7232019 Tourniquets in orthopedic surgerypdf

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6ltlt5 gt9830926Vcurhgquets gh crt`cpefgb surnery

kne sur `ttp4wwwhbjghamhg`ncvpmbkrtgbaesMB26763repcrt=prghtkjae

Ghfgkh D Crt`cp lt Dua-Kun 69(6)4 2gtgt‒202

fcg4 lt6lt2ltlt7-5627006

MBGF4 MB2676

Vcurhgquets gh crt`cpefgb surnery

Dkg rkoks` R`krmk khf Zks`mg Rka`ctrk

Fepkrtmeht ci Khest`esgcacny khf Brgtgbka Bkre Uhgversgty Bcaaene ci Mefgbka Rbgehbes khf NVJ cspgtka Fgas`kf Nkrfeh Uhgversgty ci

Fea`g Fea`g Ghfgk

Kffress icr bcrrespchfehbe4 Fr Zks`mg Rka`ctrk 02lt Igrst Iaccr R`kotg Hknkr Fea`g ‒ lt ltltgt Ghfgk E-mkga4

rks`mgb`kjrkLyk`ccbcm

Bcpyrgn`t 4 copy Ghfgkh Dcurhka ci Crt`cpkefgbs

V`gs gs kh cpeh-kbbess krtgbae fgstrgjutef uhfer t`e terms ci t`e Brektgve Bcmmchs Kttrgjutgch-Hchbcmmerbgka-R`kre Kagoe 2lt Uhpcrtef

w`gb` permgts uhrestrgbtef use fgstrgjutgch khf reprcfubtgch gh khy mefgum prcvgfef t`e crgnghka wcro gs prcperay bgtef

Kjstrkbt

Vcurhgquets kre bcmmchay usef gh agmj surnerges je gt crt`cpefgb cr pakstgb surnerges Jut t`e ghiaktgch

pressures t`e furktgch khf reaekse nugfeaghes kre stgaa hct baekr Kbbcrfghn tc k survey mkdcrgty ci

crt`cpefgb surnechs ghiakte t`e tcurhgquet tc igxef pressures icr t`e upper khf t`e acwer agmjs wgt`cut

bchsgferghn t`e jkseaghe jaccf pressure ci t`e pktgeht ch w`cm t`e tcurhgquets kre jeghn kppagef V`gs

revgew wks fesgnhef tc rebkaa khf revgew t`e skie use ci tcurhgquets khf t`e vkrgcus teb`hgques t`kt bkh je

empacyef tc mghgmgze t`e bcmpagbktgchs ci tcurhgquet use Nccnae sbgehbe fgrebt khf pujmef were

sekrb`ef icr kpprcprgkte agterkture khf reaevkht krtgbaes were gfehtgigef

Oeywcrfs4 Vcurhgquet crt`cpkefgb surnery tcurhgquet khf bcmpagbktgchs

GHVZCFUBVGCH

V`e wcrf tcurhgquet wks fergvef ircm t`e Irehb` wcrf tcurher w`gb` mekhs ‑tc turhrdquo Ekragest ohcwh

uskne ci tcurhgquet fktes jkbo tc 77 JBE‒5ltlt BE Gt wks usef jy t`e Zcmkhs tc bchtrca jaeefghn

es pebgkaay furghn kmputktgch V`ese were hkrrcw strkps mkfe ci jrchze usghn chay aekt`er icr bcmicrt

Baghgbgkhs prevgcusay usef Esmkrb` tcurhgquet w`gb` wks k type ci rujjer jkhf t`kt wks wrkppef krcuhf

t`e extremgty tc exskhnughkte t`e jaccf khf tgef gt kt t`e prcxgmka ehf sc ks tc ikbgagtkte reaktgveay

jaccfaess surnery gh t`e fgstka extremgty Jut gt wks bkpkjae ci neherktghn very gn` pressures khf s`ekrghn

icrbes furghn kppagbktgch aekfghn tc sogh trkumk uhferayghn herve trkumk khf eveh iktka bcmpagbktgchsagoe puamchkry emjcagsm Kaa t`ese bcmpagbktgchs aef tc t e kjkhfchghn ci gts use

Vc cverbcme t`ese s`crtbcmghns t`e pheumktgb tcurhgquets were ghtrcfubef gh 7lt6 jy krvey Bus`ghn

V`e prcjaems wgt` sub` tcurhgquets kre aess irequeht gi kppagef uhfer fgrebt supervgsgch ci expergehbef

perschhea khf gi prcper ghiaktgch pressures khf tcurhgquet tgmes kre cjservef Vcurhgquet ghiaktgch aekfs tc

acbka eiiebts fue tc bcmpressgch khf eiiebts ch kaa t`e crnkh systems Vcurhgquet pkgh gs che ci t`e mcst

ghtrgnughn pkghs icr t`e khest`esgcacngst khf kasc k bkuse ci bchberh icr t`e crt`cpefgb surnechs

V`gs revgew krtgbae wks kgmef tc fgsbuss () p`ysgcacngbka b`khnes ci tcurhgquet kppagbktgch ()

bcmpagbktgchs ci tcurhgquet use (2) pre-kppagbktgch prebkutgchs (6) prcper kppagbktgch ci tcurhgquet (5)

t`e skie furktgch khf pressure icr tcurhgquet use (9) rebcmmehfktgchs icr t`e skie use ci tcurhgquet (gt)

tcurhgquet pkgh4 gts bkuse khf mkhknemeht (0) tgmghn ci tcurhgquet reaekse (7) t`e eiiebts ci feiaktgch ci

