How Tight to make a Tourniquet

[52bravo]

like to know some more of field amputation Swatsurgeon

can you make a guide, on pain/anesthesia medicine ect, and when to do it. like to have one form one ho has don it.

Frank

[swatsurgeon]

field anesthesia dpends on, what you would expect, what is available to you.
I carried both local anesthetics as well as IV analgesics and sedatives.
For local anethesia, I like 0.5% lidocaine with epinephrine, 1:200,000.
Remember with lidocaine, there is a toxic level/dosing that you don't want to exceed.
1% has 10 mg of lido per mL
0.5% has 5 mg/mL
we try to stay below 5-6mg/kg, with 7 mg/kg being truly toxic, therefore just do the math....the average 70 kg person can "safely" receive ~350-420mg...translation 35-42 mL of 1% lidocaine.
In the field I try to balance local with IV. The body is already hyped up and pain is a funny thing when you're that hyped, it doesn't always hurt as much as we expect it to under normal circumstances and I take advantage of that.....meaning use what I have to in the field not what I preconceive as needing in the operating room.
Technique: IV morphine or fentanyl, titrate to get them in space, give IV versed 2-5 mg, or Ketamine ~100mg, be ready to support respirations, inject lido 0.5% with epi around skin edges, wait 2 minutes for lido effect, re-inject only when pain found/caused by what I am doing, titrate the IV drugs, give until in farther in space, keep cutting...faster is better. When down to bone, inject the periosteum (covering of bone) then saw through. Make sure you know anatomy so you can clamp major vessels before cutting them (if possible),....all done under tourniquet!!
this is a brief review but brings out some important points.
Sometimes you have nothing but a knife and tourniquet...it sucks but life over limb and a limb under tight tourniquet will dull sensation.
I hope you never have to do this to someone but if you do, do it right.

[Bill Harsey]

Originally Posted by ccrn

Is this the knife sir?


http://img.photobucket.com/albums/v6...n/T2Harsey.jpg

Thanks for posting the link ccrn. This is a Harsey (me) design made by Lone Wolf Knives in Portland Oregon.

An important feature of this knife is the steel, CPM S-30V. It's made by Crucible Steel in Syracuse New York using the particle metal process they invented. The result is unusual strength and sharpness because of the alloys and how it is made. This is an extraordinary tool steel for blade use. This isn't a sales pitch, just stating proven fact. Many others in the knife industry are now using this steel on the premium knives they manufacture.

The first ever production use of this steel was by Chris Reeve and myself in the knife called the Yarborough for United States Army Special Forces. We had been working with the test runs of this alloy for a year before it was commercially available. This is because Chris told Crucible what alloy mix he wanted in that type of steel and they did it. We both work closely with the metallurgical side of Crucible Specialty Tool Steels.

[swatsurgeon]

take it from someone who has now "field tested" (operationally or operatively??) this knife...the steel with its edge is as good as a scalpel and for that Mr. Harsey should be proud. The patient and I are most grateful for the craftmanship and sharpness of this edged tool.
It is my constant companion, is presently hooked onto my jeans waistband and will remain there .....until such time that a (?) new Harsey knife takes it's position.

[52bravo]

Originally Posted by swatsurgeon

field anesthesia dpends on, what you would expect, what is available to you.
I carried both local anesthetics as well as IV analgesics and sedatives.
For local anethesia, I like 0.5% lidocaine with epinephrine, 1:200,000.
Remember with lidocaine, there is a toxic level/dosing that you don't want to exceed.
1% has 10 mg of lido per mL
0.5% has 5 mg/mL
we try to stay below 5-6mg/kg, with 7 mg/kg being truly toxic, therefore just do the math....the average 70 kg person can "safely" receive ~350-420mg...translation 35-42 mL of 1% lidocaine.
In the field I try to balance local with IV. The body is already hyped up and pain is a funny thing when you're that hyped, it doesn't always hurt as much as we expect it to under normal circumstances and I take advantage of that.....meaning use what I have to in the field not what I preconceive as needing in the operating room.
Technique: IV morphine or fentanyl, titrate to get them in space, give IV versed 2-5 mg, or Ketamine ~100mg, be ready to support respirations, inject lido 0.5% with epi around skin edges, wait 2 minutes for lido effect, re-inject only when pain found/caused by what I am doing, titrate the IV drugs, give until in farther in space, keep cutting...faster is better. When down to bone, inject the periosteum (covering of bone) then saw through. Make sure you know anatomy so you can clamp major vessels before cutting them (if possible),....all done under tourniquet!!
this is a brief review but brings out some important points.
Sometimes you have nothing but a knife and tourniquet...it sucks but life over limb and a limb under tight tourniquet will dull sensation.
I hope you never have to do this to someone but if you do, do it right.

do u use the lidocain as a nerveblock ?

the danish army had one man in a tank (up side down), in a river some year back. if think is was dec. and ice in on the river ect.
he got the food stuck under the cannon and the top of the tank, tib-fib frac, we almose cut the leg off, but he's hypotermia was not that sever, I dont know how almosed 3hr in wather, i think hes temp was 35c at the CSH at tuzla air base.

[ccrn]

Very nice knife, although Id be tempted to buy the tactical folder instead especially for a deployment.

I'm wondering how you dressed the stump for transport-

ccrn

[swatsurgeon]

if you look at the pics I posted, he basically looked like that with a sterile 'burn' sheet covering the stump...it's alread
y dirty so just trying to keep it from getting much dirtier...LOL
really doesn't make much difference...
ONE VERY IMPORTANT ISSUE: this happened on a farm and farms around the world have one thing in common, animal waste....you MUST use appropriate antibiotics to cover this, i.e., a penicillin or derivative, without fail or the infection will only get worse despite being on other antibiotics

[NousDefionsDoc]

Check this out

[Bill Harsey]

Swatsurgeon,
Any word on our guy who tangled with the post hole auger?

[swatsurgeon]

Bill,
he's being fitted with his prosthesis this week. overall doing well except for some phantom pain. nasty injury........
just had another get himself with a circular saw and took off his right arm....sent him for replantation at Univ. of VA.....
this is why the swatsurgeon uses NO POWER TOOLS!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

[Bill Harsey]

Originally Posted by swatsurgeon

Bill,
he's being fitted with his prosthesis this week. overall doing well except for some phantom pain. nasty injury........
just had another get himself with a circular saw and took off his right arm....sent him for replantation at Univ. of VA.....
this is why the swatsurgeon uses NO POWER TOOLS!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Swatsurgeon,
Thanks for the update. We all know there is no easy ending there and hope the best for your patient.

How did a guy cut his arm off with a circle saw? Obvious answer, with it running.

[swatsurgeon]

was using it WITHOUT the guard and hit a knot in the wood, it jumped and got him....pics to follow.

[Bill Harsey]

Originally Posted by swatsurgeon

was using it WITHOUT the guard and hit a knot in the wood, it jumped and got him....pics to follow.

Which guard are you referring to?
The one that covers the whole saw or the small one that swings over the bottom of the blade?

That would be amazing if he ran it without the one that covers the top of blade.