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i was asked to respond about protocols for tourniquet removal in the ER...
we don't have one...
most tourniquets placed in the field are on for such a short time in the EMS system that none is needed except the ability to control bleeding when they come off.
the closest thing I can think of to compare to a tourniquet on for a very long time would be when we take an aortic cross clamp off that has been on for a while... lots of badness gets released and we usually prepare anesthesia. They will pretreat, if able, with things like mannitol and bicarb to help with the free oxyen radicals and metabolites that have built up and the acidosis that will often ensue.
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