Speedboat Propeller Injury with Drowning and Tourniquet

You have been asked to attend a trauma call in the emergency department of a tertiary hospital. The pre-arrival notification states that a 32-year-old man has been run over by a speedboat while swimming in the sea with an obvious lower limb injury due to the propeller. On extricating the patient from the water, significant coughing and vomiting of sea water was noted by first responders. The estimated time of arrival is 1630 hours (two hours post-injury). The patient's observations en route are: Temp 32°C HR 90 bpm BP 85/46 mmHg SpO2 91% on oxygen at 10 L/min via face mask GCS 10 (E2 V2 M6) A tourniquet was placed on the upper thigh at 1430 hours as the paramedics were unable to control the blood loss with pressure and 1 L of normal saline has been commenced. A point-of-care haemoglobin is measured as 6.3 g/dL.