Now, let's talk about how to control arterial bleeding that isn't stopping with direct pressure,
and it's not stopping with direct pressure dressings. And we may have a delay in emergency
medical response. And so when we have a life-threatening bleed, venous or arterial, that won't stop
and we have a delay in response, we then need to consider the use of tourniquets. So when
we consider tourniquets, there's two variations. There's the homemade and the commercially
bought. Now of course, the preference would be using something that's actually designed
to work as a tourniquet, but there's going to be times, whether it's wilderness, whether
it's out and about in a shop that doesn't have a first aid kit or doesn't have a tourniquet
in it, that we may actually need to improvise. So anything that actually can cover all the
way around the affected limb and could be used as a tourniquet qualifies. Whether it's
something like a flexible piece of insulated wire that could actually be wrapped around
the affected limb, go ahead and let go for a second, and we tie that into a simple knot
for the first one. Then tie in stick, a pen, a screwdriver and then tie that in and be
able to crank it down tight enough so that we actually can stop the bleeding, it will
work as a noncommercial tourniquet alternative. The point is can we stop the bleeding before
the person goes into hypovolemic shock? That's really the idea here. But I'd like to really
demonstrate the best-case scenario. If you don't have one in your first aid kit and if
you do not have one in first response kit and you think you could fall into this category
of a delayed response of emergency medial services or an arterial bleed, that's hard
to control, you should invest in one of these. Because they work. They work really well.
So here's the idea on how to use them. You can see that it's leaking through, no matter
how much pressure he's putting here, it's not stopping the arterial bleed. Now, one
point of interest. Make sure that you're actually putting direct pressure over the actual laceration.
I have had calls where they couldn't get it to stop and what happened is the bandaging
moved off the point of the injury and they were putting extremely direct pressure on
a non-affected part of the arm. And so therefore, the artery was allowed to not have any pressure
and of course, it would remain bleeding. And once we recovered it with direct pressure,
the bleeding stopped and we were fine. However, in this case, we're gonna say he is putting
direct pressure right over the wound and it's still not stopping. Maybe he's got a bleeding
issue, maybe he's on blood thinners, it doesn't matter why. The fact is, direct pressure is
not controlling it. So it's leaking through. Let go for a moment while I slip this over.
If that was a problem, I could unlace this all the way and fish it through, around, and
then really lace it. But again, one second of stopping the whole, it's not gonna ruin
the whole situation. So the point here now, is that we want to put this tourniquet as
close to the bleeding wound as possible. We want to damage as little good tissue as we
can, so we're actually gonna put this as close to that site of the injury as possible. Tighten
it down and then bring it up and fasten the Velcro. Now, look at this crank that's built
in to the actual tourniquet, is now tightened. Go ahead and let go. And we're going to tighten
it until the bleeding stops. So if we can see a pulsation of blood and we're turning
this tightness of the tourniquet handle, you will see it eventually stop bleeding. That's
when you know you have enough pressure. I'm now going to fasten it into this resting spot.
Before, with the makeshift, you would have to tie those in place and tie another knot,
so it doesn't unwind. But with this tourniquet device, it actually has a cradle to hold the
stick in. Now look, if I'm actually using this tourniquet appropriately, there will
be a delay in the refill of the capillary areas. This is another test. It should be
delayed, it should not refill in the length of time it takes to save capillary refill,
it should be a longer than that. That tells me that the tourniquet is actually working
and we're not allowing the blood to go past that point. I'm going to now finish the bandage,
tie it off. I'm gonna mark on their hands, the time that I actually tied the tourniquet
so that the surgeons can know how long this extremity went without oxygenation. This allows
them to understand how long it takes for the tissues to die, what the rate of tissue death
might be, and whether on not they can start a recirculation process and start regenerating
oxygenated blood back into this oxygen starved area. They can also help with blood clot prevention
with certain medications. We've just got a lot of good skills now to try to prevent the
loss of limb, even with tourniquet use. So if this is a life-threatening bleed, can't
be controlled with direct pressure, consider use of tourniquets, and we could actually
save this person's limb. But for sure, save their life.