# Answers

### What signs or symptoms are suspicious for pelvic instability?

- Pelvic pain, any major lower limb amputation or near amputation, physical exam findings suggestive of a pelvic fracture (for example, laceration or bruising at bony prominences of the pelvic ring, a deformed or unstable pelvis or unequal leg lengths), unconsciousness or shock with a mechanism of injury involving significant force, like an IED blast or MVA.

### How do you prevent dislocation of pelvic fragments from external rotation of the lower extremities?

- Prevent external rotation of the lower extremities by tying the casualty’s knees and/or feet together.

### Where should you apply a deliberate tourniquet when replacing one that was placed over the uniform, like a high and tight tourniquet from Care Under Fire?

- Place a replacement tourniquet directly on the skin, 2-3 inches above the wound.

### What are contraindications to converting a tourniquet to wound packing and a pressure bandage?

- Amputation, tourniquet has been on for six or more hours, shock, inability to closely monitor the wound, if the casualty will arrive at a medical treatment facility within 2 hours or if tactical or medical considerations make conversion inadvisable.

### What is the definition of Non-Compressible Torso Hemorrhage (NCTH)?

- Non-Compressible Torso Hemorrhage (NCTH) is high-grade injury in one or more of the following anatomic domains: pulmonary, solid abdominal organ, major vascular or pelvic trauma; plus, hemodynamic instability or the need for immediate hemorrhage control.