1. If in a dangerous situation or difficult situation, place TQs high and tight (military care under fire) in the groin just below inguinal ligament or high into axilla.
2. Don't place over the iliac crest or ASIS (anterior superior iliac spine). Place just below inguinal ligament, especially in undetermined hemorrhage source.
3. Do NOT get male genitals caught up in the TQ.
4. If multiple TQ needed, place flush and proximal to first TQ.
5. That first pressure tightening pull of the strap through the loop is critical. Make that thing as tight as you can, then use the windlass to synch down.
6. Standard teaching is up to 2 hours TQ time then attempt to convert to pressure dressing or other control means if in scope of practice. Some data suggest safe application for lo longer periods of time.
7. If you're not sure they need a TQ and debating with yourself, place the TQ and always error on the aggressive treatment approach in traumatic bleeding .
8. You CAN place in 2-bone compartments like forearms and lower tibia/fibula
9. If not under fire, in a dangerous setting or have good visibility, place 2-3 inches ABOVE wound.
10. Do NOT place over joints
11. After care under fire, place TQ on skin and expose area
12. CAN be placed proximal to open fractures.
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