2

7232019 Tourniquets in orthopedic surgerypdf

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6ltlt5 gt9830926Vcurhgquets gh crt`cpefgb surnery

kne sur `ttp4wwwhbjghamhg`ncvpmbkrtgbaesMB26763repcrt=prghtkjae

tcurhgquet

REKZB RVZKVENW

K sekrb` ci agterkture wks fche usghn pujmef EMJKRE nccnae Bcb`rkhe fktkjkses khf sbgehbe fgrebt

icr t`e akst teh yekrs (ltltlt‒ltlt) Oey wcrfs sub` ks tcurhgquet crt`cpkefgb surnery p`ysgcacngbka

b`khnes tcurhgquet pkgh ghtrkvehcus rengchka khkest`esgk khf tcurhgquet pkgh kffgtgves tc reageve

tcurhgquet pkgh furktgch ci ghiaktgch acbka khkest`etgbs khf tcurhgquet pkgh tcurhgquet khf bcmpagbktgchsskie use ci tcurhgquet khf feiaktgch ci tcurhgquet were usef Icrty sgx rkhfcmgzef bchtrcaaef trgkas were

retrgevef cut ci w`gb` icur were exbaufef ircm t`e revgew ks t`ey were bchfubtef ch pktgehts uhferncghn

pakstgb surnerges khf t`ree were exbaufef ks t`ey were bchfubtef ch khgmkas Cut ci t`e remkghghn 27 5

were iuaa text krtgbaes khf t`e rest were kjstrkbts V`ree revgew krtgbaes ch t`e sujdebt were kasc ghbaufef

kachn wgt` bkse repcrts ci bcmpagbktgchs ci tcurhgquet use Zebcmmehfktgchs ircm t`e Ksscbgktgch ci

pergcperktgve Zengsteref Hurses (KCZH) prkbtgbe bcmmgttee khf t`e KCZH jckrf ci fgrebtcrs were kasc

ghbaufef gh t`e revgew prcbess ks t`ese kre upfktef ircm tgme tc tgme kbbcrfghn tc t`e evgfehbe bcaaebtef

cver t`e akst iew yekrs Rtufges ch khtgjgctgb aeveas khf prcp`yakxgs were hct ghbaufef gh t`e revgew

prcbess

`ysgcacngbka b`khnes ci tcurhgquet kppagbktgch

V`e agmj s`cuaf je exskhnughktef jy eaevktghn khf usghn kh Esmkrb` jkhfkne cr tcurhgquet

exskhnughktcrs (R-MKZV) icr emptyghn t`e jaccf vesseas ircm t`e fgstka ehf tc t`e prcxgmka ehf prgcr tc

tcurhgquet ghiaktgch V`ere kre humercus kfvkhtknes ci t`gs ghbaufghn estkjags`ghn k baekr cperktghn igeaf

refubghn cverkaa jaccf acss khf refubghn t`e rgso ci mgbrcemjcag kt t e tgme ci reaekse V`gs

exskhnughktgch resuats gh kutctrkhsiusgch ci jaccf ircm t`e pergp`erka bgrbuaktgch ghtc t`e behtrka

bgrbuaktgch V`e cptgmka tgmghn khf khnae ci eaevktgch icr mkxgmka exskhnughktgchs ci krm `ks jeeh

s`cwh tc je 5 mgh kt 7ltfrac14 khf t`e skme icr aen gs 5 mgh kt 65frac14 V`ere gs prcnressgve beaauakr `ypcxgk

kbgfcsgs khf bccaghn gh t`e cbbaufef agmj Musbae gs mcre susbeptgjae tc gsb`emgb fkmkne t`kh hervegstcacngbka evgfehbe ci musbae fkmkne gs evgfeht 2lt‒9lt mgh kiter tcurhgquet ghiaktgch Febreksef p

(195) febreksef pC ghbreksef pBC ghbreksef O+ ghbreksef akbtkte cbbur prcnressgveay V`ese

b`khnes kre neherkaay mgaf khf weaa tcaerktef Vcurhgquet pkgh feveacps gh up tc 99 ci pktgehts 2lt‒9lt

mgh kiter buii ghiaktgch Vcurhgquet-ghfubef `ypertehsgch cbburs gh ‒99 ci bkses V`e chset gs

khkacncus tc t`e chset ci tcurhgquet pkgh Vgssue efemk feveacps gi t`e tcurhgquet tgme exbeefs 9lt

mgh Kiter feiaktgch t`e returh ci bgrbuaktgch aekfs tc t`e feveacpmeht ci t`e reperiusgch ghdury

Bcmpagbktgchs ci tcurhgquet

Herve ghdury gs t`e mcst bcmmch bcmpagbktgch Kat`cun` t e pkt`cp`ysgcacny ci herve ghdury

ksscbgktef wgt` tcurhgquet use remkghs uhbaekr gt gs agoeay t`kt jct` meb`khgbka bcmpressgch khf heurka

gsb`emgk paky kh gmpcrtkht rcae Gt bkh rkhne ircm mgaf trkhsgeht acss ci iuhbtgch tc grreversgjae fkmkne

khf pkrkaysgs

Ghtrkcperktgve jaeefghn mky cbbur fue tc kh uhfer-pressurgzef buii ghsuiigbgeht exskhnughktgch gmprcper

buii seaebtgch accseay kppagef buii bkabgigef vesseas cr tcc sacw ghiaktgch cr feiaktgch Bcmpkrtmeht

syhfrcme pressure scres b`emgbka jurhs fgngtka hebrcsgs feep vehcus t`rcmjcsgs aekfghn tc

puamchkry cr vehcus emjcagzktgch tcurhgquet pkgh t`ermka fkmkne tc tgssues khf r`kjfcmycaysgs kre

t`e ct`er pctehtgka bcmpagbktgchs gn` pressures khf icrnctteh fgngtka tcurhgquets bkh aekf tc severe

gsb`emgb ghdurges ci t`e fgngts

Mkssgve puamchkry emjcagsm ks kasc jeeh repcrtef furghn ghiaktgch khf pktgehts wgt` feep vegh

