Many surgeons, over the centuries, have noted the risks versus the benefits of tourniquets. As new providers see hemorrhage from extremity wounds, they should be trained in the use of tourniquets, to have a thorough understanding of their risks and how to use them to best benefit. The following quote, in particular, is a good choice to end this review, as it comes from an early, serious treatise on blood vessel injuries, written by a preeminent surgeon, Sir George Henry Makins, in 1919, and because it encapsulates all the issues of tourniquets:. The last resource for temporary control of bleeding, the application of a tourniquet, is a vexed question not easy of solution. Every surgeon would gladly eliminate this dangerous and clumsy procedure from his practice. Yet circumstances do occur when the use of the tourniquet is unavoidable, such as the absence of skilled assistance, want of time, the position in which the patient may find himself situated, or the nature of the surroundings. It can only be said, therefore, if the tourniquet be the sole available means of temporarily arresting the haemmorhage, that every precaution must be taken to make sure that the band is released at the earliest possible moment; further, that no patient be subjected to transport without being specially marked, so that the presence of the tourniquet be not overlooked. Even when the latter precaution is observed, the evil effects of too tight or too prolonged application of the tourniquet are unhappily far from unfamiliar. Naturally the most frequent instances of the evil effect of the tourniquet are seen in patients who have either constricted their own limbs, or in whom the tourniquet has been applied by a fellow soldier.25.
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