressures were higher than predicted ( p < 0.0001), highest with the CAT ( p < 0.0001), and often lower than completion pressures (completion median, range: CAT 360, 147–745 mm Hg; SWAT-T 290, 136–449 mm Hg; cuff 184, 108–281 mm Hg). Three CAT thigh and 9 CAT arm completion pressures were >500 mm Hg. Pressure decreases and occlusion losses occurred over 1 minute (pressure decrease: CAT 44 ± 33 mm Hg; SWAT-T 6 ± 8 mm Hg; cuff 14 ± 19 mm Hg; p < 0.0001; loss/initially occluded: CAT 17 of 61, SWAT-T 5 of 61, cuff 40 of 64, p < 0.01). CAT pressures before turn did not have a clear relationship with turns to occlusion.</p><p style="text-align: justify;"> </p><p><img id="media-5103578" style="text-align: center; margin: 0.7em auto; display: block;" title="" src="http://citerahiadesgenettes.hautetfort.com/media/02/02/2301939569.jpg" alt="LostPressure.jpg" width="437" height="224" /><strong>Conclusions:</strong> Limb circumference/ tourniquet width occlusion pressure predictions are not good substitutes for measurements. The wider SWAT-T has lower occlusion and completion pressures than the CAT. Decreases in muscle tension lead to decreases in tourniquet pressure, especially with the nonelastic CAT, which can lead to occlusion loss.</p><p style="text-align: center;"> </p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlTourniquet: Que disent les utilisateurs ?tag:citerahiadesgenettes.hautetfort.com,2014-12-07:55054992014-12-07T13:54:00+01:002014-12-07T13:54:00+01:00 Le garrot en dotation dans l'armée française est le Special Operation...
<p style="text-align: justify;">Le garrot en dotation dans l'armée française est le Special Operation Tactical Tourniquet (<a href="http://www.tacmedsolutions.com/category/hemorrhage-control/" target="_blank">SOFT-T</a>) , concurrent du Combat Application Tourniquet (<a href="http://combattourniquet.com/" target="_blank">CAT</a>). Il existe de nombreux travaux qui cherchent à comparer entre eux les divers produits proposés par l'industrie. Tel garrot semble plus efficace sur des modèles expériemetaux, un autre voit <a href="https://ronna.apan.org/AFAMS/HT/Shared%20Documents/GME/4_Resources/3_Anaesthesia/Lectures/Anaesthesia%20for%20Trauma/TCCC%20Kragh%20TQ%20LL%20Mil%20Med%202011.pdf" target="_blank">sa barre de torsion se brise</a>r, un autre est plus fragile que son concurrent lorsque les <a href="http://publications.amsus.org/doi/pdf/10.7205/MILMED-D-12-00454" target="_blank">conditions de stockage ne sont pas optimales</a>.</p><p style="text-align: center;"><img id="media-4786825" style="margin: 0.7em 0;" title="" src="http://citerahiadesgenettes.hautetfort.com/media/00/00/1155931663.jpg" alt="tourniquet" /></p><p style="text-align: justify;"><span style="font-size: 11px;">Une autre démarche consiste à demander à ceux qui les ont employé en conditions réelles. Une idée est donnée par le tableau qui suit et qui est tiré d'un questionnaire de suivi de mise en oeuvre des équipements du TCCC. Le modèle actuellement en dotation apparaît parfaitement adapté.</span></p><p style="text-align: center;"><a href="http://www.usaisr.amedd.army.mil/assets/pdfs/NMLLC_TCCC_Equip_Eval_Summary_120807.pdf" target="_blank"><img id="media-4786786" style="margin: 0.7em 0;" title="" src="http://citerahiadesgenettes.hautetfort.com/media/01/01/3339519089.jpg" alt="Tourniquet Preference User.jpg" /></a></p><p style="text-align: center;">Clic sur l'image pour accéder au suivi des équipemens du TCCC</p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlTourniquet: La largeur comptetag:citerahiadesgenettes.hautetfort.com,2014-12-07:55053062014-12-07T09:26:00+01:002014-12-07T09:26:00+01:00 Tourniquets and Occlusion: The Pressure of Design Wall PL et AL. ...
<h1 style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: medium;">Tourniquets and Occlusion: The Pressure of Design</span></h1><p style="text-align: center;"><a href="http://publications.amsus.org/doi/pdf/10.7205/MILMED-D-12-00490" target="_blank"><span style="font-family: arial, helvetica, sans-serif; font-size: small;">Wall PL et AL. </span><span style="font-family: arial, helvetica, sans-serif; font-size: small;">Military Medicine, 178, 5:578, 2013</span></a></p><p style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: small;">-------------------------------------------------------------------</span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: small;">Cet article est intéressant car il met en évidence que d'autres garrots que les tourniquets du type du CAT sont efficaces en matière d'occlusion notamment ceux basés sur l'emploi de bandes compressives comme le <a href="http://www.swattourniquet.com/" target="_blank">SWAT-T</a> et d'autre part que le niveau de pression d'occlusion observé avec un tourniquet classique peut être associé à un resaignment si l'on observe un relâchement musculaire</span></p><p style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: small;"><span style="text-align: center;">-------------------------------------------------------------------</span></span> </p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: small;">Nerve injuries result from tourniquet pressure. The objective was to determine arterial occlusion and completion pressures with the 3.8-cm-wide windlass Combat Application Tourniquet (CAT) and the 10.4-cm-wide Stretch, Wrap, and Tuck Tourniquet (SWAT-T). Methods: Sixteen volunteers self-applied and had tourniquets applied to their thighs and arms (CAT and SWAT-T, random order, then blood pressure cuffs). Results: Occlusion (Doppler signal elimination) pressures were higher than predicted ( p < 0.0001), highest with the CAT ( p < 0.0001), and often lower than completion pressures (completion median, range: CAT 360, 147–745 mm Hg; SWAT-T 290, 136–449 mm Hg; cuff 184, 108–281 mm Hg). Three CAT thigh and 9 CAT arm completion pressures were >500 mm Hg. Pressure decreases and occlusion losses occurred over 1 minute (pressure decrease: CAT 44 ± 33 mm Hg; SWAT-T 6 ± 8 mm Hg; cuff 14 ± 19 mm Hg; p < 0.0001; loss/initially occluded: CAT 17 of 61, SWAT-T 5 of 61, cuff 40 of 64, p < 0.01). CAT pressures before turn did not have a clear relationship with turns to occlusion. Conclusions: Limb circumference/ tourniquet width occlusion pressure predictions are not good substitutes for measurements. The wider SWAT-T has lower occlusion and completion pressures than the CAT. <span style="background-color: #ffff99;"><strong>Decreases in muscle tension lead to decreases in tourniquet pressure, especially with the nonelastic CAT, which can lead to occlusion loss</strong></span></span></p><p style="text-align: center;"> </p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlGarrot: A partir de quand est on fiable ?tag:citerahiadesgenettes.hautetfort.com,2014-11-01:54804692014-11-01T10:39:00+01:002014-11-01T10:39:00+01:00 Single versus Double Routing of the Band in the Combat Application...
