title: Evaluation of rapid training in ultrasound guided tourniquet application skills.
abstract: Tourniquet application has been widely accepted to improve survival for major limb trauma. Colour duplex ultrasound (US) can be used as a non-invasive method of confirming cessation of arterial flow. Participants with no or limited experience of ultrasound were taught to apply the Combat Application Tourniquet with ultrasound guidance. Following this, participants were tested in effective tourniquet application: Blind and with ultrasound guidance. US guidance improved abolition of limb perfusion from 22 to 93 per cent in upper limb; from 25 to 100 per cent in lower limb (p=0.0027 and <0.0001). No significant difference was found in application time for the lower limb; less time was taken for application with US guidance in the upper limb 8.1 (7.1, 8.6) vs 4.5 s (4.0, 5.3; median (IQR)), p=0.002. Tourniquet ultrasound skills are rapidly acquired by novice operators. Accuracy improves with ultrasound guidance, this may have a role in improving survival.
authors.affiliation: Department of Vascular Surgery, Imperial College School of Medicine, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK. usman.jaffer@doctors.org.uk
authors.forename: U
authors.initials: U
authors.lastname: Jaffer
authors.forename: M
authors.initials: M
authors.lastname: Aslam
authors.forename: V
authors.initials: V
authors.lastname: Kasivisvanathan
authors.forename: R
authors.initials: R
authors.lastname: Patni
authors.forename: M
authors.initials: M
authors.lastname: Midwinter
authors.forename: N
authors.initials: N
authors.lastname: Standfield
mesh_terms: D000293:Adolescent; D000328:Adult; D002983:Clinical Competence; D005260:Female; D006470:Hemorrhage / Q000628:therapy*; D006801:Humans; D023821:Limb Salvage / Q000379:methods; D008297:Male; D010147:Pain Measurement / Q000379:methods; D018709:Statistics, Nonparametric; D013997:Time Factors; D014111:Tourniquets; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000295:instrumentation / Q000379:methods*