[swatsurgeon]

Jason,
a few points...
1) pressure of 80 is wonderful, especially in penetrating trauma. To much fluid does a few bad things. First, the higher the BP the faster the bleeding and the "pop" the clot syndrome, second, the more dilution the worse the coagulation cascade can function. Avoid pressure >80 until definitive care can be rendered. All organ systems will do fine with function with a SBP ~80. It's actually based on the mean BP but we make allowances in the field since a SBP is quick to get, remember, a femoral pulse roughly = SBP of atleast 70, brachial of atleast 60 and carotid at least 50....too low; DANGER!! give fluid until femoral back up to palp.
2) moist dressing appropriate unless big burns
3) think of what kills people with this injury.....hemorrhage, therefore tourniquet ASAP just tight enough to stop the bleeding and no tighter....look closely at the pic and you can see where the tourniquet was applied.
4) neuro/vascular assessment a must when it is safe to perform.
5) remember the artery has a muscular wall and will constrict on its own to slow bleeding and maybe even stop it for some time. The veins have no such muscular layer and are the cause for bleed outs in the majority of cases. This is where traumadex, 'loose' tourniquet, tight dressing wrap can all come together to save a life but probably not this arm.....have to wait to see....will need multiple operative debridements, attempts at stabilization of bone fractures and vascular repain as indicated.
T-2