<h1 style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: medium;">Single versus Double Routing of the Band in the Combat Application Tourniquet.</span></h1><p style="text-align: center;"><a href="http://www.asymresponse.com/uploads/7/1/5/6/7156427/cat_routing_study_-_2013.pdf" target="_blank"><span style="font-family: arial, helvetica, sans-serif; font-size: small;">J Spec Oper Med. 2013 Spring;13(1):34-41.</span></a></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: small;">Le sauvetage au combat met en avant l'importance d'arrêter toute hémorragie le plus tôt possible. Le garrot tient là une place essentielle. Mais à partir de quand l'apprentissage de cette technique peut il être considéré comme optimal. Une réponse est apporté par ce travail: La maîtrise de ce geste semble être obtenue à partir de 30 poses.</span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: small;"><strong>Background: </strong>Common first aid tourniquets, like the Combat Application Tourniquet (CAT) of a windlass and band design, can have the band routed through the buckle in three different ways, and recent evidence indicates users may be confused with complex doctrine.</span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: small;"><strong>Objective:</strong> The purpose of the present study is to measure the differential performance of the three possible routings in order to better understand good tourniquet practice. </span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: small;"><strong>Methods:</strong> A training manikin was used by two investigators to measure tourniquet effectiveness, time to stop bleeding, and blood loss. </span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: small;"><strong>Results:</strong> The effectiveness rate was 99.6% (239/240) overall. Results were similar for both single-slit routings (inside vs. outside, p > 0.05). Effectiveness rates (yes-no results for hemorrhage control expressed as a proportion of iterations) were not statistically different between single and double routing. However, the time to stop bleeding and blood loss were statistically different (p < 0.05). </span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: small;"><strong>Conclusions:</strong> CAT band routing, through the buckle either singly or doubly, affects two key performance criteria: time to stop bleeding and volume of blood lost. Single routing proved to be faster, thereby saving more blood. <span style="background-color: #ffff99;"><strong>Learning curves required to optimize user performance varied over 30-fold</strong></span> depending on which variable was selected (e.g., effectiveness vs. blood loss).</span></p><p style="margin: 0px 0px 0.5em; font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: justify;"> </p><p style="text-align: justify;"> </p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlGarrot: Pas de jeu avant de serrertag:citerahiadesgenettes.hautetfort.com,2014-10-31:54796482014-10-31T06:41:38+01:002014-10-31T06:41:38+01:00 No slackers in tourniquet use to stop bleeding Polston RW...
<h1 style="font-size: 1.231em; margin: 0.375em 0px; line-height: 1.125em; font-family: arial, helvetica, clean, sans-serif; text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: medium;">No slackers in <span class="highlight">tourniquet</span> use to stop bleeding</span></h1><p style="text-align: center;"><a href="https://www.jsomonline.org/SharedScience/2013212Polston.pdf" target="_blank"><span style="font-family: arial, helvetica, sans-serif; font-size: small;">Polston RW et Al. J Spec Oper Med. 2013 Summer;13(2):12-9.</span></a></p><p style="text-align: center;"> </p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: small;">La performance d'un garrot tient pour beaucoup à la manière dont il va être posé. Le garrot en dotation comporte un dispositif de serrage de type tourniquet. L'efficacité de ce dispositif est en grande partie liée à l'absence de jeu au niveau de la sangle du garrot avant le serrage. Il est fondamental de positionner le garrot à la racine du membre, de le mettre en tension manuellement en tirant sur la sangle de façon à effectuer un premier serrage du garrot et ensuite de renforcer ce serrage par la barre du tourniquet. On rappelle qu'en principe l'efficacité est obtenue à partir de 3 tours. (<a href="http://citerahiadesgenettes.hautetfort.com/list/procedure/2967722686.pdf" target="_blank">la fiche technique)</a>. Le travail présenté ci après est éloquent sur l'intérêt de <span style="background-color: #ffff99;"><strong>prohiber tout jeu avec de tourner la barre de torsion</strong></span>.</span></p><p style="text-align: justify;"> </p><p style="text-align: center;">----------------------------------------------------------------------------------</p><p style="text-align: justify;"><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;"><strong>Background:</strong> </span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;">Tourniquets</span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;"> on casualties in war have been loose in 4%?9% of uses, and such slack risks death from uncontrolled bleeding. A </span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;">tourniquet</span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;"> evidence gap persists if there is a mechanical slack?performance association.</span></p><p style="text-align: justify;"><strong style="font-family: arial, helvetica, clean, sans-serif; font-size: 12.7272720336914px; line-height: 17.9998016357422px;">Objective:</strong><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;"> The purpose of the present study was to determine the results of </span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;">tourniquet</span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;"> use with slack in the strap versus no slack before windlass turning, in order to develop best practices. Methods: The authors used a </span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;">tourniquet</span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;"> manikin 254 times to measure </span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;">tourniquet</span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;"> effectiveness, windlass turns, time to stop bleeding, and blood volume lost at 5 degrees of strap slack (0mm, 25mm, 50mm, 100mm, and 200mm maximum). </span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;"><strong>Results:</strong> When comparing no slack (0mm) to slack (any positive amount), <span style="background-color: #ffff99;"><strong>there were increases with slack in windlass turns (p < .0001, 3-fold), time to stop bleeding (p < .0001, 2-fold), and blood volume lost (p < .0001, 2-fold)</strong></span>. When comparing no slack to 200mm slack, the median results showed an increase in slack for windlass turns (p < .0001), time to stop bleeding (p < .0001), and blood volume lost (p < .0001).</span></p><p style="text-align: center;"><img id="media-4742845" style="margin: 0.7em 0;" title="" src="http://citerahiadesgenettes.hautetfort.com/media/00/00/2660613094.jpg" alt="Slack.jpg" width="278" height="239" /></p><p style="text-align: justify;"> </p><p style="text-align: justify;"><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;"><strong>Conclusions:</strong> Any slack presence in the strap impaired </span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;">tourniquet</span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;"> performance. More slack had worse results. Trainers can now instruct </span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;">tourniquet</span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;"> users with concrete guidance.</span></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlGarrot: Comment positionner la boucle ?tag:citerahiadesgenettes.hautetfort.com,2014-10-31:54796432014-10-31T06:14:53+01:002014-10-31T06:14:53+01:00 Emergency tourniquet effectiveness in four positions on the...
