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Tourniquet for crush injury

Question #4

Is there any evidence to suggest applying a tourniquet to an individual whose sustained a prolonged crush injury to an extremity will improve outcomes before releasing them? This came up in the current CME with hyperkalemia in terms of an unconscious person laying on their limbs for prolonged time. Thanks!

Answer:

The evidence on this topic is mixed. There may be some protective properties of proactively applying a tourniquet to an extremity that has suffered a prolonged crush injury however we must weigh the risk of causing an ischemic injury to that person by applying the tourniquet as well.

True compartment syndrome does take time to set in. Paramedics should weigh how long the injury has been present for to determine the risk of compartment syndrome.

Please seek further direction from your service as tourniquet application is managed under the BLS PCS and your service may have specific direction in the setting of a crush injury. 

There is a good review on compartment syndrome below.

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https://openorthopaedicsjournal.com/VOLUME/8/PAGE/185/ABSTRACT/

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Medical Directive Category

Hyperkalemia

Published

23 January 2025

Views

88

Please reference the MOST RECENT ALS PCS for updates and changes to these directives.