Tourniquets: Devices for the compression of a blood vessel by application around an extremity to control the circulation and prevent the flow of blood to or from the distal area. (From Dorland, 28th ed)Hemostasis, Surgical: Control of bleeding during or after surgery.Anesthesia, Conduction: Injection of an anesthetic into the nerves to inhibit nerve transmission in a specific part of the body.Blood Loss, Surgical: Loss of blood during a surgical procedure.Arthroplasty, Replacement, Knee: Replacement of the knee joint.Anesthesia, Intravenous: Process of administering an anesthetic through injection directly into the bloodstream.Ischemia: A hypoperfusion of the BLOOD through an organ or tissue caused by a PATHOLOGIC CONSTRICTION or obstruction of its BLOOD VESSELS, or an absence of BLOOD CIRCULATION.Operating Room Technicians: Specially trained personnel to assist in routine technical procedures in the operating room.Orthopedic Procedures: Procedures used to treat and correct deformities, diseases, and injuries to the MUSCULOSKELETAL SYSTEM, its articulations, and associated structures.Arm: The superior part of the upper extremity between the SHOULDER and the ELBOW.Phlebotomy: The techniques used to draw blood from a vein for diagnostic purposes or for treatment of certain blood disorders such as erythrocytosis, hemochromatosis, polycythemia vera, and porphyria cutanea tarda.Leg: The inferior part of the lower extremity between the KNEE and the ANKLE.Prilocaine: A local anesthetic that is similar pharmacologically to LIDOCAINE. Currently, it is used most often for infiltration anesthesia in dentistry.Encyclopedias as Topic: Works containing information articles on subjects in every field of knowledge, usually arranged in alphabetical order, or a similar work limited to a special field or subject. (From The ALA Glossary of Library and Information Science, 1983)Biomedical Engineering: Application of principles and practices of engineering science to biomedical research and health care.Calibration: Determination, by measurement or comparison with a standard, of the correct value of each scale reading on a meter or other measuring instrument; or determination of the settings of a control device that correspond to particular values of voltage, current, frequency or other output.Materials Management, Hospital: The management of all procurement, distribution, and storage of equipment and supplies, as well as logistics management including laundry, processing of reusables, etc.AmputeesPatents as Topic: Exclusive legal rights or privileges applied to inventions, plants, etc.First Aid: Emergency care or treatment given to a person who suddenly becomes ill or injured before full medical services become available.Emergencies: Situations or conditions requiring immediate intervention to avoid serious adverse results.Emergency Service, Hospital: Hospital department responsible for the administration and provision of immediate medical or surgical care to the emergency patient.Emergency Medical Services: Services specifically designed, staffed, and equipped for the emergency care of patients.Movement: The act, process, or result of passing from one place or position to another. It differs from LOCOMOTION in that locomotion is restricted to the passing of the whole body from one place to another, while movement encompasses both locomotion but also a change of the position of the whole body or any of its parts. Movement may be used with reference to humans, vertebrate and invertebrate animals, and microorganisms. Differentiate also from MOTOR ACTIVITY, movement associated with behavior.Head: The upper part of the human body, or the front or upper part of the body of an animal, typically separated from the rest of the body by a neck, and containing the brain, mouth, and sense organs.Microscopy, Electron: Microscopy using an electron beam, instead of light, to visualize the sample, thereby allowing much greater magnification. The interactions of ELECTRONS with specimens are used to provide information about the fine structure of that specimen. In TRANSMISSION ELECTRON MICROSCOPY the reactions of the electrons that are transmitted through the specimen are imaged. In SCANNING ELECTRON MICROSCOPY an electron beam falls at a non-normal angle on the specimen and the image is derived from the reactions occurring above the plane of the specimen.Foramen Ovale, Patent: A condition in which the FORAMEN OVALE in the ATRIAL SEPTUM fails to close shortly after birth. This results in abnormal communications between the two upper chambers of the heart. An isolated