Tourniquets and Bleeding Varicose Veins

A large varicose vein ruptured on the back of this 37-year-old man’s lower leg. He had been afflicted with chronic lymphedema and large varicose veins for years. The bleeding was vigorous. A coworker created a makeshift tourniquet by wrapping his belt around the thigh. Unfortunately, the bleeding continued unabated for 20 minutes, and did not stop until the paramedics arrived and applied pressure dressings. Nevertheless, the prehospital providers applauded the coworker’s efforts and went so far as to give him credit for saving his colleague’s life. Was that a correct attribution? Is it possible that the proximal tourniquet aggravated the bleeding? Observers said the blood continued to flow unabated from the ruptured varicose vein. Is a bleeding varicose vein that big a deal? Should it be managed differently? Interestingly, multiple case reports in the literature describe patients who have died from a varicose vein hemorrhage. (1-7) Many of these are forensic investigations of deceased elderly patients found in their homes surrounded by pools of blood. One report described a deceased patient found with three makeshift tourniquets wrapped around his leg in an unsuccessful attempt to stop bleeding from a ruptured varicose vein. (1) I want to make it clear that I am firm believer in the value of tourniquets. The military has the greatest experience with tourniquets, and the benefit of tourniquets for traumatic extremity bleeding is now well established. (8-13) But the mili...
Source: M2E Too! Mellick's Multimedia EduBlog - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs