Dorothy FarrarTourniquet syndrome
Tourniquet syndrome entails life-threatening complications, which usually occur after reperfusion (reconnection) of a part of the body that has previously been tied off over a longer period of time to the bloodstream. Patients may experience cardiac arrhythmias, shock levels and irreversible kidney damage.
What is tourniquet syndrome?
Tourniquet syndrome is also referred to as reperfusion trauma. This condition occurs whenever a part of the body has not been adequately supplied with blood for a long period of time and is then reconnected to the bloodstream. The tolerance time of this reduced blood flow (ischemia) is an average of six hours, whereby this time window also depends on the individual condition of the patient. The scientific term goes back to tourniquet ligation, which is a surgical aid to connect large vascular trunks, which, however, is no longer used.
Causes
Tourniquet syndrome is paradoxical because medical laymen assume that restoring blood flow to an underserved part of the body saves lives and is not life-threatening. However, the medical starting point is different. The ischemia (reduced blood flow) of the undersupplied and thus tied off from the bloodstream limb confuses the metabolism.
The German term is tournium syndrome and describes the “strangulation of extremities by suitable foreign materials” (eg cords, hair, cloths). This process leads to painful swelling and an undersupply of blood to the affected part of the body and represents a surgical emergency because ischemia can lead to life-threatening tissue necrosis.
Tourniquet syndrome is therefore predominantly caused by accidents or violence (e.g. strangulation). If infants and young children show such external signs, they may be victims of child abuse. The need to tie off extremities is indicated, for example, in the case of serious injuries to protect the affected person from excessive blood loss.
Symptoms and course
Through reperfusion, the reconnection of the bound body part to the bloodstream, pathological metabolic products wash into the rest of the organism, which lead to considerable damage there. The part of the body affected by ischemia has acidosis (hyperacidity) due to increased lactate formation. In this way, more oxygen radicals are produced, which have a harmful effect on the cell structure.
After a certain time, the dissolution of striated muscle tissue (rhabdomyolysis) begins. The dying cells now release myoglobin and potassium. These released particles cause edema in the extra-cellular space, which increases pressure on the surrounding tissue structures. The potassium produced in this process is responsible for the patient’s life-threatening condition.
If this substance spreads over the entire organism after reconnection (reperfusion), hyperkalemia occurs, which can cause cardiac arrhythmias or even cardiac arrest. The typical symptoms of tourniquet syndrome are ischemia, necrosis, hyperacidity, cardiac arrhythmias, kidney failure and cardiovascular arrest.
Diagnosis
Tourniquet syndrome can be determined by the tied limb that is undersupplied with blood. This part of the body tied off from the bloodstream is swollen, reddened and overheated. Reperfusion causes volume deficiency shock and generalized edema. This leads to the typical pale skin color, increased heart rate and drop in blood pressure.
For the physician, the shock index is thus positive. Laboratory findings support diagnostics. The blood has severe metabolic acidosis and the elevated potassium levels typical of this condition. The dark red colored urine indicates kidney damage.
Treatment and therapy
Treatment of this ischemic state of shock initially focuses on eliminating the life-threatening conditions. Hypovolemic shock and cardiac arrhythmias must be treated. Hyperventilation counteracts metabolic acidosis. A mitigation by bicarbonates is also possible. In order to maintain kidney function, hemofiltration (dialysis to withdraw urinary substances) and massive volume administration are indicated. The success of these therapy methods depends on the time window in which the reperfusion (reconnection) of the tied body part takes place.
If the blood deficiency (ischemia) of the affected body part has existed for a long time and the tissue damage is already too strong, there is only the possibility of amputation to prevent even worse, the death of the patient. If the treatment is within a time window of four hours, the amputation rate is only four percent. If the ischemia already lasts twelve hours, an amputation rate of thirty to fifty percent must be expected.
Innovative intensive care treatment methods have reduced the life-threatening effects of tourniquet syndrome, but this clinical picture should not be underestimated. The medical literature still assumes a mortality rate of twenty percent in the case of ischemia of the lower extremity.
Prevention
The best prevention of this life-threatening condition is to never tie off any part of the body longer than necessary. If a tie is necessary to protect the affected person from extreme blood loss, for example after an accident, cooling down before reconnection (reperfusion) is indicated. This measure reduces the formation of harmful metabolic products and reduces the activity of certain enzymes that have a negative impact on the rest of the body.
In order to protect the patient from the consequences of touriquet syndrome after prolonged ischemia, the only option left is amputation of the part of the body with reduced blood flow.
Hello and welcome to my Health Guide & Encyclopedia! My name is Dorothy Farrar, and I'm the founder and main author of this platform.
My passion for health and wellness started at a young age when I became interested in the connection between the food we eat and the way we feel. This fascination led me to study nutrition and dietetics in college, where I learned about the importance of a balanced diet and the impact of various nutrients on the body.