<h1 style="font-size: 1.231em; margin: 0.375em 0px; line-height: 1.125em; font-family: arial, helvetica, clean, sans-serif; text-align: center;">Emergency <span class="highlight">tourniquet</span> effectiveness in four positions on the proximal thigh.</h1><p style="text-align: center;"><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 11px; line-height: 15.9565258026123px;">Kragh JF et Al. <a style="outline: 0px; color: #660066; border-bottom-width: 0px;" title="Journal of special operations medicine : a peer reviewed journal for SOF medical professionals." href="http://www.ncbi.nlm.nih.gov/pubmed/24604435">J Spec Oper Med.</a></span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 11px; line-height: 15.9565258026123px;"> 2014 Spring;14(1):26-9.</span></p><p style="text-align: center;"> </p><p style="text-align: justify;"><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 11px; line-height: 15.9565258026123px;">La procédure du sauvetage au combat précise que le garrot doit être posé à la racine du membre. Elle ne précise cependant pas comment le dispositif de serrage doit être placé: en avant sur le côté en arrière du membre. Ce travail tente de répondre à cette question.</span></p><p style="text-align: center;"><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 11px; line-height: 15.9565258026123px;">----------------------------------------------------------------------------------</span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;"><strong>Objective:</strong> The purpose of the present study is to determine the performance of </span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;">tourniquet</span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;"> use by the placement of the </span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;">tourniquet'</span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;">s windlass on the extremity in four positions: medial, lateral, anterior, and posterior? to inform </span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;">tourniquet</span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;"> instructors and develop best </span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;">tourniquet</span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;"> practices. </span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;"><strong>Methods:</strong> A HapMed™ Leg </span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;">Tourniquet</span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;"> Trainer was used as a manikin to test the effectiveness of an emergency </span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;">tourniquet</span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;">, the Special Operations Forces Tactical </span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;">Tourniquet</span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;">. Two users made 10 tests, each in four positions. </span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;"><strong>Results:</strong> Effectiveness rates of </span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;">tourniquet</span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;"> use were 100% in all four positions. The two </span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;">tourniquet</span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;"> users were both right-hand dominant and used their right hand to turn the windlass. One user turned the windlass clockwise, and the other turned it counterclockwise. The association between time to stop bleeding and </span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;">tourniquet</span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;"> position was statistically significant but associations between time to stop bleeding and the user, user-by-position, and windlass turn number were not statistically significant. The association between </span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;">tourniquet</span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;"> position and pressure under the </span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;">tourniquet</span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;"> was statistically significant, and the association between user and pressure under the</span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;">tourniquet</span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;"> was statistically significant, but the user-by-position and windlass turn number were not statistically significant. The associations between</span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;">tourniquet</span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;"> position and blood loss volume, user and blood loss volume, and user-by-position and blood loss volume were statistically significant. Conclusions: <span style="background-color: #ffff99;"><strong>The present study found that </strong></span></span><span style="background-color: #ffff99;"><strong><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;">tourniquet</span></strong></span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;"><span style="background-color: #ffff99;"><strong> effectiveness rates were uniformly 100% irrespective of whether the windlass position was medial, lateral, anterior, or posterior</strong></span>. These excellent clinical and statistical results indicate that users may continue to place the </span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;">tourniquets</span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17.9998016357422px; text-align: left;"> as they prefer upon the proximal thigh</span></p><p style="text-align: justify;"> </p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlThe tourniquet manualtag:citerahiadesgenettes.hautetfort.com,2014-01-28:52840352014-01-28T21:10:21+01:002014-01-28T21:10:21+01:00 Clic sur l'image pour accéder au document
<p style="text-align: center;"><a href="http://elib.fk.uwks.ac.id/asset/archieve/e-book/TRAUMATOLOGY/The%20Tourniquet%20Manual-Principles%20and%20Practice.pdf" target="_blank"><img id="media-4419966" style="margin: 0.7em 0;" title="" src="http://citerahiadesgenettes.hautetfort.com/media/01/02/2421391698.2.jpg" alt="Tourniquet.jpg" /></a></p><p style="text-align: center;"><span style="font-size: small;"><strong>Clic sur l'image pour accéder au document</strong></span></p><p style="text-align: center;"> </p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlTourniquet abdominal: Compression axillaire ?tag:citerahiadesgenettes.hautetfort.com,2013-09-06:51572682013-09-06T07:59:00+02:002013-09-06T07:59:00+02:00 Clic pour accéder au document , l ire aussi
<p style="text-align: center;"><a href="http://citerahiadesgenettes.hautetfort.com/media/01/02/942605660.jpg" target="_blank"><img id="media-4239758" style="margin: 0.7em 0;" title="" src="http://citerahiadesgenettes.hautetfort.com/media/01/02/154733019.jpg" alt="AAT Axill.jpeg.jpg" /></a></p><p style="text-align: center;"><a href="http://www.compressionworks.net/resources/Case_Report_preview.pdf" target="_blank">Clic pour accéder au document</a>, l<a href="http://www.compressionworks.net/resources/AAT-JSOM-SUMMER13.pdf" target="_blank">ire aussi</a></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlTourniquet: Serrer fort et surtout vérifier l'efficacitétag:citerahiadesgenettes.hautetfort.com,2013-07-22:51264132013-07-22T01:34:34+02:002013-07-22T01:34:34+02:00 Forward Assessment of 79 Prehospital Battlefield Tourniquets Used in the...
