blood clot what do we think

[wullie reilly]

hi all

was in iraq few weeks ago and i was doing some medic stuff with a brit comapny and i was showing internationals the pros and cons of bloodclot is it a good thing or a bad thing in my experance it worked for me when i had to use it in iraq when my team got Ied and some guys got whacked so what do you think

wullie

[Paul999]

Wullie,

This is an area where I have no hands on experience I'm afraid. I've read articles on the different haemostatic agents and I think my civvy ambulance service is currently looking at the possible use of quikclot in the civvy world, but other than that I know very little.

I di dfind this interesting video of quikclot being tested on a pig. As most are probably aware, pigs anatomy and human anatomy are very similar, hence the test on pigs:

QUIKCLOT demonstration

I watch with interest and wait to learn.

Regards,
paul

[KEVTHEMED]

I have used quickclot, Celox and HEMCON.
The first version of Quicklot had a lot of negative user feedback about its exothermal reaction (heat generated on contact with patient). The newer versions are the advanced clotting sponge which is packed into the wound and the formula has being refined to produce less heat.
Celox does not produce any heat but is only available in granual form and is poured into the wound. This is ok as long as it is not windy or raining.
HEMCON is the gold standard of blood clotting agents, but it comes with a gold standard price. The 4inc x 4inch (1100mm x 100mm) dressing is around £100.00 each.
All the above can be used with blood containing haparin and warfarin.
KTM

[Roadhog]

I have used most of the leading clotting agents; Quikclot, Quikclot ACS, Celox and Hemcon- not used Traumadex though. Of them all I would rate the Hemcon as the best option and worst price tag. The original Quikclot- the ACS version less so- produce an exothermic reaction at the wound site, potentially exacerbating the local tissue damage. The Celox and the original Quikclot are both powder forms which need to be poured into the wound- this creates issues for the patient when he reaches surgery, because of the additional wound debridement required- the Quikclot grains are quite small. I prefer the Hemcon because it is of a dressing form and produces no heat.
However it is not certain- from my experience- the level of bleeding that any of these will stop. A catastophic bleed may not allow enough time for clots to be formed, the clotting agents are to be considered additional measures and assistance and not the be all and end all. They can replace bandages, but only replace them and proper haemorraghe control should be followed first- torniquets etc if required. The other potential issue is whether the clots will survive the rapid introduction of additional fluids- IVs etc.

[KEVTHEMED]

The problem i found was that as HEMCON is designed to adhere to blood it also sticks to anything wet or even damp. The application of the dressing takes some practice to get right.
Ive wasted a couple of the big dressings trying to hold the packet as directed, line up the dressing with casualty and get it on target first go.
It is the dogs dangly bits but make sure you have a few goes with the training dressing first.

On the IV Point you raised. In studies by the US (again!) it was shown that a percentage of combat casualties had a IV set up by the medic when it was not really necessary. The studies showed that the IV was given before effective haemorrage control was established.
Also it was noted that IV therapy was started in casualties for conditions that didnt really warrant it.
US medics on the CLS course now cannulate a casualty but dont necessarily start running fluids.
Exceptions are usually GSW, Explosive trauma and or burns.

[Roadhog]

The trouble with fluid replacement in casualties, is that until you have effective haemorrage control, as fast as you put fluid in one hole, it is coming out another. The US Army is now looking at NOT starting IVs until blood is available, as long as there is a good radial pulse the US recommendation is not to begin infusion.

[benyoung89]

also remember you do tend to see a lot of us medics squeezing the fluids in thus "blowing" the clot. fluids are good for adding volume.

[Edelweiss Tactical]

Our MedKits have QuikClot First Response & ACS+ imported from the US for $39 for a pack of 5.

[ASAA Europe]

I came across an incident in the mountains where a guy had shoved an ice axe through his leg after a bad fall, and ripped out a big old chunk. He was bleeding pretty badly, and Quikclot saved the day. I always had a pouch in my kit because of this sort of thing, and I am glad to say that it did the job. The French medical teams had not seen or heard of it and were very happy to take the info away with them. Its not a gunshot wound, but bleeding is bleeding, and he was in a bit of a state. Happy to say that he made a good recovery and is still doing daft things in the mountains!

[benyoung89]

think the general consesious is that its a good bit of kit in the right hands. i did hear a story of a chap in northern iraq whos mucka had a servere head injury and he applyed quick clot to the brain!! needless to say the guy was a gabbage after and im not sure if he made it!! but i would use it and then also a tornique if need be. some people will take a big inhale or breath but better to "possibly" lose a limb than lose a life? (depends on whos the guy on the ground doing the biz i guess!)