patent ovale foramen without other structural heart defects is usually of no hemodynamic significance.Toes: Any one of five terminal digits of the vertebrate FOOT.Ear, External: The outer part of the hearing system of the body. It includes the shell-like EAR AURICLE which collects sound, and the EXTERNAL EAR CANAL, the TYMPANIC MEMBRANE, and the EXTERNAL EAR CARTILAGES.Scrotum: A cutaneous pouch of skin containing the testicles and spermatic cords.Hair: A filament-like structure consisting of a shaft which projects to the surface of the SKIN from a root which is softer than the shaft and lodges in the cavity of a HAIR FOLLICLE. It is found on most surfaces of the body.Penis: The external reproductive organ of males. It is composed of a mass of erectile tissue enclosed in three cylindrical fibrous compartments. Two of the three compartments, the corpus cavernosa, are placed side-by-side along the upper part of the organ. The third compartment below, the corpus spongiosum, houses the urethra.Atrial Appendage: Ear-shaped appendage of either atrium of the heart. (Dorland, 28th ed)PubMed: A bibliographic database that includes MEDLINE as its primary subset. It is produced by the National Center for Biotechnology Information (NCBI), part of the NATIONAL LIBRARY OF MEDICINE. PubMed, which is searchable through NLM's Web site, also includes access to additional citations to selected life sciences journals not in MEDLINE, and links to other resources such as the full-text of articles at participating publishers' Web sites, NCBI's molecular biology databases, and PubMed Central.Periodicals as Topic: A publication issued at stated, more or less regular, intervals.BooksPublishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing.MEDLINE: The premier bibliographic database of the NATIONAL LIBRARY OF MEDICINE. MEDLINE® (MEDLARS Online) is the primary subset of PUBMED and can be searched on NLM's Web site in PubMed or the NLM Gateway. MEDLINE references are indexed with MEDICAL SUBJECT HEADINGS (MeSH).Serial Publications: Publications in any medium issued in successive parts bearing numerical or chronological designations and intended to be continued indefinitely. (ALA Glossary of Library and Information Science, 1983, p203)Music: Sound that expresses emotion through rhythm, melody, and harmony.Friends: Persons whom one knows, likes, and trusts.Music Therapy: The use of music as an adjunctive therapy in the treatment of neurological, mental, or behavioral disorders.Friend murine leukemia virus: A strain of Murine leukemia virus (LEUKEMIA VIRUS, MURINE) producing leukemia of the reticulum-cell type with massive infiltration of liver, spleen, and bone marrow. It infects DBA/2 and Swiss mice.Singing: Modulation of human voice to produce sounds augmented by musical tonality and rhythm.Polynesia: The collective name for the islands of the central Pacific Ocean, including the Austral Islands, Cook Islands, Easter Island, HAWAII; NEW ZEALAND; Phoenix Islands, PITCAIRN ISLAND; SAMOA; TONGA; Tuamotu Archipelago, Wake Island, and Wallis and Futuna Islands. Polynesians are of the Caucasoid race, but many are of mixed origin. Polynesia is from the Greek poly, many + nesos, island, with reference to the many islands in the group. (From Webster's New Geographical Dictionary, 1988, p966 & Room, Brewer's Dictionary of Names, 1992, p426)Exsanguination: Rapid and extreme blood loss leading to HEMORRHAGIC SHOCK.Neurologic Examination: Assessment of sensory and motor responses and reflexes that is used to determine impairment of the nervous system.Silicon: A trace element that constitutes about 27.6% of the earth's crust in the form of SILICON DIOXIDE. It does not occur free in nature. Silicon has the atomic symbol Si, atomic number 14, and atomic weight [28.084; 28.086].Thermometry: Measurement of the temperature of a material, or of the body or an organ by various temperature sensing devices which measure changes in properties of the material that vary with temperature, such as ELASTICITY; MAGNETIC FIELDS; or LUMINESCENCE.Drug Approval: Process that is gone through in order for a drug to receive approval by a government regulatory agency. This includes any required pre-clinical or clinical testing, review, submission, and evaluation of the applications and test results, and post-marketing surveillance of the drug.United States Food and Drug Administration: An agency of the PUBLIC HEALTH SERVICE concerned with the overall planning, promoting, and administering of programs pertaining to maintaining standards of quality of foods, drugs, therapeutic devices, etc.