<p style="text-align: center;"><span style="font-weight: bold; color: #444444; font-family: arial, sans-serif; font-size: small; line-height: 16px; text-align: left;">Forward </span><span style="font-weight: bold; color: #444444; font-family: arial, sans-serif; font-size: small; line-height: 16px; text-align: left;">Assessment of 79 Prehospital Battlefield Tourniquets Used in the Current War</span></p><p style="text-align: center;"><a href="http://issuu.com/jsomwinter2012/docs/jsom_winter_2012" target="_blank"><span style="color: #000000;"><span style="font-family: arial, sans-serif; font-size: small; line-height: 16px; text-align: left;">King DR et All. </span><span style="font-family: arial, helvetica, clean, sans-serif; line-height: 15.953125px;"><span>J Spec Oper Med.</span></span><span style="font-family: arial, helvetica, clean, sans-serif; line-height: 15.953125px;"> 2012 Winter;12(4):33-8.</span></span></a></p><p style="text-align: center;"><span style="font-family: arial, helvetica, clean, sans-serif; line-height: 15.953125px;"><br /></span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, clean, sans-serif; line-height: 15.953125px;">Un article important qui doit faire réfléchir à la manière dont l'instruction sur le garrot est conduite aussi bien au niveau du SC1 que du SC 2. </span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, clean, sans-serif; line-height: 15.953125px;">Dans </span><a style="font-family: arial, helvetica, clean, sans-serif; line-height: 15.953125px;" href="http://issuu.com/jsomwinter2012/docs/jsom_winter_2012" target="_blank">ce document</a><span style="font-family: arial, helvetica, clean, sans-serif; line-height: 15.953125px;"> </span><span style="font-family: arial, helvetica, clean, sans-serif; line-height: 15.953125px;">il est expliqué que 79 garrots sont posés sur 65 jambes garrotées de 54 combattants. Seules 17 jambes avaient des lésions artérielles. 14 d'entre elles étaient majueres mais seules 4 avait un garrot sérré correctement c'est à dire avec abolition du pouls distal. mais qu'aucune lésion artérielle n'a été prise en charge sans garrot sur la même période. Un rappel simple est fait sen outre sur l'importance de la largeur du garrot.</span></p><p style="text-align: center;"><span style="font-family: arial, helvetica, clean, sans-serif; line-height: 15.953125px; text-align: center;">________________________________________________</span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px; text-align: left;"><strong>Introduction</strong>: </span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px; text-align: left;">Battlefield</span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px; text-align: left;"> </span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px; text-align: left;">tourniquet</span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px; text-align: left;"> use can be lifesaving, but most reports are from hospitals with knowledge gaps remaining at the forward surgical team (FST). <span style="background-color: #ffff99;">The quality of </span></span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px; text-align: left; background-color: #ffff99;">tourniquet</span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px; text-align: left;"><span style="background-color: #ffff99;"> applications in forward settings remain unknown</span>. The purpose of this case series is to describe observations of</span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px; text-align: left;">tourniquet</span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px; text-align: left;"> use at an FST in order to improve clinical performance. </span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px; text-align: left;"><strong>Methods:</strong> War casualties with </span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px; text-align: left;">tourniquet</span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px; text-align: left;"> use presenting to an FST in Afghanistan in 2011 were observed. We identified appliers by training, device effectiveness, injury pattern, and clinical opportunities for improvement. Feedback was given to treating medics. Results: </span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px; text-align: left;">Tourniquet</span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px; text-align: left;"> applications (79) were performed by special operations combat medics (47, 59%), flight medics (17, 22%), combat medics (12, 15%), and general surgeons (3, 4%). Most </span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px; text-align: left;">tourniquets</span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px; text-align: left;"> were Combat Application </span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px; text-align: left;">Tourniquets</span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px; text-align: left;"> (71/79, 90%). <strong><span style="background-color: #ffff99;">With </span></strong></span><strong><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px; text-align: left; background-color: #ffff99;">tourniquets</span></strong><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px; text-align: left;"><strong><span style="background-color: #ffff99;"> in place upon arrival at the FST, most limbs (83%, 54/65) had palpable distal pulses present</span></strong>; 17% were pulseless (11/65). <strong>Of all </strong></span><strong><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px; text-align: left;">tourniquets</span></strong><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px; text-align: left;"><strong>, the use was venous in 83% and arterial in 17%.</strong> In total, there were 14 arterial injuries, but only 5 had effective arterial </span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px; text-align: left;">tourniquets</span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px; text-align: left;">applied. </span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px; text-align: left;"><strong>Discussion: </strong></span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px; text-align: left;">Tourniquets</span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px; text-align: left;"> are liberally applied to extremity injuries on the </span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px; text-align: left;">battlefield</span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px; text-align: left;">. 