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/ 3 Îðãàíèçàöèÿ çäðàâîîõðàíåíèÿ
C. med. s. Nazymok Ye. V., C.
med. s. Biryuk
I. G.,
٭ C. med. s. Protsak T. V., ٭٭ C. med. s. Zinevych Ia. V.
Higher State Educational Establishment of Ukraine “Bukovinian
State Medical University”, Department of Disaster medicine and military medicine (Head
of department, Assistant of professor, I. G.
Biryuk), Chernivtsi, Ukraine;
٭Assistant of professor, Department
of Human Anatomy named after M. H. Turkevych, Higher State Educational
Establishment of Ukraine “Bukovinian State Medical University”, Chernivtsi,
Ukraine;
٭٭Assistant of professor, Department
of Medical and Biological disciplines, National University of Physical
Education and Sport of Ukraine Kyiv, Ukraine.
Different
techniques of applying tourniquets
The
technique of application of the Tourniquet has been an established many years
ago as a means to affect blood supply to a distant part of a limb.
In
1593, Wilhelm Fabry of Hilden (Fabricius Hildanus), often called the father of
German surgery, described use of a stick to twist a circumferentially
constrictive bandage in amputation surgery. The stick, sometimes called a
Spanish windlass, acted as a means to gain mechanical advantage in tightening
(Pilcher L.S., 1899).
The
most spread method of a temporary arrest of arterial bleeding is applying
tourniquet. Esmarch’s bandage (Johannes Friedrich August von Esmarch
(1823-1908), a German surgeon) is a strong rubber tube 1,5 m long with a metal
chain on one end and a hook on another one. The tourniquet can be applied on
the upper arm, forearm, ankle, femur etc.
Of
a large number of versions of existing tourniquets drew the attention to the
Emergency Medical Tourniquet (EMT). It was designed and distributed by Delfi
Medical Innovations (Vancouver, BC, Canada). It was invented by a team led by
James A. Mc-Ewen and made by a company with extensive organizational expertise
in designing tourniquets for elective use in the operating room.
The
EMT device is a pneumatic tourniquet that has a bladder that goes around the
limb, a clamp that limits the inflated portion while holding the bladder close
to the limb, and an inflator bulb with connector tube and twist cap. The
bladder, 88 mm wide, has midpoint spot welds so that the cuff lies flat and
wide on the skin. These features make it similar to a blood pressure cuff
except for the clamp. The EMT clamp is precision-milled; has individual device
serial numbers; and is designed for use in hospitals, clinics, or ambulances (Naimer S.A., 2014).
The
Combat Application Tourniquet (CAT) was invented by military medics in an
Afghanistan (Shipman N. et al., 2009). CAT utilizes a
durable windless system with a free-moving internal band with a Velcro
fastening system providing circumferential pressure to the extremity. Once
adequately tightened a hook and loop windless retention strap is then applied,
securing the it to maintain pressure during casualty evacuation. The CAT’s dual
securing system avoids the use of screws and clips which can become difficult
to operate under survival stress or where fine motor skills are compromised.
The
CAT’s effectiveness rate was the highest of the field tourniquets at 79% in
stopping compressible bleeding on the battlefield (Kragh et al., 2008) and
therefore this is the device of choice in this class.
Israeli
Bandage designed to increase the pressure under pressure applicator (pressure
bar). The bandage is similar to elastic bandage used for wrapping sprained
ankle, knees, elbows or wrists. Three special components have been included in
this they are: the dressing, pressure bar, closure bar. The dressing is a non
adhering dressing that allows removing the bandage without reopening the wound.
The pressure bar improves the pressure under the pressure bar to stop bleeding.
The closure bar secures the bandage with sliding motion. Additional pressure
can be build up by sliding the closure bar under the surface dressing layer.
The
bandages are provided in various sizes such as: 4-inches wide, 6-inches wide,
8-inches wide.
The
tourniquets should be used at the right time in the right way for the right
casualties saved lives!