6

6

5 9

gt

0

7

5

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lt

2

6

2

5

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5gt

7232019 Tourniquets in orthopedic surgerypdf

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6ltlt5 gt9830926Vcurhgquets gh crt`cpefgb surnery

kne 2 sur `ttp4wwwhbjghamhg`ncvpmbkrtgbaesMB26763repcrt=prghtkjae

t`rcmjcsgs (FYV) must je bacseay mchgtcref furghn agmj exskhnughktgch

‑cst-tcurhgquet syhfrcmerdquo mky cbbur gh pktgehts w`c kve kf tcurhgquets kppagef icr prcachnef

tgmes V`e presehtghn iektures ci t`e syhfrcme kre swcaaeh stgii pkae agmj wgt` wekohess jut hc

pkrkaysgs usukaay kiter ‒9 weeos ci tcurhgquet kppagbktgch cstcperktgve efemk gs t`e mkgh etgcacny

re-kppagbktgch prebkutgchs

V`e pressure scurbe buii renuaktcr tujghn khf bchhebtcrs heef tc je b`eboef jeicre use khf ks wgfe k

buii ks pcssgjae s`cuaf je usef gfer buiis prcvgfe jetter trkhsmgssgch ci tgssue bcmpressgch khf acwer

buii pressures kre requgref tc bcmpress t`e krtery khf ehbe mghgmgze pctehtgka pressure-reaktef

bcmpagbktgchs Gh k brcss-cver vcauhteer stufy ci lt pktgehts kaa t`e pktgehts were sujdebtef tc wgfe ks

weaa ks hkrrcw buiis khf gt wks icuhf t`kt wgfer buiis (6 bm) were aess pkghiua t`kh hkrrcw buiis (gt bm)

gi ghiaktef kt acwer pressures khf t`ey were stgaa eiiebtgve kt cbbaufghn jaccf iacw V`e buii s`cuaf hct

fgrebtay cverage jchy prcmghehbes agoe t`e `ekf ci igjuak cr mkaaecag ks t`ere gs rgso ci fgrebt herve

bcmpressgch ehbe gt gs rebcmmehfef t`kt t`e efne ci t`e tcurhgquet s`cuaf je kt aekst bm fgstka tc

t`e `ekf ci igjuak khf bm prcxgmka tc t`e mkaaecag gh bkse ci bkai buiis Gt gs rebcmmehfef t`kt

tcurhgquets je kvcgfef gh igxktgch ci sgmpae gscaktef irkbtures ci igjuak ks gt mky ghbrekse t`e tgme ci rebcvery khf pcstcperktgve bcmpagbktgchs V`e aehnt ci t`e buii s`cuaf je ghfgvgfukagzef kbbcrfghn tc

t`e sgze khf bgrbumierehbe ci t`e pktgehts agmj Gt gs rebcmmehfef t`kt t`e s`kpe s`cuaf kaacw k shun igt kt

jct` prcxgmka khf fgstka efnes V`e wgft` s`cuaf je t`e wgfest pcssgjae jut gt s`cuaf hct ehbrckb` upch

t`e surngbka sgte V`e aehnt` s`cuaf je t`e mghgmum t`kt kssures cverakp krcuhf t`e agmj suiigbgeht tc iuaay

ehnkne t`e ikstehers V`e buii s`cuaf cverakp kt aekst 2 ghb es jut hct mcre t kh 9 ghb`es ks gt mky

bkuse neherktgch ci gn` pressures

Agmjs wgt` severe ghiebtgch pktgehts wgt` pccr bkrfgkb reserve khf trkumktgzef agmjs kre reaktgve

bchtrkghfgbktgchs tc tcurhgquet use ergp`erka heurcpkt`y FYV gh t`e agmj Zeyhkufs fgsekse khf

pergp`erka vksbuakr fgsekse s`cuaf je ruaef cut jeicre bchsgferghn tcurhgquet kppagbktgch Vcurhgquets`kve jeeh usef gh pktgehts wgt` sgboae beaa fgsekse khf trkgt khf k bcmpagbktgch rkte ci 5 wks

cjservef gh icur stufges ghbaufef gh k revgew krtgbae w`gb` ghbaufef 79 pktgehts Uhevehtiua use ci t e

tcurhgquet gh sub` bkses `ks jeeh repcrtef jy ct er ghvestgnktcrs Extrk bkutgch gh t`e pergcperktgve

pergcf s`cuaf je prkbtgbef gh sub` pktgehts

rcper kppagbktgch ci tcurhgquet

V`e tcurhgquet s`cuaf je kppagef very bkreiuaay tc t`e prcxgmka pkrt ci t`e agmj kt t`e nrektest

bgrbumierehbe jebkuse t`e musbae juao kt t`kt sgte gs t`e nrektest khf `ehbe gt kiicrfs k nrekter prctebtgch

knkghst herve ghdury V`e tcurhgquet s`cuaf je igrst feiaktef khf smcct`ehef cut Kfequkte pkffghn s`cuaf

je fche kt t`kt sgte Ykrgcus types ci sogh prctebtgch pkffghn kre kvkgakjae sub` ks t`e Rciijkh sogh

prctebtgch (JRH Mefgbka Meajcurhe Kustrkagk) Ktakhteb` sogh prctebtgch frkpe (Ktakhteb` Mefgbka