17% were arterial and 83% were venous </span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px; text-align: left;">tourniquets</span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px; text-align: left;">. When ongoing bleeding or distal pulses were appreciated, medics tightened </span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px; text-align: left;">tourniquets</span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px; text-align: left;"> under surgeon supervision until distal pulses stopped. <strong>Medics were generally surprised at how tight a </strong></span><strong><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px; text-align: left;">tourniquet</span></strong><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px; text-align: left;"><strong> must be to stop arterial flow ?</strong> convert a venous </span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px; text-align: left;">tourniquet</span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px; text-align: left;"> into an arterial </span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px; text-align: left;">tourniquet</span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px; text-align: left;">. Implications for sustainment training should be considered with regard to this life-saving skill.</span></p><p style="text-align: center;"><span style="font-family: arial, helvetica, clean, sans-serif; line-height: 15.953125px;">________________________________________________</span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, clean, sans-serif; line-height: 15.953125px;">1. Les garrots doivent être serrés de manière conforme; arrêt du saignement et dès que possible contrôle de l'absence de pouls. </span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, clean, sans-serif; line-height: 15.953125px;">2. Les garrots doivent être surveillés tout au long de la chaine de prise en charge</span></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, clean, sans-serif; line-height: 15.953125px;">3. La <a href="http://citerahiadesgenettes.hautetfort.com/list/procedure/2208369119.pdf" target="_blank">fiche mémento</a> sur le concept de garrot tactique est à lire et relire</span></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlGarrot: Une nouvelle ère ?tag:citerahiadesgenettes.hautetfort.com,2013-07-05:51148362013-07-05T07:56:00+02:002013-07-05T07:56:00+02:00 New Tourniquet Device Concepts for Battlefield Hemorrhage...
<p style="text-align: center;"><strong><span style="font-size: medium;">New Tourniquet Device Concepts for Battlefield Hemorrhage Control </span></strong></p><p style="text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: small;"><a href="http://www.cs.amedd.army.mil/AMEDDJournal/2011AprJun.pdf" target="_blank">Kragh JF et all.<span style="line-height: 15.953125px;"><span style="color: #660066;">US Army Med Dep J.</span></span><span style="line-height: 15.953125px;"> 2011 Apr-Jun:38-48.</span></a></span></p><p style="margin-bottom: 0cm;"><span style="font-family: Arial, sans-serif;"><strong>Ground:</strong></span></p><p style="margin-bottom: 0cm;"><span style="font-family: Arial, sans-serif; font-size: small;">Given the recent success of emergency tourniquets, </span><span style="background: #ffff00;">limb exsanguination is no longer the most common cause of preventable death on the battlefield; hemorrhage amenable to truncal tourniquets now is.</span><span style="font-family: Arial, sans-serif; font-size: small;"> The purpose of the present study is to discuss the gaps today in battlefield hemorrhage control and candidate solutions in order to stimulate the advancement of prehospital combat casualty care.</span></p><p style="margin-bottom: 0cm;"><span style="font-family: Arial, sans-serif;"><strong>Methods: </strong></span></p><p style="margin-bottom: 0cm;"><span style="font-size: small;"><span style="font-family: Arial, sans-serif;">A literature review, a market survey of candidate devices, a request for devices, and an analysis of the current situation regarding battlefield hemorrhage control were performed.</span></span></p><p style="margin-bottom: 0cm;"><span style="font-family: Arial, sans-serif;"><strong>Results: </strong></span></p><p style="margin-bottom: 0cm;"><span style="font-family: Arial, sans-serif;"><span style="background: #ffff00;">Hemorrhage control for wounds in the junction between the trunk and the limbs and neck is a care gap in the current war</span>, and, of these, the pelvic (including buttock and groin proximal to the inguinal ligament) area is the most common. Historical and recent reports give background information indicating that truncal tourniquets are plausible devices for controlling junctional hemorrhage on the battlefield. A request for candidate devices yielded few prototypes, only one of which was approved by the US Food and Drug Administration.</span></p><p style="margin-bottom: 0cm;"><span style="font-family: Arial, sans-serif;"><strong>Conclusions:</strong></span></p><p style="margin-bottom: 0cm;"><span style="font-family: Arial, sans-serif;">In order to solve the now most common cause of preventable death on the battlefield, junctional hemorrhage from the pelvic area, the planned approach is a systematic review of research, device and model development, and the fielding of a good device with appropriate training and doctrine.</span></p><p style="margin-bottom: 0cm; text-align: center;"><a href="http://www.cs.amedd.army.mil/AMEDDJournal/2011AprJun.pdf" target="_blank">Page 38 de la revue présentée dans le lien</a></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlGarrots: Sur soi mais pas n'importe comment !tag:citerahiadesgenettes.hautetfort.com,2013-06-03:50881762013-06-03T22:31:00+02:002013-06-03T22:31:00+02:00 Efficacy of tourniquets exposed to the afghanistan combat...
