Page 386 - ATP-P 11th Ed

(b) Bleeding remains refractory to other methods of hemostasis (e.g., direct
pressure, pressure dressing, etc.), AND
(c) The anatomical site is amenable to tourniquet application (e.g., limbs and
tail wounds)
(d) When a tourniquet is warranted (as per above), consider applying a wide,
®
elastic, non-windlass, moldable tourniquet (e.g., SWAT-T ), if available.
(e) Immobilize and Elevate the area when practical and feasible. Keep the
MWD as calm as possible to avoid inadvertent elevations in arterial blood
pressure
(f) Expose and clearly mark all tourniquets with the time of tourniquet ap-
plication. Note tourniquets applied and time of application; time of re-
application; time of conversion; and time of removal on the canine TCCC
Casualty Card. Use a permanent marker to mark on the tourniquet and the
casualty card.
NOTE: Pelvic binders have not been evaluated in dogs. However, because pelvic
fractures in dogs are very unlikely to result in life threatening hemorrhage, pelvic
binders are not recommended in MWDs at this time.
b. IV/IO Access
i. Intravenous (IV) or intraosseous (IO) access is indicated if the MWD is in hem-
orrhagic shock or at significant risk of shock (and may therefore need fluid re-
suscitation), or if the MWD needs medications, but cannot take them by mouth.
ii. An 18-gauge IV or saline lock is preferred. Place in the cephalic (dorsal/anterior
SECTION 4 aspect over the radius) or lateral saphenous (hind limb over the lateral distal
tibia) vein. The external jugular vein can be considered as an alternative option.
For external jugular vein access, due to the increased length and flexibility of
the MWD’s neck as compared to a person, a longer catheter (eg.14 or 16-gauge
× 3.25 inch) is preferred over an 18-gauge × 1.25 to 1.5 inch catheter commonly
used for peripheral vein access.
(a) If vascular access is needed but not quickly obtainable via the IV route, use
the IO route,
(b) Recommended sites for IO placement in a canine include the:
• Proximal, lateral humerus at the caudal aspect of the greater tubercle, or
• Proximal, medial tibia caudal to the distal aspect of the tibial tuberosity
• Recommended IO catheter size is 25mm × 15-gauge (BLUE) for MWDs
over 40 lb

376 SECTION 4 CANINE/K9 TACTICAL COMBAT CASUALTY CARE GUIDELINES (C-TCCC)