Fevgbes krrcnkte UO) Yeajkhfs etb Yeajkhfs were icuhf tc je skie khf bcst-eiiebtgve sogh prctebtgch

jehekt` t`e tcurhgquet Rciijkh khf Ktakhteb` sogh prctebtgch frkpes kve jeeh icuhf tc febrekse t`e

rkte ci sogh bcmpagbktgchs ks bcmpkref tc fgrebt kppagbktgch ci tcurhgquet ch t`e sogh Rtretb`ef saeeves

mkfe ci twc-akyer tujuakr eakstgb mktergka khf mktb`ef tc t`e spebgigb tcurhgquet buiis prcfubef

sgnhgigbkhtay aesser khf aess severe pghb`es khf wrghoaghn ci t`e sogh ks bcmpkref tc ct`er agmj prctebtgch

fevgbes stufgef gh 55 fgiiereht trgkas usghn igve types ci agmj prctebtgch fevgbes Khy scautgch kppagef tc

t`e sogh must hct je kaacwef tc ruh uhferhekt` t`e tcurhgquet ks gt mky aekf tc sogh jurhs K

bgrbumierehtgka kf`esgve jkboef pakstgb frkpe kppagef dust fgstka tc t`e tcurhgquet bkh `eap gh prevehtghnt`gs V`e tcurhgquet s`cuaf je ghiaktef kiter t`e agmj ks jeeh exskhnughktef khf prepkref icr surnery

0

2

5 5

7

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26

5

5

5

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2

7

2

7232019 Tourniquets in orthopedic surgerypdf

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6ltlt5 gt9830926Vcurhgquets gh crt`cpefgb surnery

kne 6 sur `ttp4wwwhbjghamhg`ncvpmbkrtgbaesMB26763repcrt=prghtkjae

V`e skie furktgch khf pressure icr tcurhgquet

Rkie furktgch khf pressure icr tcurhgquet use remkghs k bchtrcversy Hc strgbt nugfeaghes kve jeeh akgf

fcwh K skie tgme agmgt ci ‒2 `ks jeeh fesbrgjef cracboer et ka (ltlt9) `kve icuhf k strchn

bcrreaktgch ci herve ghdury wgt` prcachnef tctka tcurhgquet tgme wgt` kh kpprcxgmkte t`reeicaf ghbrekse gh

rgso ci heurcacngbka bcmpagbktgchs icr ekb` 2lt mgh ghbrekse gh tcurhgquet ghiaktgch V`e furktgch ci

uhghterruptef tcurhgquet ghiaktgch kasc ghbreksef t e agoeag ccf ci heurka fysiuhbtgch Use ci tcurhgquet

icr 8 ` khf pressures ci 825lt mm n gh acwer extremgty khf 85lt mm n gh upper extremgty ghbreksest`e rgso ci bcmpressgch heurkprkxgk Gi 8 ` gs requgref t`e tcurhgquet s`cuaf je feiaktef icr 5 mgh icr

every 2lt mgh ci ghiaktgch tgme

Crt`cpefgb surnechs neherkaay prkbtgbe igxef ghiaktgch pressures (typgbkaay 5lt mm n icr upper krm khf

2ltlt mm n icr t`gn`) cr igxef kmcuht ci pressure kjcve systcagb krtergka pressure (typgbkaay +ltlt mm n

icr upper krm khf ltlt‒5lt mm n icr t`gn ) V`ese prkbtgbes s`cuaf hct je icaacwef ks t`ese fc hct

tkoe ghtc kbbcuht t`e kne gh jct` khf t`e jaccf pressure (J) ci t`e pktgeht gh t`e icrmer teb`hgque Ks gt

`ks jeeh ypct`esgzef jy cracboer et ka (ltlt9) ycuhner pktgehts kve acwer systcagb jaccf pressures

(RJ) khf ehbe ghiaktghn t`e tcurhgquets tc igxef pressures aekfs tc k akrner fgiierehbe jetweeh

tcurhgquet ghiaktgch pressure khf krtergka pressure aekfghn tc exbessgve bcmpressgch Use ci acwesteiiebtgve ghiaktgch pressure ks jeeh kfvcbktef tc mghgmgze tcurhgquet-reaktef herve ghdury

Agmj cbbausgch pressure (AC) ks jeeh utgagzef tc bkabuakte t`e tcurhgquet ghiaktgch pressure jy t`e

KCZH Gt gs t`e pressure gh t`e tcurhgquet kt w`gb` t`e fgstka krtergka jaccf iacw ks kssessef jy k Fcppaer

prcje `eaf cver k fgstka krtery gs cbbaufef V`gs vkaue gs neherkaay gn`er t`kh t`e RJ V`e KCZH

nugfeaghes rebcmmehf t`kt t`e tcurhgquet je ghiaktef ghtrkcperktgveay tc k pressure `gn`er t`kh t`e AC K

skiety mkrngh gs kffef tc bcver ghtrkcperktgve iaubtuktgchs gh krtergka pressure Gi AC gs 12lt mm n t`e

skiety mkrngh gs 6lt mm n icr AC 2‒7lt mm n t`e mkrngh gs 9lt mm n khf gi AC gs 87lt mm

n t`e mkrngh gs 0lt mm n Icr pefgktrgb pktgehts kffghn 5lt mm n `ks jeeh rebcmmehfef

Rtufges `kve s`cwh t`kt buii pressure jksef ch AC meksuref gmmefgkteay prgcr tc surnery gs neherkaayacwer t`kh t`e bcmmchay usef buii pressures khf gs suiigbgeht tc mkghtkgh k sktgsikbtcry surngbka igeaf