<h1 style="font-size: 1.231em; margin: 0.375em 0px; line-height: 1.125em; font-family: arial, helvetica, clean, sans-serif; text-align: center;">Efficacy of <span class="highlight">tourniquets</span> exposed to the afghanistan combat environment stored in individual first aid kits versus on the exterior of plate carriers</h1><p style="text-align: center;">Weppner J et all. Mil Med. 2013 Mar;178(3):334-7</p><p style="text-align: justify;"><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px;">Between February and May 2010, 1st Battalion, <strong><span style="background-color: #ffff99;">6th Marines reported a 10% (10/92) breakage rate for </span></strong></span><strong><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px; background-color: #ffff99;">tourniquets</span></strong><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px;"><strong><span style="background-color: #ffff99;">.</span></strong> One theory suggested was that </span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px;">tourniquets</span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px;"> were weakened by exposure to the Afghan environment. Our study was designed to compare three groups of Afghanistan-exposed </span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px;">tourniquets</span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px;"> to unexposed </span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px;">tourniquets</span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px;">. The three experimental arms were: (1) Afghan-exposed </span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px;">tourniquets</span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px;"> worn on the plate carrier, (2) Afghan-exposed </span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px;">tourniquets</span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px;"> carried in the Individual First Aid Kit (IFAK) and wrapped in manufacturer plastic wrapping, and (3) Afghan-exposed </span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px;">tourniquets </span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px;">carried in the IFAK with the manufacturer plastic wrapping removed. The outcome measures of this study were efficacy, breakage, and number of turns required to successfully stop the distal pulse. </span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px;">T<strong><span style="background-color: #ffff99;">ourniquets</span></strong></span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px;"><strong><span style="background-color: #ffff99;"> worn on the plate carrier had an efficacy of 57%</span></strong>, which was significantly lower than the control efficacy rate of 95.2%. When compared to the control arm, <strong><span style="background-color: #ffff99;">there were no significant differences in efficacy between the </span></strong></span><strong><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px; background-color: #ffff99;">tourniquets </span></strong><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px;"><strong><span style="background-color: #ffff99;">stored in the IFAK with or without manufacturing packaging</span></strong>.<strong><span style="background-color: #ffff99;"> No control </span></strong></span><strong><span style="background-color: #ffff99;"><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px;">tourniquets</span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px;"> or </span><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px;">tourniquets</span></span></strong><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px;"><strong><span style="background-color: #ffff99;"> stored in IFAKs broke</span></strong>; however, 46<span style="background-color: #ffff99;"><strong> (12%) of the plate carrier-exposed </strong></span></span><span style="background-color: #ffff99;"><strong><span class="highlight" style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px;">tourniquets</span></strong></span><span style="font-family: arial, helvetica, clean, sans-serif; font-size: 13px; line-height: 17px;"><span style="background-color: #ffff99;"><strong> did break</strong></span>. No statistically significant differences were found between the four groups with regard to the median number of turns required to stop the distal pulse.</span></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlHémorragies jonctionnelles: Comprimer le pelvistag:citerahiadesgenettes.hautetfort.com,2013-06-02:50873072013-06-02T23:10:00+02:002013-06-02T23:10:00+02:00 UK Combat-Related Pelvic Junctional Vascular Injuries 2008 - 2011...
<p style="text-align: center;"><span style="font-size: small;"><span style="font-weight: bold; color: #444444; font-family: arial, sans-serif; line-height: 16px; text-align: left;">UK Combat-Related Pelvic Junctional Vascular Injuries 2008</span><span style="color: #444444; font-family: arial, sans-serif; line-height: 16px; text-align: left;">-</span><span style="font-weight: bold; color: #444444; font-family: arial, sans-serif; line-height: 16px; text-align: left;">2011</span><span style="color: #444444; font-family: arial, sans-serif; line-height: 16px; text-align: left;">: </span><span style="font-weight: bold; color: #444444; font-family: arial, sans-serif; line-height: 16px; text-align: left;">Implications for Future Intervention</span><span style="color: #444444; font-family: arial, sans-serif; line-height: 16px; text-align: left;">.</span></span></p><p style="text-align: center;"><a href="http://www.bjjprocs.boneandjoint.org.uk/content/95-B/SUPP_8/13.abstract" target="_blank"><span style="color: #444444; font-family: arial, sans-serif; font-size: small; line-height: 16px;">Walker NM et All. - Bone Joint Journal (2013) vol. 95-B no. SUPP 8 13</span></a></p><p style="margin: 15px 0px; padding: 0px; border: 0px; outline-style: none; font-size: 13px; font-family: Verdana, Arial, Helvetica, 'Lucida Grande', 'Lucida Sans Unicode', Tahoma, sans-serif; line-height: 1.5; vertical-align: baseline; color: #403838; text-align: center;">---------------------------------------------------------------------------------------</p><p style="margin: 15px 0px; padding: 0px; border: 0px; outline-style: none; font-size: 13px; font-family: Verdana, Arial, Helvetica, 'Lucida Grande', 'Lucida Sans Unicode', Tahoma, sans-serif; line-height: 1.5; text-align: justify; vertical-align: baseline; color: #403838;">L'arrêt d'une hémorragie jonctionnelle est un enjeu majeur. <a href="http://citerahiadesgenettes.hautetfort.com/archive/2013/01/19/hemorragies-jonctionnelles-de-quoi-dispose-t-on-en-prehospit.html" target="_blank">Plusieurs dispositifs ont été récemment proposés</a>. Il semble que la grande majorité des lésions observées se situent au dessus du ligament inguinal rendant ainsi l'efficacité de dispositif comme le CRoC limité. Le tourniquet abdominal ou le sam junctionnal tourniquet paraissent ainsi au moins théoriquement un meilleur choix si toutefois ils permettent une compression suffisante.</p><p style="margin: 15px 0px; padding: 0px; border: 0px; outline-style: none; font-size: 13px; font-family: Verdana, Arial, Helvetica, 'Lucida Grande', 'Lucida Sans Unicode', Tahoma, sans-serif; line-height: 1.5; vertical-align: baseline; color: #403838; text-align: center;">---------------------------------------------------------------------------------------</p><p style="margin: 15px 0px; padding: 0px; border: 0px; outline-style: none; font-size: 13px; font-family: Verdana, Arial, Helvetica, 'Lucida Grande', 'Lucida Sans Unicode', Tahoma, sans-serif; line-height: 1.5; text-align: justify; vertical-align: baseline; color: #403838;">In a recent publication, 4.6% of 6450 Coalition deaths over ten years were reported to be due to junctional bleeding. The authors suggested that some of these deaths could have been avoided with a junctional hemorrhage control device.