[swatsurgeon]

A few things.....
You are taught to place the tourniquet because of the circumstances under which you applied it.....need both of your hands to do other things and you saw a wound that had the POTENTIAL to have the patient bleed out....so apply the tourniquet (SOP). When things have calmed down you can loosen it to see if the a) bleeding wasn't really too bad and can be controlled by some other means, b) the wound wasn't as nasty as you originally thought and a tourniquet wasn't needed at all. But if you see the limb is gone/almost gone, do NOT loosen the tourniquet...blood is life and every red cell lost in the field is one closer to shock.

The reperfusion injury can only be attenuated/reduced with the reversal of the ischemia sooner. If you mis-apply a tourniquet for 30 minutes, the reperfusion injury is less than if were on an hour...etc., but what had been discussed in the medical literature is given IV and po.....antioxidants, vit A, C, E, mannitol, antiinflammatories. If you can give an oral form of mega vitamin, allopurinol, celebrex (doesn't ruin your platelet function) than you are attenuating the reperfusion injury. If the limb is not going to be amputated, we would do fasciotomies to release the pressure of the referfused muscles which SWELL like hell after a prolonged ischemic period. These can be closed later...I'll post pics when I find a few.

Moral of the story, apply the tourniquet when needed, keep it on to prevent loss of blood (life), LOOSEN ONLY WHEN OTHER APPROPRIATE MEDICAL TREATMENTS ARE AVAILABLE or unless it was put on and not really needed.

ss