R`kw et ka (70) rebcmmehf t`kt acwest tcurhgquet pressure t`kt mkghtkghs k jaccfaess igeaf s`cuaf je

usef Aevy et ka (772) icuhf t`kt t`e mekh bkabuaktef tcurhgquet pressure wks lt2 raquo 26 mm n icr

kfequkte `emcstksgs gh t`e upper agmj w`gb` wks weaa jeacw t`e 5lt‒2ltlt mm n prevgcusay

rebcmmehfef khf irequehtay empacyef Bachgfghe ks jeeh icuhf tc exkberjkte t`e refubtgch gh mekh

krtergka J khf feakyef J rebcvery icaacwghn tcurhgquet feiaktgch prcjkjay ksscbgktef wgt` bachgfghe-

ghfubef gh`gjgtgch ci hcrkfrehkaghe reaekse Vcurhgquet reaekse kaacwghn k reperiusgch ghtervka ci lt‒2lt

mgh icaacwef jy re-ghiaktgch gs rebcmmehfef tc extehf t e furktgch ci tctka tcurhgquet tgme Rghbe t e

feiaktgch icr 5 mghutes kiter every 2lt mgh seems gmprkbtgbka ircm t`e surngbka pcght ci vgew sc icr kaa

prkbtgbka purpcses gt s`cuaf je feiaktef icr kt aekst lt mghutes gi t`e surngbka tgme gs mcre t kh `r V`gs gs

kasc suppcrtef jy k survey jy Cfghhsch et ka w`eregh gt `ks jeeh s`cwh t`ktmcst ci t`e crt`cpefgb

surnechs ieat t`kt k 5-mgh feiaktgch tgme kiter ` tcurhgquet tgme wks skie V`e ghbgfehbe ci repcrtef

bcmpagbktgchs gh t`gs survey wks 9 gh 92606 bkses Igiteeh cut ci t`ese were heurcacngbka gh hkture cut

ci w`gb` twc were permkheht Achner furktgch ci feiaktgch ks jeeh ksscbgktef wgt` k mcfest febrekse

gh irequehby ci heurcacngbka bcmpagbktgchs Gt gs bchbaufef t`kt t e tcurhgquet s`cuaf je ghiaktef

kbbcrfghn tc t`e AC khf s`cuaf je feiaktef kiter ` icr t`e acwer agmj khf kiter ` icr t`e upper agmj

icr kt aekst lt mghutes

Zebcmmehfktgchs icr t`e skie use ci tcurhgquet

V`e KCZH jckrf ci fgrebtcrs `ks kpprcvef t e icaacwghn prkbtgbes icr t`e skie use ci tcurhgquets V`ese

22

6

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27

6lt

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6

6

7232019 Tourniquets in orthopedic surgerypdf

httpslidepdfcomreaderfulltourniquets-in-orthopedic-surgerypdf 512

6ltlt5 gt9830926Vcurhgquets gh crt`cpefgb surnery

kne 5 sur `ttp4wwwhbjghamhg`ncvpmbkrtgbaesMB26763repcrt=prghtkjae

kre eiiebtgve ircm Dkhukry ltltgt

ktgeht skiety s`cuaf je t`e prgmkry bchsgferktgch gh evkauktgch seaebtgch purb`kse khf use ci t`e

pheumktgb tcurhgquet khf kbbesscrges V`e tcurhgquet khf gts kbbesscrges s`cuaf je ghspebtef testef khf

mkghtkghef kbbcrfghn tc mkhuikbturers wrgtteh ghstrubtgchs V`e pergcperktgve hurse s`cuaf kssess t`e

pktgeht precperktgveay icr rgsos khf repcrt pctehtgka bchtrkghfgbktgchs tc t`e surnech V`e pheumktgb

tcurhgquet s`cuaf je bchhebtef tc t`e kpprcprgkte pcwernks scurbe t`e bcmpchehts s`cuaf je khfaef

khf t`e buii kppagef gh k mkhher tc mghgmgze t`e rgso ci pktgeht ghdury V`e extremgty s`cuaf je

exskhnughktef jeicre ghiaktgch ci t`e tcurhgquet Vcurhgquet ghiaktgch pressure s`cuaf je oept tc t`e

mghgmum eiiebtgve pressure Ghiaktgch tgme s`cuaf je oept tc k mghgmum khf feiaktgch mkhknef tc

mghgmgze rgsos tc t`e pktgeht V`e pktgeht s`cuaf je mchgtcref bchtghucusay wgt` spebgka bchsgferktgch tc

pkrkmeters agoe `ypertehsgch khf tkb`ybkrfgk ks k surrcnkte ci tcurhgquet pkgh khf temperkture ci t`e agmj

w`gae t`e tcurhgquet buii gs ghiaktef V`e pergcperktgve rengsteref hurse s`cuaf evkaukte t`e cutbcme ci t`e

pktgeht bkre kt t e ehf ci t`e prcbefure Kffgtgchka bkre s`cuaf je tkoeh gh prcbefures ghvcavghn

tcurhgquet bchtrca ch twc extremgtges jebkuse t`e rgso ci bcmpagbktgchs khf t`e systemgb eiiebts ci

tcurhgquet use mky je ghbreksef ctehtgka pktgeht ghdurges khf bcmpagbktgchs ksscbgktef wgt` ghtrkvehcus

rengchka khest`esgk (GYZK Jgers jacbo) s`cuaf je gfehtgigef khf skie prkbtgbes estkjags`ef V`e

tcurhgquet user s`cuaf kve k very baekr uhferstkhfghn ks tc t`e sequehbe ci ghiaktgch khf feiaktgch w`eh

usghn k fuka jakffer buii cr twc sghnae jakffer buiis Kaaernges tc acbka khest`etgb scautgchs s`cuaf je ruaef

cut jeicre khf Revere ghdurges khf eveh fekt`s kve jeeh repcrtef w`eh t`e wrchn buii wks feiaktef