</p><p id="p-2" style="margin: 15px 0px; padding: 0px; border: 0px; outline-style: none; font-size: 13px; font-family: Verdana, Arial, Helvetica, 'Lucida Grande', 'Lucida Sans Unicode', Tahoma, sans-serif; line-height: 1.5; text-align: justify; vertical-align: baseline; color: #403838;">Prospectively collected data on all injuries sustained in Afghanistan by UK military personnel over a 2 year period were reviewed. All fatalities with significant pelvic injuries were identified and analysed, and the cause of death established.</p><p id="p-3" style="margin: 15px 0px; padding: 0px; border: 0px; outline-style: none; font-size: 13px; font-family: Verdana, Arial, Helvetica, 'Lucida Grande', 'Lucida Sans Unicode', Tahoma, sans-serif; line-height: 1.5; text-align: justify; vertical-align: baseline; color: #403838;">Significant upper thigh, groin or pelvic injuries were recorded in 124 casualties, of which 92 died. Pelvic injury was the cause of death in 42; only 1 casualty was identified where death was at least in part due to a <span style="background-color: #ffff99;">vascular injury below the inguinal ligament, not controlled by a tourniquet, representing <1% of all deaths</span>. <span style="background-color: #ffff99;">Twenty one deaths were due to vascular injury between the aortic bifurcation and the inguinal ligament</span>, of which 4 survived to a medical facility.</p><p id="p-4" style="margin: 15px 0px; padding: 0px; border: 0px; outline-style: none; font-size: 13px; font-family: Verdana, Arial, Helvetica, 'Lucida Grande', 'Lucida Sans Unicode', Tahoma, sans-serif; line-height: 1.5; text-align: justify; vertical-align: baseline; color: #403838;"><span style="background-color: #ffff99;">Some potentially survivable deaths due to exsanguination may be amenable to more proximal vascular control. We cannot substantiate previous conclusions that this can be achieved through use of a groin junctional tourniquet. <strong>There may be a role for more proximal vascular control of pelvic bleeding</strong>.</span></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlTourniquet: Quel efficacité et avec quoi ?tag:citerahiadesgenettes.hautetfort.com,2013-03-23:50244602013-03-23T21:19:00+01:002013-03-23T21:19:00+01:00 Performance improvement in emergency tourniquet use during the Baghdad...
<p class="svTitle" style="border: 0px; font-size: 1.4em; margin: 0px 0px 6px; padding: 0px; vertical-align: baseline; color: #5c5c5c; line-height: 1.5em; clear: both; font-family: 'Arial Unicode MS', 'Arial Unicode', Arial, 'URW Gothic L', Helvetica, Tahoma, sans-serif; text-align: center;"><strong><span style="font-family: arial, helvetica, sans-serif; font-size: small;">Performance improvement in emergency tourniquet use during the Baghdad surge</span></strong></p><p class="svTitle" style="border: 0px; margin: 0px 0px 6px; padding: 0px; vertical-align: baseline; clear: both; text-align: center;"><span style="font-family: arial, helvetica, sans-serif; font-size: small;">Kragh JF et all. </span><span style="color: #5c5c5c; font-family: arial, helvetica, sans-serif; font-size: x-small;"><span style="line-height: 23.09375px;">Am J Emerg Me<span style="font-family: arial, helvetica, sans-serif; font-size: small;">d</span></span></span><span style="font-family: arial, helvetica, sans-serif; line-height: 15.953125px; font-size: small;"> 2013 Mar 4. pii: S0735-6757(12)00611-0.</span></p><p class="svTitle" style="border: 0px; margin: 0px 0px 6px; padding: 0px; vertical-align: baseline; clear: both; text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: small;"> Cette lettre à l"éditeur rapporte l'étude comparée sur 3 périodes des conditions d'emploi et l'efficacité des garrrots pendant les combats s'étant déroulés pour le contrôle de la ville de Baghdad. <span style="background-color: #ffff99;">1252 garrots ont été posés chez 727 blessés sur 952 membres</span>. L'emploi avant la structure chirurgicale est bien plus fréquente dans la dernière période avec un taux qui passe de 84% à 97% et un taux de survie de 86.6% à 90.8%.</span></p><p class="svTitle" style="border: 0px; margin: 0px 0px 6px; padding: 0px; vertical-align: baseline; clear: both; text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: small;"><br /></span></p><p class="svTitle" style="border: 0px; margin: 0px 0px 6px; padding: 0px; vertical-align: baseline; clear: both; text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: small;"> La réponse initiale à la pose de ce garrot est dans 87% une <span style="background-color: #ffff99;">réduction du saignement</span>. Dans 5% des cas le saignement n'est pas modifié. Il est augmenté dans 0.3%. La réponse au garrot n'est pas documentée dans 8% des cas. </span><span style="font-family: arial, helvetica, sans-serif; font-size: small;"> </span><span style="font-family: arial, helvetica, sans-serif; font-size: small;">Ce document confirme les précautions à prendre lors du déserrement de garrot rapportant une <span style="background-color: #ffff99;">baisse de la pression artérielle d'au moins 30 mmHg chez 2% des blessés</span>. </span></p><p style="text-align: center;"><a href="http://citerahiadesgenettes.hautetfort.com/media/02/02/3349314014.jpg" target="_blank"><img id="media-4028135" style="margin: 0.7em 0;" title="" src="http://citerahiadesgenettes.hautetfort.com/media/02/02/1139791496.jpg" alt="Tourniquet efficacité 2.jpg" /></a></p><p style="text-align: justify;"><span style="font-family: arial, helvetica, sans-serif; font-size: small;"> Par ailleurs l'emploi isolé d'un garrot ne s'observe que dans 18% des cas. Le plus souvent il est utilisé avec un pansement simple et dans 13% des cas avec un pansementcompressif et 1% un bandage compressif du membre.</span></p><p style="text-align: center;"><a href="http://citerahiadesgenettes.hautetfort.com/media/01/00/509650160.jpg" target="_blank"><img id="media-4028130" style="margin: 0.7em 0;" title="" src="http://citerahiadesgenettes.hautetfort.com/media/01/00/1361755539.jpg" alt="Tourniquet efficacité.jpg" /></a></p><p style="text-align: center;"><span style="background-color: #ffcc99;"><strong><em><span style="font-size: medium;">En résumé le garrot doit être posé plus tôt et plus souvent permettant d'obtenir une meilleure survie.</span></em></strong></span></p><p style="text-align: center;"><span style="background-color: #ffffff;"><span style="font-size: medium;">Approfondir <a href="http://www.dtic.mil/cgi-bin/GetTRDoc?Location=U2&doc=GetTRDoc.pdf&AD=ADA514928" target="_blank">1</a> <a href="http://www.medicalscg.de/files/tccc_childers_tourniquets_in_the_field_mil_med_2011.pdf" target="_blank">2</a> <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2151059/pdf/1749-7922-2-28.pdf" target="_blank">3</a></span></span></p><p style="text-align: center;"><a href="http://citerahiadesgenettes.hautetfort.com/list/procedure/2208369119.pdf" target="_blank"><span style="background-color: #ffffff;"><span style="font-size: medium;">Fiche mémento</span></span></a></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlUse of tourniquets and their effects on limb function in the modern combat environmenttag:citerahiadesgenettes.hautetfort.com,2012-04-22:46882202012-04-22T00:11:24+02:002012-04-22T00:11:24+02:00 Use of tourniquets and their effects on limb function in the modern combat...
