# Situation: A 30-year-old man weighing 70 kg is brought to the emergency department after a motorcycle crash at 13:10. He is talking in full sentences. Bright red blood spurts from a deep wound of the left thigh despite a pressure dressing applied in the field. He has no head injury and no known drug allergies. A tourniquet is applied above the thigh wound. Which statement about its use is correct?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630137  
> language: ko  
> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

Situation: A 30-year-old man weighing 70 kg is brought to the emergency department after a motorcycle crash at 13:10. He is talking in full sentences. Bright red blood spurts from a deep wound of the left thigh despite a pressure dressing applied in the field. He has no head injury and no known drug allergies.

A tourniquet is applied above the thigh wound. Which statement about its use is correct?

## 보기

1. Tighten it only until the venous oozing from the wound slows
2. Loosen it every 15 minutes to let blood reach the tissues
3. Tighten it until bleeding stops and distal pulse is gone **✔ 정답**
4. Cover it with the dressing to keep the site warm and clean

**정답: 3**

## 해설

A tourniquet for life-threatening limb bleeding is placed above the wound and tightened until bleeding stops and the distal pulse is gone. It stays visible, the application time is recorded, and it is not loosened periodically by the nurse.

## 심화 해설

Why the tourniquet must be tightened until bleeding stops and the distal pulse disappears

The patient has a deep left thigh wound with bright red, spurting blood despite a pressure dressing. That description indicates arterial injury, not venous oozing. In this situation, the goal is complete occlusion of arterial inflow to the injured limb segment. A tourniquet is placed above the wound and tightened until arterial bleeding stops and the distal pulse is no longer palpable. If the distal pulse remains, arterial blood is still passing beneath the tourniquet, and the wound can continue to bleed.

Bright red spurting blood is a sign of arterial hemorrhage, which requires full arterial occlusion, not just reduction of venous oozing. Tightening only until venous oozing slows would leave arterial pressure intact and would not control life-threatening hemorrhage.

Key point! The correct endpoint for a tourniquet is cessation of bleeding plus absence of the distal pulse. A tourniquet that is too loose can actually worsen bleeding by blocking venous return while allowing arterial inflow to continue.

Why the tourniquet is not loosened periodically

Once a tourniquet is applied for life-threatening extremity hemorrhage, it should remain in place until definitive surgical or advanced care is available. Periodic loosening by the nurse is not recommended because releasing the tourniquet can allow renewed hemorrhage, dislodge early clot, and permit ischemic byproducts to enter the systemic circulation.

Routine loosening every 15 minutes is not appropriate in the emergency setting because it risks recurrent bleeding and reperfusion injury. The application time is recorded and communicated to the receiving team, but the tourniquet itself is not intermittently released by nursing staff.

The concern about limb ischemia is real, but the immediate threat of exsanguination takes priority. Watch out! Do not confuse tourniquet care with the management of a cast or a simple pressure dressing. A tourniquet for arterial hemorrhage is not a device that is periodically released to “let blood reach the tissues.”

Why the tourniquet must remain visible

The tourniquet should not be covered by a dressing, blanket, or clothing. It must remain visible so that the healthcare team can quickly identify its presence, inspect the site, and note the application time. Covering the tourniquet to keep the site warm or clean delays recognition and can lead to the tourniquet being overlooked during handoff or transport.

A tourniquet is kept exposed and clearly documented so that it is not accidentally left in place without appropriate reassessment. The application time is recorded on the patient or in the handoff report, but the device itself stays visible.

Clinical reasoning for the licensure exam

This question tests the priority action for arterial hemorrhage from an extremity. The correct answer reflects the standard endpoint for tourniquet application: bleeding stops and the distal pulse is gone. The other options describe incorrect practices that would either fail to control arterial bleeding or delay recognition of the tourniquet.

| Option | Why it is incorrect |
| --- | --- |
| Tighten only until venous oozing slows | Does not occlude arterial flow; arterial spurting continues |
| Loosen every 15 minutes | Risks recurrent hemorrhage and is not done by the nurse |
| Tighten until bleeding stops and distal pulse is gone | Correct endpoint for arterial occlusion |
| Cover with dressing to keep warm and clean | Tourniquet must remain visible for monitoring and handoff |

In trauma, hemorrhage is the leading cause of preventable death, and extremity tourniquets are a standard intervention when direct pressure fails [1][2]. The evidence emphasizes that tourniquets can be lifesaving when applied correctly, but inappropriate application—such as insufficient tightening or improper monitoring—can lead to complications [1][3]. The correct application endpoint is complete cessation of bleeding with loss of the distal pulse, and the device is not loosened periodically in the emergency phase [1][2][3].References (research sources)

- [1]Do tourniquets for extremity injuries save lives?Research articleMiller T, Polk T, Henry SM. (2026) · DOI: 10.1136/tsaco-2026-002341

- [2]Tourniquet use for civilian extremity hemorrhage: systematic review of the literature.Meta-analysis/systematic reviewBenÍtez CY, Ottolino P, Pereira BM, Lima DS, Guemes A, Khan M (2021) · DOI: 10.1590/0100-6991e-20202783

- [3]Tourniquets as a haemorrhage control measure in military and civilian care settings: An integrative review.Research articleRoman P, Rodriguez-Alvarez A, Bertini-Perez D, Ropero-Padilla C, Martin-Ibañez L, Rodriguez-Arrastia M (2025) · DOI: 10.1111/jocn.15834

## 임상 시나리오

Tourniquet Application for Arterial HemorrhageTighten until bleeding stops and distal pulse is gone
For arterial bleeding (bright red, spurting), place the tourniquet above the wound and tighten until bleeding stops and the distal pulse disappears. A persistent distal pulse means arterial flow is still passing beneath the tourniquet.

Record the application time and keep the tourniquet visible at all times. Do not cover it with dressings or blankets.

CautionNever loosen the tourniquet periodically. Releasing it can cause renewed hemorrhage, dislodge early clot, and release ischemic byproducts into systemic circulation. Leave it in place until definitive surgical care is available.

## 핵심 개념

- **arterial hemorrhage** — Bright red, spurting bleeding indicating arterial injury requiring complete arterial occlusion.
- **tourniquet endpoint** — Cessation of bleeding plus absence of distal pulse confirms full arterial occlusion.
- **distal pulse** — Pulse below the tourniquet site; its absence indicates arterial flow is fully blocked.
- **reperfusion injury** — Release of ischemic byproducts into systemic circulation when a tourniquet is loosened prematurely.

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