The tourniquet in total knee arthroplasty. A prospective, randomised study. (1/227)

We assessed the influence of the use of a tourniquet in total knee arthroplasty in a prospective, randomised study. After satisfying exclusion criteria, we divided 77 patients into two groups, one to undergo surgery with a tourniquet and one without. Both groups were well matched. The mean change in knee flexion in the group that had surgery without a tourniquet was significantly better at one week (p = 0.03) than in the other group, but movement was similar at six weeks and at four months. There was no significant difference in the surgical time, postoperative pain, need for analgesia, the volume collected in the drains, postoperative swelling, and the incidence of wound complications or of deep-venous thrombosis. We conclude that the use of a tourniquet is safe and that current practice can be continued.  (+info)

The effect of using a tourniquet on the intensity of postoperative pain in forearm fractures. A randomized study in 32 surgically treated patients. (2/227)

We have analysed the relationship between the intensity of postoperative pain and the use of a pneumatic tourniquet in procedures for operative fixation of fractures of the forearm. Thirty-two patients were divided randomly into two groups as a control (NT) and tourniquet (T). The pain scores in the NT group were significantly lower. Patients over the age of 30 had notably more pain than those younger after the use of a tourniquet. Avoidance of the tourniquet gave better postoperative analgesia in male patients and in those with comminuted fractures. When a tourniquet was used the best results were obtained if it was kept inflated for less than one hour.  (+info)

Simultaneous bilateral total knee arthroplasty in a single procedure. (3/227)

Eighty-eight consecutive patients undergoing total knee arthroplasty (TKA) were reviewed retrospectively and divided into two groups. Group I (64 patients) had both knees replaced simultaneously by one team in a single procedure while Group II (24 patients) had 2 operations staged about 7 days apart. The blood loss, operative time, knee functional score, period of hospitalisation and complications were documented in order to compare the 2 groups. Performing simultaneous bilateral TKA (Group I) did not increase the incidence of operative or post-operative complications. Equally, the functional score and mean intra- and post-operative blood loss were not influenced. The operative time and duration of hospitalisation were significantly shorter in Group I than in Group II. On the basis of the results of this study, it appears that simultaneous bilateral TKA is beneficial.  (+info)

Duplex scanning may be used selectively in patients with primary varicose veins. (4/227)

Reflux was assessed using hand-held Doppler (HHD) and duplex scanning in 72 patients with primary, previously untreated varicose veins (108 limbs). The aims of the study were (i) to compare the accuracy of HHD assessment with duplex scanning, (ii) to assess the benefit of tourniquet testing and (iii) to identify patients who would benefit from a policy of selective duplex scanning. HHD accurately assesses the saphenofemoral junction (SFJ) and long saphenous vein (LSV) reflux. HHD assessment of the saphenopopliteal junction (SPJ) reflux has a low positive predictive value. A high negative predictive value reflects absent SPJ reflux assessed using HHD accurately. Tourniquet testing is not helpful. Selective duplex scanning of limbs with suspected SPJ reflux, no identifiable site of reflux or posterior thigh perforator reflux on HDD (39% of limbs), would result in the appropriate surgical procedure being performed in 102 (94%) limbs, excessive surgery in 5 (5%) limbs and inadequate surgery in only 1 (1%) limb. The use of selective criteria for duplex scanning would reduce the workload of the vascular laboratory without compromising patient care.  (+info)

Intraoperative spasm of coronary and peripheral artery--a case occurring after tourniquet deflation during sevoflurane anesthesia. (5/227)

A 68-yr-old man with a 9-yr history of hypertension presented for hemiglossectomy, segmental resection of the mandible, and the radial forearm free flap grafting. Intraoperatively, facial artery spasm was observed during microvascular suturing of the radial artery to the facial artery. Simultaneously, systolic blood pressure decreased from 100 to 80 torr and the ST segment elevated to 15 mm from the base line. The possible mechanisms responsible for vasospasm in coronary as well as in peripheral arteries under sevoflurane anesthesia are discussed.  (+info)

Traditional bone setter's gangrene. (6/227)

Traditional bone setter's gangrene (TBSG) is the term we use to describe the sequelae sometimes seen after treatment with native fracture splints. Twenty five consecutive complications were recorded in 25 patients aged between 5-50 years with a median age of 10 years. The major complication of the native fracture splint treatment was distal limb gangrene necessitating proximal amputations in 15 cases.  (+info)

Analgesic effect of adenosine on ischaemic pain in human volunteers. (7/227)