<p style="text-align: center;"><a href="http://www.ap-services.dk/Files/Billeder/Artikler/TCCC%20Kragh%20Tourniquet%20Effects%20on%20Foot%20Ankle%20Clin%202010.pdf" target="_blank"><strong>Use of tourniquets and their effects on limb function in the modern combat environment </strong></a></p><p style="text-align: center;"><a href="http://www.ap-services.dk/Files/Billeder/Artikler/TCCC%20Kragh%20Tourniquet%20Effects%20on%20Foot%20Ankle%20Clin%202010.pdf" target="_blank"><span style="text-align: center;">Kragh JF Foot Ankle Clin N Am 15 (2010) 23–40</span></a></p><p><span style="text-align: center;"><br /></span></p><p>Un article à lire avec attention car il exprime bien à la fois l'histoire des garrots et les enjeux actuels</p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlTourniquet: Le point vu du côté UStag:citerahiadesgenettes.hautetfort.com,2012-02-23:46111022012-02-23T21:40:00+01:002012-02-23T21:40:00+01:00 The Military Emergency Tourniquet Program's Lessons Learned With Devices...
<p style="text-align: center;"><strong>The Military Emergency Tourniquet Program's Lessons Learned With Devices and Designs</strong></p><p style="text-align: center;"><a href="http://www.medicalsci.com/files/tccc_kragh_tq_ll_mil_med_2011.pdf" target="_blank"><em>Kragh et all. MILITARY MEDICINE, 176, 10:1144, 2011</em></a></p><p style="text-align: justify;">Un travail très intéressant qui porte sur l'analyse de 159 garrots après leur emploi. Les trois plus fréquemment rencontrés sont le CAT, le Delfi EMT et le SOFT-T. 119 était encore utilisables. 28 étaient inefficaces, 52 efficaces et pour le reste étaient non analysable.Le plus efficace est le Delfi EMT suivi par le CAT et le SOFT-T. Il n'a pas été identifié de pose de tourniquet à une main. L'efficacité globale du garrot est en partie rapporté à sa largeur. Une explication retneue d'inefficacité est une tension insuffisante du tourniquet avant la torsion. Des bris de barre de torsion du CAT sont observées. D'autres garrots que l'EMT, le CAT et le SOFT-T sont rencontrés: Le Tourniquet RATCHET LBT et les garrots improvisés dont un exemple est présenté ci-après.</p><p style="text-align: center;"><a href="http://citerahiadesgenettes.hautetfort.com/media/01/01/1372767846.JPG" target="_blank"><img id="media-3454227" style="margin: 0.7em 0;" title="" src="http://citerahiadesgenettes.hautetfort.com/media/01/01/3185296420.JPG" alt="Garrot improvisé.JPG" /></a></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlDocument SFMU: Choc hémorragique en médecine de l'avanttag:citerahiadesgenettes.hautetfort.com,2011-12-08:38985512011-12-08T08:40:00+01:002011-12-08T08:40:00+01:00 http://www.sfmu.org/urgences2011/donnees/articles/fs_conf28_art03.htm
<p style="text-align: center;"><a href="http://www.sfmu.org/urgences2011/donnees/articles/fs_conf28_art03.htm">http://www.sfmu.org/urgences2011/donnees/articles/fs_conf28_art03.htm</a></p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlContrôler une hémorragietag:citerahiadesgenettes.hautetfort.com,2010-11-30:30081692010-11-30T00:05:00+01:002010-11-30T00:05:00+01:00
<p style="text-align: center;"> </p><p style="text-align: center;"> </p><p style="text-align: center;"><a href="http://citerahiadesgenettes.hautetfort.com/media/00/00/2436587711.JPG" target="_blank"><img id="media-2774136" style="margin: 0.7em 0;" src="http://citerahiadesgenettes.hautetfort.com/media/00/02/1196194920.JPG" alt="Sans titre4.JPG" /></a></p><p> </p><p> </p>
Médecine tactiquehttp://citerahiadesgenettes.hautetfort.com/about.htmlAu sujet des garrotstag:citerahiadesgenettes.hautetfort.com,2008-12-07:19352112008-12-07T11:42:00+01:002008-12-07T11:42:00+01:00 Forum garrot
<p>Forum garrot</p>