blood clot what do we think

[M4MED]

Ben,

Having worked as a medic in Iraq and applied numerous torniquets on partial and complete amputatons and upto 3 extremities per casualty, I honestly don't know anyone out there (with any common sense, CLS or TCCC training) who would not advocate the use of tourniquets immediately on identifying catatrophic haemorrhage.
Many casualties have been saved by their use (CAT's ad SOFTTs) and the study carried out while I worked in the combat hospital indicated that limbs were being saved with little or no tissue damage upto 2 hours later and with a broad band EMT tourniquet upto 6 hours later.
Given the nature of the injuries and the likly hood of death, put a torniquet on and leave it on.
Use haemosatics combined with gauze packing and direct pressure and when the bleeding has stopped, cannulate, assess for a radial pulse and if present hold fluids. If not present, give 250ml, reassess.Continue this process, so as not to force fluid in, which may blow clots, dilute cloting factors and depending on the type of fluid could cause circultory overload.
Do not give fluids unecessarilly but remember, a casualty should not arrive for surgery dehydrated, it will delay his treatment.

[Paul999]

Good post M4MED,

Seeing as tourniquets have been mentioned a couple of times in this thread I thought i'd post a link to the thread relating to just the very things: http://www.closeprotectionworld.co.u...quets-not.html

Regards,
Paul.

[praetorian550]

Great information level here .

My experience is of the new quickclot in a traumatic amputation with associate arterial bleed it worked far and away better than I expected. But I am aware of ituations wher it hasnt been so effective.

I would also concur that Hemcon is outstanding -again having used it at the sharp end it performed extremely well , but again as noted in the cp/psd is often precusively pricey.

Of the two I carry hemcon out of choice backed up by quicklot . hope I dont get to the point of having to triage who gets what!

[cpmedic]

Re: Fluid Replacement

Fluid replacement via IV or IO is only recommended when the radial (check both) has gone.

As well as the haem clotting products mentioned, they are only as good as part of the overall picture of "normal" blood stopping techniques (Indirect/Direct pressure, Tourniquets etc)

If you are following MARCH then Major bleed comes before Airway as it takes a lesser amount of time for claret to squirt out than it does from dying from holding your breath.

Blood clotting agents in my opinion have a place in non-limb trauma, but they technically clot the hole not the artery thats pissing out. So you end up with an internal bleed behind the man made clot (one on the floor four more?)

I therefore use as an adjunct to all other means, as opposed to whacking it in and having a molle pouch toppers with the stuff and thinking its the dogs bollocks. Id rather carry a load of CATs than heamclot etc.

M4MED knows his onions.

[cpmedic]

Paul Re QuikClot vid, that is one of two vids and the second is hard to get hold of as the makers dont want anyone to see it.

Basically the vid posted shows a pig having its fem artery sliced, then suctioned, and its already laid out flat. Once most of the blood has been suctioned off into a bucket hidden well out of sight (notice the dodgy editing during the suction section) the quickclot is applied (without any pressure from the artery affecting application)

The "other" vid shows the stuff being whacked in without suction and along with the blood, it paints a Rembrant on the theatre wall. Pouring the stuff onto an Israeli bandage then into the hole was another option but again it plugged the hole not the artery, so you could technically loose upto 2 litres into the muscle.

No account during trials was made of total blood loss and blood retention and no vital signs were taken, so yes it made a nice mould of the hole, but did it actually do anything else??

Stopping the outward visible signs is one thing, but I still would prefer a CAT, cannulate the ACFs and standby with 250's of fluid incase.

PS in WW2 similar attempts were made with Sugar.

[jakeyt]

I have used the original quickclot to good effect but the main thing to bear in mind, as with all advances is in 9 out of 10 cases good old direct pressure and correctly applied pressure dressings work a treat. Keep it simple!!

[wingnut]

With regurds to "Qickclot" etc, Yes it is a good piece of kit, when used at the right times, unfortunately some individuals tend to use it when there is absolutely no need making the work of a proper medic a lot more awkward. Yes its messy as hell at times.
With reguards to IV access, its always been taught to me that I would stem MAJOR blood loss followed very quickly by getting an IV line in as waiting to long sometimes makes it hard t get one going later. Now im not saying I would start adding fluids straight away just that I would want that option.

[cpmedic]

I agree, getting a line in is sooner the better before peripheral shutdown and you have to fark about with cut downs or IO's

I also agree that quimclot does tend to piss up definitive care atempts at sustaining life, identifying artery, surgery etc

But it is new, it is shiny and some "medics" swear by it, I also swear by it but in a different vein, no pun intended.

CAT plus knee plus FFD plus IV plus fluids if radials are gone. Endex.

Any thoughts on vagal pressures to reduce heart rate to slow circulation? Tried it once, seemd to slow heart rate a tad so ergo I would say slowed circulation but I havent done a double blind randomised multi centre trial with an emminent swedish consultant with a beard so its not a definitive study as yet.......lancet are interested in a write up but my crayon has snapped. My second trial is PR beta blockers, too slow down any patient who is shitting himself.

Only the red stuff carries O2 to cells so at the end of the day whatever keeps it going round is a good thing, but does quimclot keep it going round or just leak internally?

[praetorian550]

Great level of information here from guys who have/are doing it ,not the 'textbook'experts.
It is very true that quickclot has a place- no question - but the insight into getting canulation done early is something that only experience can teach I've been a big fan of early canulation since had to fight to get it done on someone who very nearly didnt make it some years ago. I hope anyone with plans to go operational somewhere 'interesting' invests in some good traning before going. Invest in yourself- save others. The real world doesn't do re-tests.

Thankyou to all

[wingnut]

Some excellent uptodate info there, My own med skills have suffered skill fade for a little while and all your comments and accounts on usage of kit and proccedures means I will be stepping up my own training ASAP.
Also whilst on the subject of kit has anyone used the CAT, and if so succsessful or not ?