blood clot what do we think

[cpmedic]

Re: CAT

Put is this way within the thread conversation, by the time someone has retrieved, opened, and readied quickclot, cleaned wound of excess blood and poured it in, I would with a CAT stemmed the blood, gone back to airway, checked ABC's, quick scan for secondaries and back to original wound to tidy up. (unless he has a landrover sticking out of his right ear then of course my priorities would change)

I havent further damaged the artery or surrounding tissue for the surgeons to mank over and in my opinion stemmed blood flow in a superior way.

I also find the CAT easier to use and carry than the MAT etc, less to go wrong, cheap, easy to carry etc, maybe it is a little on the narrow side but adequate.

[wingnut]

A very good point, the question is if your some way off adequate med help IE MERT etc would you leave the CAT in place? or would you use it initially to stem the flow then apply your quick clot and release it slowly odviously depending on the severity.
I have in the past managed to stem flow with one, which has enabled me to assess the wound more throughly then release slowly. Not the recommended way but it worked.

[cpmedic]

Personally once on I would leave on

Some would argue about ischaemia of the limb if left in place, i prefer this to blood loss and death. Removing the CAT would give a sudden burst of arterial blood that may pop the clot, also if its been in place for over two hours the pooled blood distal to the CAT would be toxic and is called compartment syndrome, this toxic blood suddenly released into the circulation would possibly cause cardiac arrest.

Similar thing happens to guys wearing harnesses such as climbers/paras etc who are hung in place with harnesses restricting blood flow, treatment there is a tourniquet in place and released periodically at definitive care so the body can self clean over time. In the past harnesses/tourniquets have been released and upto 48 hrs later the patient arrests and dies.

In my experience some "medics" get hung up on the sexy side and forget the basics, fark the gucci kit until the basics are done. Direct pressure, indirect pressure, limb raised, cannulation, comms, move, handover, back out. re-assess at each stage, adapt as required.

[wingnut]

Good advice, I accept your point on once on leave it there and Compartment Syndrome is a very real possibility, however I am talking of it being there for less than 5 mins.
Yeah your right people get new or shinny kit and forget the basics.

[cpmedic]

Ive been thinking on the debat of CATs v Quickclot etc

At the end of the day a blood tube has been spilt and is leaking blood. Now if the wound is open and its discolouring the ground then stemming the flow is priority, CAT is best along with direct pressure raise limb etc. Now damming the wound with quickclot may solve the external flow but in my opinion all that has happened is the wound has now become an internal bleed, and in some cases some may think, well i cant see the blood anymore so job done, time for tea.

If someone has fractured their femur blood loss is the main concern, traction, limb raise, CAT at pelvic region to stem bllod flow. Remember blood on the floor four more...(Chest, Abdo, Pelvic, Long bones) Internal bleeds are dangerous in that we cant see them until it is to late (changes in obs, swelling, bruising etc)

I think quick clot just moves an external bleed into an internal one, but the initial shock of squirting claret is taken away and everyone chills, that in my personal opinion is dangerous and unless you want to spend the next how ever many hours during transit checking BPs etc every minute with a scalpel on hand to remove the artificial clot then whack on a CAT and leave alone, easier to remove an FFD and have a look.

On a subsequent note about FFDs the current thinking is two is max, if still leaking remove and apply fresh. Now this went against my thinking and training of moons ago, but on looking at evidence etc lots of FFDs on a wound and the bottom two are wet and warm.....alien to clotting and a breading ground for bacteria. So now I recommend remove and apply fresh. Your not removing a clot because clotting isnt happening.

[cpmedic]

Quote:

Originally Posted by wingnut Good advice, I accept your point on once on leave it there and Compartment Syndrome is a very real possibility, however I am talking of it being there for less than 5 mins. Yeah your right people get new or shinny kit and forget the basics.

Why would it be there less than 5 mins? If its an arterial bleed a surgeons knife is the treatment of choice. Also if you fark about and start using all your kit whats to say in another 5 mins theres another contact and someone else is pissing claret? All your kit is strewn across the cuds and no-one is benefitting. Stabilise, leave alone, check obs and assess if changes, if no changes leave alone and get out of dodge. If I remove a CAT and 5 mins later his radials are gone, or hes drifitng off from electrolyte imblance etc and I give fluids, that weak clot is going to pop and we are back to square one.

CATS can also be applied at ease on the move, quimclot cant. When instructing and we do contact drills with injuries I expect a quick debuss, cross deck and scoot with lads applying CATS and Chest seals etc onroute to safe haven, pull up and re-assess. If they debug at safe haven and theres no CAT applied then they are binned.

Would I interfere with a CAT put in place by someone else? Nope, its there because there was a witnessed gusher on scene. Its happily doing its job, doesnt need feeding or paying.

[wingnut]

Some really good points made there and I can asure you very much taken on board, with reguards to removing all FFD's I too was always taught to leave the initial one on, but your thoughts with reguards to bacterial infections and the fact no clotting has taken place is very sensible.
Well as previosly mentiond my med skills have suffered considerable skill fade which will be rectified ASAP thanks for your insight.

Would you mind me asking what Q's you hold, breifly mearly as a guide.

[cpmedic]

ex RN Medic RM Attached
C&G in advanced emergency and clinical care
ATACC (Anaesthetic ATLS)
ACLS
ALS
Offshore Medic
PHTLS
IHCD EMT
Diver EMT

Currently studying for Diploma in Immediate Care Medicine RCOS

[wingnut]

Oh so not mush then. haha
Well cheers for your help think I may be pestering you from time to time for advice.
Also I heard Kevthemed was running a remote medic course, you attended any of these ? Just wondering there value.
no offence Kev, if I can get time off work I will probably attend your July course.

[cpmedic]

I dont know Kevthemed so cant comment

Only places I'd recommend are.....

Deployement Medicine and/or Prometheus as I know them.