SAQ 305 – Trauma – rural shotgun limb haemorrhage and tourniquet conversion

Trauma – rural shotgun limb haemorrhage and tourniquet conversion.

a. Immediate management

• Apply a tourniquet, such as a combat application tourniquet.
• Give immediate blood transfusion, such as O negative blood if available.
• Titrate resuscitation to cerebral perfusion, initially accepting systolic BP around 80 mmHg if appropriate.
• Give tranexamic acid 1 g.

b. Tourniquet complications

• Limb loss.
• Compartment syndrome.
• Myonecrosis, rhabdomyolysis, or acute kidney injury.
• Nerve injury.
• Venous thromboembolism.

c. Tourniquet conversion

• Replacing a tourniquet with haemostatic dressing and/or pressure dressing when it is clinically safe.
• The aim is to reduce tourniquet-related complications while maintaining the life-over-limb principle.

d. Indications

• Bleeding remains controlled after release.
• Haemostatic agent or pressure dressing is effective.
• Prolonged transport time, such as more than two hours, where conversion is not otherwise high risk.