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Pediatric Tourniquet

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Do Adult Tourniquets work in children? Unfortunately, school shootings and Mass Casualty producing events continue at alarming rates, so we all must be prepared to treat all ranges of patients.

The article is: Adult Tourniquet for Use in School-Age Emergencies from The American Academy of Pediatrics. In this study the authors used 60 volunteers (36M, 24F) aged 6-16 to evaluate efficacy of the CAT Gen 7 in stopping arterial flow in the upper and lower extremity. Placement was mid-thigh or mid-bicep with ½ turn increments until Doppler Ultrasound Pulse could not be heard.

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Upper Extremity - Successful occlusion in all 60. Circumference ranged from 16-37cm. # of turns required= ½ - 2. More turns as arm circumference increased.

Lower Extremity - 56/60 successful occlusion (1 stopped for pain the other 3 stopped per protocol as 3 turn max reached without cessation of pulse. Each of these 3 had a BMI of 35, 38, 35). Circumference ranged from 26-55.5cm. # of turns required= 1-3. The authors suspected that occlusion would have occurred had they been able to use more than 3 turns.

The authors noted a few significant findings: Bending the base plate when applying the CAT makes it more effective (less turns required). The CAT still worked when applied over loose, lightweight clothing. The arm typically required 1-1.5 turns, the thigh required 1.5-2.5 turns which is helpful information when training.

Additional notes: With approximately 80ml/kg of blood volume, even a small amount of blood can lead to hemorrhagic shock. Adult TQs applied to pediatric patients have over 50 documented case uses in Iraq and Afghanistan. CTECC guidelines state: “Provider should not hesitate to apply tourniquets to pediatric casualties”. CAT is recommended for circumference down to 12.7 cm (note average upper arm circumference in 4-6m is 12.9cm, average thigh circumference in 0-3m is 17.8cm).

Additional Reading: Pediatric Extremity Hemorrhage and Tourniquet Use from Journal of Emergency Medical Services (JEMS)

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