This study was designed to measure ischaemic pain during and after infusion of adenosine. In a double-blind, placebo-controlled, crossover study, eight ASA 1 male volunteers received infusion of adenosine 100 micrograms kg-1 min-1 or placebo for 10 min. This was repeated 1 week later with the alternate infusion. Pain measurements were made during tourniquet-induced ischaemia in an exercising arm before infusion, during infusion and for 24 h afterwards. Pain was reduced significantly in the adenosine group compared with the saline group during infusion (median difference 20.8; 95% confidence interval 2.0-40). There was no significant difference in pain after infusion and there were no significant changes in cardiovascular variables. During infusion of adenosine, transient mild chest discomfort, shortness of breath and facial flushing occurred. We conclude that adenosine had measurable effects on ischaemic pain which were not sustained after discontinuation of infusion.  (+info)

Endothelial cell compatibility of clindamycin, gentamicin, ceftriaxone and teicoplanin in Bier's arterial arrest. (8/227)

In patients with infected diabetic foot lesions, and gangrenous, peripheral, occlusive arterial disease, it is important to achieve high concentrations of antibiotics in the tissues, as the extent of amputation is often influenced by the presence of infection. Local transvenous pressure injection of antibiotics, in Bier's arterial arrest, allows high local tissue concentrations to be attained in the extremities. Information on the endothelial compatibility of antibiotics in high concentrations combined with the effect of reperfusion injury following tissue hypoxia is lacking. To evaluate the effect of clindamycin, gentamicin, ceftriaxone and teicoplanin injected in Bier's arterial arrest, on endothelial cells, an in-vitro model using human umbilical venous endothelial cells (HUVEC) has been devised. The intracellular levels of purine nucleotides, reflecting DNA/RNA synthesis, energy production and signal transduction of these cells were measured by means of high-performance liquid chromatography. Incubation of cells with 10 mg/mL clindamycin, gentamicin, ceftriaxone and teicoplanin for 20 min resulted in no significant decline of intracellular purines. Levels of purines obtained after exposure of the cells to 0.1 mmol/L hydrogen peroxide (H2O2), to simulate reperfusion injury, were not significantly different from those obtained from cells allowed to recover after antibiotic exposure. These findings indicate that the infusion of high doses of antibiotics, during Bier's arterial arrest, is compatible with maintenance of endothelial cell function, even in the presence of increased free radical activity, provided the exposure is limited to 20 min.  (+info)

