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Tourniquet time < 2 h is considered safe The general conclusion is that a tourniquet can be left in place for 2 h with little risk of permanent ischemic injury. However, the majority of the literature looks at pneumatic tourniquets in elective theatre cases with normovolemic patients. In hypovolemic trauma patients with non‐pneumatic tourniquets these figures may not be applicable. There is very little data on the complication rate of clinically indicated pre‐hospital tourniquet application and therefore there is no safe tourniquet time. One study identified that 5.5% of 110 pre‐hospital tourniquet applications resulted in neurological complications, with an ischemic time between 109–187 min. None of these resulted in limb loss. The mean ischemic time for use of a tourniquet with no complications was 78 minutes. References: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2660095/  From PHTLS 8th Ed... Not all traumatic PTX require chest tube! PTX < 35 mm on chest CT can be safely observed in both penetrating and blunt trauma if hemodynamically stable (failure rate 9%). Observing pneumothoraces: The 35-millimeter rule is safe for both blunt and penetrating chest trauma. J Trauma Acute Care Sure. 2019 Apr; 86(4):557-564. https://www.ncbi.nlm.nih.gov/pubmed/30629009  The coronary artery segment diagram from the American College of Cardiology.   Alteplase may be considered in some patients with a presumed or confirmed pulmonary embolism.
Kearon C, Aki EA, Ornelas J, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest 2016;149:315-352.  Gossypiboma or textiloma
Gossypiboma, textiloma or more retained foreign object (RFO) is the technical term for surgical complications resulting from foreign materials, such as a surgical sponge, accidentally left inside a patient's body. The term "gossypiboma" is derived from the Latin gossypium (“cotton wool, cotton”) . "Textiloma" is derived from textile (surgical sponges have historically been made of cloth). https://en.m.wikipedia.org/wiki/Gossypiboma |
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