Part Four of the Five First Aid myths: The use of tourniquets in dogs.

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Tourniquets are in vogue. And having a passion for first aid I am absolutely all for preparedness, having a survivalist mindset, and being well equipped for anything life should throw at me.

However, there can never be a one size fits all approach. That would be way too simple right? And boring!

I listen to badass podcasts where ex-military, bushcrafters, survivalists, and over landers are geeking out on medical equipment, first aid, and how to sustain life should shit hit the fan. AND I LOVE IT.  One guy I listen to has a tourniquet in his truck, in his go bag, and on him at all times....Over kill? It won’t be when he needs them. This guy is a complete badass and has been around the horn serving several tours. And if he thinks he needs that many tourniquets it has me questioning if I need that many too! Haha!

However, while talking about his badassery and tourniquet collection he made a causal comment in passing about the CAT tourniquet in his first aid kit. He simply stated “ …and it can be used on pets.”  And low and behold one little comment has me writing a whole damn blog post about the subject. Hell, it could have been where I got the idea for the mini-series?! Lord only knows where I get my inspiration.

So that raises the question. Can the CAT tourniquet be used on dogs? Why yes, I suppose it can be. We use tourniquets for lots of different things in daily practice.

But I just have to get on my soap box here for a second because this is an area that most certainly needs some education.

Back to the one size fits all approach. Dogs are not little people. Remember when I told you they aren’t allergic to gluten? Yeah, huge buzz kill I know. We all wanted to believe the marketers… those marketers who figured out that- if they put a wolf - jumping over a log- on a bag of dog food-…. it would make it the best food on the market.

Okay I digress and I will cut the sarcasm.

Let’s get down to it.

Let’s start this with some research:

There was a study done on U.S. Military dogs who suffered gunshot wounds. The study concluded that direct pressure to the wound or source of the bleed (like direct, firm, pressure with a hand or a wrap/bandage) was sufficient for hemorrhage control from the extremities.

Why is this?

Anatomy

When you think of a dog’s anatomy it really makes sense. Dogs don’t have the musculature in their limbs like we do. People have a higher risk from bleeding out from an extremity because of the big muscle bellies or muscle mass in their upper legs and arms. Apparently dogs were engineered differently.

Slippage

Which brings us to our second point, it is really difficult to get a human tourniquet tight enough on a dog’s leg to control hemorrhage. They have anatomy that tapers. So, the front and back legs are wide at the top and taper to a more narrow point. This makes a tourniquet slip and if its slipping it's not tight enough.

Vessel location

Also, their major vessels run deep up into their armpit and deep up into their groin. So, from an anatomical standpoint these major vessels are better protected. And not only that, but if you do have bleeding from these vessels- unfortunately it would be virtually impossible to place a tourniquet high enough and tight enough to be effective- think of the taper.

It is recommended to place the tourniquet 2-3 inches above the wound. Because the vessels run deep in the arm pit/groin area- you would not be able to place anything circumferential (around the leg) and proximal enough (closer to the body) to the area of the hemorrhage.

So what should I do?

So how should you stop the hemorrhage? Firm, direct, constant pressure with your hand and absorbent material. If the wound is deep you may apply combat gauze or roll gauze. Roll gauze tends to work well- because you can unroll it and pack it tightly within the wound for massive bleeds. Cover or pack the wound with dressing (combat gauze or roll gauze) and continue to apply firm pressure without peeking. It will take the body 3-5 minutes to form a clot. Even if you are using gauze impregnated with hemostatic agents- it still takes about 3-5 minutes to form this clot. So, during that time it is imperative that you apply constant, firm, pressure and do not let up. If the dressing soaks through with blood- apply additional absorbent materials over the top of it. Do not remove the underlying dressing layer as this can disrupt the clot.

Next, once the bleed has stopped-  in order to free up your hands to initiate a hike out to get your dog to the vet- you may place a pressure wrap to keep the dressing or gauze in place. And that wrap will continue to apply that firm, even pressure for you.

If you must use a tourniquet…

Now, tourniquets can and have been used in dogs. As a last resort only. You may use a tourniquet temporarily (when the bleed is below the elbow or below the knee) to get the bleeding to stop quickly- for example while you are getting all your first aid supplies out and situated to apply absorbent gauze and a pressure wrap for direct pressure.

If you must apply a tourniquet to quickly stop bleeding until you can better assess the situation- your goal should be to remove it as quick as possible and replace it with a pressure bandage- or use direct pressure to get the bleeding to stop.

If the wound is on a limb that is a traumatic amputation you may attempt a tourniquet- if the wound is still bleeding after direct, firm pressure and a pressure wrap has been applied and failed.

This also applies to the tail, which does have a major vessel running to it.

However, once again, realize that tourniquets in dogs should be used as last resort only.

Also realize that dogs are anatomically more predisposed to nerve damage- so use of a tourniquet can result in permanent damage and in amputation of the limb.

If you must apply a tourniquet as a last resort and you are trying to save the limb (ie the limb will still be functional and not amputated)- the maximum time it can be left on is 2 hours. So, make sure you date and time your tourniquet.- I know I am getting repetitive here but once again, this approach is last resort only.

Which tourniquets are effective?

As far as the type of tourniquets that are recommended for dogs: remember that with a human tourniquet it will be very difficult to impossible to get it tight enough. Use a wide cloth or bandana with a wind glass (a stick or metal rod) to turn. Make the tourniquet tight enough to where the bleeding has stopped and no pulse beneath or away from the tourniquet can be felt. A wide cloth will not be as painful as something narrow. Which brings us to our next point…

Keep in mind that tourniquets are painful. If you apply one to a dog for whatever reason and it is extremely painful- consider removing it and trying again to get the bleeding stopped via direct pressure.

In conclusion...

So, in conclusion, yes you may use a tourniquet. But only as a last resort. And recognize that it has major limitations. Also recognize that it has been proven that direct pressure is the best way to stop bleeding in dogs, it is less painful, and it gives them the best chance to keep their limb.

I was inspired to post about this topic because I did not want ANYONE to jump right to this method as a first resort for hemorrhage control. But, its worth discussing because it may have potential to be an effective tool in your tool box once ALL other options have been exhausted. 

Hemorrhage is scary! But at least you now have peace of mind and the confidence to know exactly what you might need to do to stop it.

Happy tails and safe trails!

Libbie Fort, DVM

 

P.S. Spring is coming! And if you ever get outside in the heat with your dog you need our quick reference cheat sheet for heat stress symptoms. Snag it by clicking here.

 

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