V`e tcurhgquet khf kbbesscrges s`cuaf je baekhef kiter ekb` use ktgeht kssessmehts pakh ci bkre

ghtervehtgchs gmpaemehtef khf evkauktgch ci bkre reaktef tc use ci k pheumktgb tcurhgquet s`cuaf je

fcbumehtef Efubktgch bcmpetehby kssessmeht khf vkagfktgch s`cuaf je bchfubtef jeicre t`e

pergcperktgve rengsteref hurse mkhknes t`e bkre ci k pktgeht usghn k pheumktgb tcurhgquet cagbges khf

prcbefures icr pheumktgb tcurhgquets s`cuaf je feveacpef revgewef pergcfgbkaay revgsef khf upfktef ks

hebesskry khf s`cuaf je kvkgakjae icr rekfy reierehbe gh t`e prkbtgbe settghn V`e ekat` bkre crnkhgzktgchs

qukagty mkhknemeht prcnrkm s`cuaf ghbaufe ghvestgnktgch ci kfverse evehts khf hekr mgsses ksscbgktefwgt` t`e use ci k pheumktgb tcurhgquet

V`e Ksscbgktgch ci Rurngbka Veb`hcacngsts (KRV) `ks kasc rebcmmehfef t`kt t`e surngbka tekm memjers

s`cuaf bcmpaete trkghghn tc femchstrkte t`e ohcwaefne khf bcmpetehby gh prcper use ci t`e pheumktgb

tcurhgquet Fcbumehtktgch ci t`e use ci tcurhgquet s`cuaf je ghbaufef gh t`e pktgehts cperktgch t`ekter

rebcrfs

V`gn` tcurhgquet s`cuaf hct je ghiaktef wgt` t`e ohee gh t`e iaexef pcsgtgch icaacwef jy aen strkgn`tehghn

ks t`gs igxktes t`e sbgktgb herve tc t`e iemur khf bkuses extreme trkbtgch ch t`e herve

Jruher `kf akgf fcwh lt ruaes icr t`e skie use ci tcurhgquet w`gb` `kve jeeh mcfgigef jy Jrkgt`wkgte khfOaehermkh khf kre ngveh gh Vkjae

Fgngtka tcurhgquets gh t`e icrm ci rcaaef nacve ehrcse frkgh cr bkt`eters kve jeeh s`cwh tc neherkte

wgfe rkhnes ci pressures ehbe skie use nugfeaghes were akgf fcwh jy R`kw et ka jy meksurghn

p`ysgcacngbka pressures Vcurhgquets `kve kasc jeeh usef gh igxktgch ci bacsef irkbtures khf

ghtrkmefuaakry hkgaghn fgkjetgb icct kmputktgchs khf trkumk khf wkr sgtuktgchs gh t e kjsehbe ci

s`cbo regmpakhtktgch khf mgbrcvksbuakr prcbefures

Vcurhgquet pkgh4 Gts bkuse khf mkhknemeht

V`e baghgbka syhfrcme ci tcurhgquet pkgh bchsgsts ci severka bcmpchehts khf gs hct dust fue tc t`e pkgh khf pressure uhfer t`e tcurhgquet V`e smkaaer uhmyeaghktef B-igjers kre mcre resgstkht tc acbka khest`etgb

65

2

69

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60

60

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httpslidepdfcomreaderfulltourniquets-in-orthopedic-surgerypdf 612

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kne 9 sur `ttp4wwwhbjghamhg`ncvpmbkrtgbaesMB26763repcrt=prghtkjae

(AK) ghfubef bchfubtgch jacbo ks bcmpkref tc t`e akrner myeaghktef K-igjers Kiter ghtrkt`ebka

kfmghgstrktgch ci kh kfequkte fcse ci AK bchfubtgch gh jct` K- khf B-igjers gs jacboef Jut ks t`e

bchbehtrktgch ci AK gh t`e berejrcspghka iaugf (BRI) febrekses t`e B-igjers stkrt bchfubtghn gmpuases

jeicre t`e K-igjers resuatghn gh k fuaa tcurhgquet pkgh gh t e presehbe ci kh khest`etgb w`gb` w`eh

kssessef jy pgh prgbo kppekrs kfequkte

Eutebtgb mgxture ci acbka khest`etgb (EMAK) brekm kppagbktgch AKs ngveh vgk t`e heurkxgka rcute

wgt` cr wgt`cut cpgcgfs cr GYZK `kve jeeh usef tc kttehukte tcurhgquet-ghfubef pkgh

Mknhesgum suaikte oetkmghe khf oetcrcakb `kve kasc jeeh usef ks kfduvkhts gh GYZK wgt`

vkrgkjae resuats Bachgfghe ks kasc jeeh subbessiuaay usef Ykrgcus knehts ghbaufghn

fexmefetcmgfghe khf oetkmghe `kve kasc jeeh usef ghtrkvehcusay tc kttehukte t gs pkgh

Katerhktgve teb hgques agoe eaebtrcpuhbture khf mefgtktgch `kve kasc jeeh usef icr tcurhgquet pkgh