  • A tourniquet can be defined as a constricting or compressing device used to control arterial and venous blood flow to a portion of an extremity for a period of time. (
  • In surgical settings, a tourniquet is used to occlude arterial blood flow following exsanguination to produce a relatively bloodless operative field and to minimize blood loss. (
  • In rehabilitation settings, a tourniquet is used to restrict arterial blood flow at a consistent and safe pressure for short periods of time during low intensity exercise to more rapidly increase muscle size and strength. (
  • Other side effects related to tourniquet use, include pulmonary embolus caused by venous thrombosis and arterial thrombosis as a result of the dislodgement of an arterial plaque. (
  • As defined by Wikipedia , a tourniquet is a constricting or compressing device, specifically a bandage, used to control venous and arterial circulation to an extremity for a period of time. (
  • A vast majority of practitioners begin by exsanguinating the limb as Bier did with an elastic bandage ( Esmarch bandage ), squeezing blood proximally toward the heart, then pneumatic tourniquets are applied to the limb and inflated 30mmHg above arterial pressure to occlude all blood vessels and then the elastic bandage is removed. (
  • A too tight or too loose tourniquet can cause veins not to distend and may result to you cutting off their arterial circulation. (
  • Tourniquets with wider straps or cuffs, especially those with pneumatic actuation in contrast to mechanical force, distribute pressure more evenly and produce lower pressure gradients. (
  • In 1785 Sir Gilbert Blane advocated that, in battle, each Royal Navy sailor should carry a tourniquet: "It frequently happens that men bleed to death before assistance can be procured, or lose so much blood as not to be able to go through an operation. (
  • A dangerous job is a good reason to carry a tourniquet in civilian life. (
  • This device is known as Esmarch's bandage for surgical haemostasis or Eschmarch's Tourniquet. (
  • He used an Esmarch bandage to exsanguinate the arm and injected procaine between two tourniquets to rapidly induce anesthetic and analgesic effects in the site. (
  • Designed tourniquet devices are routinely tightened over healthy limbs during training with no ill effects, and recent evidence from combat hospitals in Iraq suggests that morbidity rates are low when users adhere to standard best practices. (
  • A Combat Ready Clamp (CRoC™) is placed in the inguinal area to stop circulation to the pelvic and femoral region when a casualty is in danger of bleeding to death from wounds that cannot be controlled by traditional bandages or tourniquets. (
  • They are therefore more likely to stop bleeding and less likely to cause damage to underlying tissue, in addition to being significantly less painful than tourniquets with narrow straps and bands. (
  • [ 10 ] The tissue injury from constricting bands may be caused by ischemic compression of blood vessels and the direct cutting action of the tourniquet. (
  • The main difference to other pneumatic tourniquets is the LOP and the Recommended tissue pressure (RTP) feature. (
  • Furthermore, tourniquet-induced hypertension with general anaesthesia, muscle injury, a wide spectrum of neurologic injuries, and tissue changes (Oedema compartment syndrome, post-tourniquet syndrome) have been reported. (
  • The anesthetic agent is intravenously introduced into the limb and allowed to diffuse into the surrounding tissue while tourniquets retain the agent within the desired area. (
  • For example, the Association of periOperative Registered Nurses, the National Quality Forum, and the Association of Surgical Technologists have made recommendations regarding tourniquet use. (
  • The students' proposed model will emulate the process used in surgical tourniquets, and will use a unique algorithm to scan through a pressure range until a distal pulse is not present and blood flow has stopped. (
  • But modern surgical tourniquets are also much more. (
  • Today, surgical tourniquets are specifically designed to enable surgeons to perform delicate dissections in a bloodless operative field. (
  • Advancements in surgical technologies have allowed surgeons to adopt alternative or minimally invasive approaches to knee replacement surgery which include reducing or eliminating the use of a tourniquet during the procedure. (
  • However, with advancements in surgical technologies that reduce blood loss, questions have been raised regarding the safety of tourniquet use, and whether or not the benefits outweigh the risks. (
  • A tourniquet is used to increase venous pressure so the phlebotomist or medical personnel can see and feel the patient's veins more easily. (
  • It is well established by evidence in the clinical literature that higher tourniquet pressures are associated with higher probabilities of tourniquet-related injuries. (
  • Hair tourniquet syndrome is a rare clinical phenomenon that involves hair, thread, or similar material becoming so tightly wrapped around an appendage that it results in pain, injury, and, sometimes, loss of the appendage. (
  • Nerve injury is a serious potential complication associated with the clinical use of exsanguinating tourniquets in surgery. (
  • Since the introduction of modern cementing techniques, no previous clinical studies have investigated the advantages or disadvantages of tourniquet use in knee replacement surgery. (
  • And in three independent studies by the Army, Navy, and Marine Corps that compared tourniquet products and methodologies, MAT performance was ranked first for stopping blood flow, the primary clinical outcome a tourniquet is supposed to deliver. (
  • In traditional knee replacement surgery, tourniquets are routinely used to reduce blood loss and provide efficiency for the surgeon. (
  • More specifically, a 2012 study proved that patients who underwent knee replacement surgery without the use of a tourniquet had 11° better range of motion at two years following surgery-that difference could prevent you from riding a bike or walking up and down the stairs. (
  • Safe tourniquet practice involves: Latest field trials suggest that wider straps are more effective and less painful than tourniquets with thinner straps. (
  • Another emerging need is more refined training regimes and doctrine based on scientific evidence, which can ensure that future tourniquet practice and policies are in line with the most current body of knowledge. (
  • However, simple principles and general guidelines regarding tourniquet use can be extrapolated to guide safe practice. (
  • Changes include updated recommended practices for managing the patient receiving local anesthesia, prevention of transmissible infections in the perioperative practice setting, selection and use of packaging systems for sterilization and use of the pneumatic tourniquet in the perioperative practice setting. (
  • In emergency settings, a tourniquet is used stop traumatic bleeding such that medical care can be provided in time before the injured person bleeds out. (
  • Existing guidelines call for the use of improvised "rope-and-stick" tourniquets as a last resort to stop severe bleeding. (
  • USAMRMC posted request for information for device ideas that could potentially stop bleeding at compressible sites where regular tourniquets cannot be applied. (
  • When a tourniquet is needed in an emergency situation, only one result matters-how fast it can stop the bleeding. (
  • however, Combat Medical does not believe anyone should routinely need two tourniquets to stop the bleeding of one extremity. (
  • To the layperson, a tourniquet is a cloth - and - stick device used to stop bleeding in an emergency. (