Vgmghn ci tcurhgquet reaekse

V`ere kre fgiiereht sb`ccas ci t`cun`t renkrfghn t`e tgmghn ci reaekse ci tcurhgquet V`ree stufges ch

tgmghn ci tcurhgquet reaekse were icuhf ghbaufghn lt ohees (0lt pktgehts wgt` uhgakterka prcbefures khf lt

pktgehts wgt` jgakterka tctka ohee krt`rcpaksty) khf 0 pktgehts icr jgakterka bkrpea tuhhea reaekse V`e stufy

nrcup wks fgvgfef ghtc twc equka nrcups (6lt pktgehts gh ekb` nrcup gh che stufy khf lt pktgehts gh t`e

sebchf stufy wgt` lt ohees w`ere tcurhgquet wks reaeksef jeicre khf lt ohees w`ere tcurhgquet wks

reaeksef kiter t`e bacsure) Gh che nrcup t`e tcurhgquet wks feiaktef jeicre wcuhf bacsure khf gh t`e

ct`er kiter wcuhf bacsure V`ere kre hc sgnhgigbkht fgiierehbes gh bcmpagbktgchs agoe pkgh cr ebb`ymcsgs gh

pktgehts gh w`cm t`e tcurhgquet wks reaeksef prgcr tc cr kiter sogh bacsure emcstksgs bchtrca wks jetter gi

gt wks reaeksef kiter wcuhf bacsure khf gt kasc `eapef febrekse t`e cperktgve tgme jy refubghn t`e tgme acst

gh kb`gevghn emcstksgs gi t`e tcurhgquet wks reaeksef prgcr tc sogh bacsure

V`e eiiebts ci feiaktgch ci tcurhgquet

Feiaktgch aekfs tc k febrekse gh mekh krtergka J sgnhgigbkhtay pkrtay cwghn tc t`e reaekse ci metkjcagtes

ircm t`e gsb`emgb agmj ghtc t`e bgrbuaktgch khf t`e febrekse gh pergp`erka vksbuakr resgstkhbe K trkhsgeht

ghbrekse gh EtBC febrekse gh temperkture khf behtrka vehcus cxyneh tehsgch kre seeh

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gsb`emgb fkmkne mefgktef jy cxyneh iree rkfgbkas khf gs ohcwh ks t`e ‑reperiusgch syhfrcmerdquo V`ere

gs ghterkbtgch jetweeh t`e kbtgvktef heutrcp`gas khf t`e surikbe kf`esgch mcaebuaes ch t`e vksbuakr

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BF0 ehfct`eagka beaa kf`esgch mcaebuae- (BKM-) cbburs V`gs `ks acbka khf wgfesprekf systemgb

eiiebts Kbute Zespgrktcry Fgstress Ryhfrcme (KZFR) rehka khf bkrfgkb ghdurges mky cbbur khf mkyaekf tc ct`er severe khf citeh iktka bcmpagbktgchs Zeperiusgch ghdury kasc cbburs furghn crnkh

trkhspakhtktgch kcrtgb brcss bakmpghn bkrfgkb jypkss tgssue nrkitghn khf ghtestghka resebtgchs Vrektmeht

wgt `yfrcneh suaigfe khf a-krnghghe khf pre-trektmeht wgt ghfgvgfuka mchcbachka khtgjcfges `ks

jeeh s`cwh tc agmgt t`e gsb`emgk reperiusgch ghdury

Yehcus emjcagzktgch gs khct`er bcmpagbktgch repcrtef kiter feiaktgch ci tcurhgquet espebgkaay ci t`e acwer

agmjs

BCHBAURGCH

Vcurhgquets kre useiua kgfs icr agmj prcbefures ks t`ey febrekse t`e jaccf acss furghn surnery khf prcvgfek reaktgveay jaccfaess igeaf icr t`e surnech gi usef prcperay Rkie use ci tcurhgquets jy gmpaemehtktgch ci

56

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7232019 Tourniquets in orthopedic surgerypdf

httpslidepdfcomreaderfulltourniquets-in-orthopedic-surgerypdf 712

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kne gt sur `ttp4wwwhbjghamhg`ncvpmbkrtgbaesMB26763repcrt=prghtkjae

prcper pkffghn uhferhekt` t`e tcurhgquet hct exbeefghn t`e skie agmgt ci tcurhgquet pressure khf furktgch

feiaktghn t`e tcurhgquet icr s`crt ghtervkas ci lt‒5 mgh gi t`e skie tcurhgquet tgme `ks eakpsef khf

prcvgfghn kfequkte khkanesgk jy jacbos rengchka teb`hgques cr AK fruns cr brekms GY cpgcgfs cr

khkanesgbs bkh nc k achn wky gh refubghn t`e bcmpagbktgchs ksscbgktef wgt` tcurhgquet use re-

fetermghktgch ci AC khf ghiaktghn tcurhgquets kbbcrfghnay bkh eap refube t`e bcmpagbktgchs ksscbgktef

wgt` t`e use Gt s`cuaf je kvcgfef gh pktgehts wgt` FYV pergp`erka heurcpkt`ges pergp`erka vksbuakr

fgsekse sgboae beaa fgsekse khf Zeyhkufs fgsekse cr gh smkaa surnerges ci igjuak rcper pktgehtmchgtcrghn khf bkre kiter feiaktgch khf bkreiua sekrb` icr heurcacngbka feigbgt pcstcperktgveay gi khy bkh

feighgteay mghgmgze t`e bcmpagbktgchs ksscbgktef wgt` tcurhgquet uskne Kaa t`ese meksures tc refube t`e

bcmpagbktgchs ci tcurhgquet heef tc je prcvef jy bchfubtghn akrne-sbkae rkhfcmgzef bchtrcaaef baghgbka

trgkas Mcre humjer ci rkhfcmgzef bchtrcaaef trgkas khf prcspebtgve stufges heef tc je fche tc evkaukte t`e

fgiierehtgka herve ghdurges kiter tcurhgquet use V`e hewer tcurhgquet feiaktgch fevgbes agoe R-MKZV kve

rebehtay bcme gh t`e mkroet khf akrner trgkas khf stufges heef tc je fche tc prcve t`egr eiigbkby

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Hccrfgh R MbEweh DK Orkn` DI Egseh K Mksrg JK Rurngbka tcurhgquets gh crt`cpkefgbs D Jche

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6 Vcurhgquet ‒ K R-MKZV bchbept Rgmch Kxch Ircm4

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5 Fuiiy D V`e krtergka tcurhgquet Fepkrtmeht ci Khkest`esgk Cttkwk Neherka cspgtka Kbbessef ircm4

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9 ^krreh D krfgmkh DD- ^ccai YD Agmj exskhnughktgch G V`e krm4 eiiebt ci khnae ci eaevktgch

khf krtergka bcmpressgch Khh Z Bcaa Rurn Ehna 77gt642lt‒ _MBGF4 MB67gt9gt]

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0 kmpsch HJ gkhtkfcsg BK Hekr ghirkref mchgtcrghn ci umkh soeaetka musbae cxynehktgch furghn

icrekrm gsb`emgk D Kppa `ysgca 700964667‒5gt _ujMef4 26lt260]

7 Goemctc W Ocjkyks`g Usug M Gs`gg R B`khnes gh serum mycnacjgh aeveas bkusef jy tcurhgquet

gsb`emgk uhfer hcrmct`ermgb khf ypct`ermgb bchfgtgchs Bagh Crt`cp Zeakt Zes 70026479‒2lt

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lt Mgb`eka O Urjkh Khkest`esgk icr crt`cpkefgb surnery Gh4 Mgaaer ZF efgtcr Mgaaers Khest`esgk gtt`

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ekrse FD Zeperiusgch ci t`e gsb`emgb mycbkrfgum D Mca BeaaBkrfgca 7gtgt749lt5‒9

2 Esteje D^ Bcmpagbktgchs ci tcurhgquet use _Kbbessef ch lt7lt9lt] Ircm4

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6 cracboer VV eja DZ Nkag J Dkhocwsog BD Juroae BM Jerry FD et ka Khest`etgb pktgeht khf

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5 Kvbg N Kokh M Wgafgrgm R Kougravez V Fgngtka heurcvksbuakr bcmpressgch fue tc k icrnctteh tcurhgquet

khf Rurn ltlt20422‒9 _ujMef4 7275lt]

9 kamer R Nrk`km N Vcurhgquet-ghfubef r`kjfcmycaysgs kiter tctka ohee repakbemeht Khh Z Bcaa

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gt Furrkht B Vcwhaey ^K Zkmoumkr R O`cc BV Icrnctteh fgngtka tcurhgquet4 Rkavkne ci kh gsb`emgb

ighner jy kppagbktgch ci mefgbghka aeeb`es Khh Z Bcaa Rurn Ehna ltlt900469‒6

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0 Rchn DE B`uh F R`gh D kro B Aee DW uamchkry t`rcmjcemjcagsm kiter tcurhgquet ghiaktgch

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7 MbEweh DK Ghopeh O Vcurhgquet skiety prevehtghn sogh ghdurges Rurngbka Veb`hca ltlt2649‒5

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pkrt ci t`e igjuak K prcspebtgve rkhfcmgzef trgka D Jche Dcght Rurn Km 772gt54gtltlt‒2

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2 Zebcmmehfef Rtkhfkrfs ci rkbtgbe icr skie use ci heumktgb Vcurhgquets _Akst kbbessef ch lt

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6 Zebcmmehfef rkbtgbes icr use ci t`e pheumktgb tcurhgquet gh t`e pergcperktgve prkbtgbe settghn

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5 Okm B Okvkhkn` Z Wcchn II V`e krtergka tcurhgquet4 pkt`cp`ysgcacngbka bchsequehbes khf

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9 Igs`er J Zcjerts BR Vcurhgquet use khf sgboae beaa `emcnacjghcpkt`y4 cw s`cuaf we prcbeef3

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Khest` Khkan ltlt2704562‒6

0 Kfu-Nykmig W Rkhokrkhoutty M Mkrwk R Use ci k tcurhgquet gh pktgehts wgt` sgboae-beaa fgsekse

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7232019 Tourniquets in orthopedic surgerypdf

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2lt Nuc R Gs Yeajkhf stgaa k skie khf bcst eiiebtgve sogh prctebtgch jehekt` t`e tcurhgquet gh `khf surnery3

khf Rurn lt945‒0 _ujMef4 260lt6]

2 Fgh Z Neffes V Rogh prctebtgch jehekt` t`e tcurhgquet Kprcspebtgve rkhfcmgzef trgka KHT D Rurn

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22 efcwgtz ZK Vcurhgquet-ghfubef heurc-musbuakr ghduryKrebeht revgew ci rkjjgt khf baghgbka

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26 ^`eeaess BZ 2rf Gh ^`eeaess Vextjcco ci Crt`cpefgbs Extremgty Vcurhgquets Kvkgakjae ch ghterhet

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25 Feacun`ry DA Nrgiigt`s Z Krtergka tcurhgquets Bchtghughn Efubktgch gh Khkest`esgk Brgt Bkre kgh

(Ghfgkh Efgtgch) ltlt7496‒0

29 Mc`aer AZ efcwgtz ZK Myers ZZ C`krk ^M Acpez MK Ners`uhhg F Ghtermgtteht reperiusgch

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2gt KCZH Zebcmmehfef rkbtgbes Bcmmgttee Zebcmmehfef prkbtgbes icr t`e use ci t`e pheumktgb

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20 Vrefweaa RD ^gamgho M Ghopeh O MbEweh DK efgktrgb tcurhgquets4 Khkaysgs ci buii khf agmj

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7232019 Tourniquets in orthopedic surgerypdf

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gt B`cg K Musgka I Kmt`cr H Akub`e Z Zkmpp V Rk`k D et ka V`e eiiebt ci eaebtrc kbupuhbture khf

mefgtktgch ch expergmehtka tcurhgquet pkgh Eur D Ghtenr Mef ltlt0(Ruppa )45‒9

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