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Fonzy
02-01-2015, 11:13
Gentlemen,

I try to post less and read most. When I wss overseas my medic and I used to get into debates about using tampons in lieu of gauze to pack wounds. He claimed it was the best "field expedient" method and I threatened him bodily harm if he ever stuck a tampon in me without first going through the two aide bags we had on the truck. Since I've moved on to complete my Paramedic we still argue over it, but I digress.

Just recently came across this article and would love someone who knows more than I input. You've been there and done that.

Article with pictures for comparison: http://privatebloggins.ca/?p=1026


Every now and again, this bad recommendation surfaces. I actually saw this printed in an emergency veterinary book recently which prompted me to finally write this article. It’s time to bust this myth.
I think it was the 2008 SOMA conference and the medic’s were presenting their combat medical vignettes. A medic was presenting his casualty vignette when it started going something like this:
“…so I stuck my finger in the wound, and it…no shit…, it felt like a vagina.”
At which point, the entire audience of about 500 collectively looked at their neighbor and asked “did he actually just say that?”. And then he continued:
“…so I put a tampon in it.”
I’m sure almost everyone that has ever received ‘tactical medical’ training, and many that haven’t, has probably heard this advice in some form. Back in 2000 during my EMT ambulance practicum, noticing there were no big field dressings like the Army issued me, I asked my preceptor ‘if we get a really big bleeder, what do we have to use?’ to which he answered ‘probably the diapers’.
Enter critical thought.
To start with, let’s define exactly what the issue is I’m addressing in plain language. Often, so called “subject matter experts” will give the advice, that to treat massive hemorrhage, tampons, sanitary pads and even diapers are acceptable and effective ‘bandages’. The qualification they give is that they are designed to ‘soak up blood’.
I’ve said it before, and I’ll say it again; if you’re ‘soaking up blood’, you aren’t controlling hemorrhage. You are only keeping the floor clean. When someone asks the question ‘how much blood can this bandage soak up?’, they are completely missing the point, and don’t fully understand hemorrhage control.
Sanitary Pads and Diapers
Let me first address sanitary pads and diapers. These are specifically engineered and manufactured to soak up blood and urine and hold it in ‘keeping you dry’. They rapidly wick fluid away from the surface.
If you consider the way blood clots in a wound, this actually works against what you are trying to accomplish. Effective hemorrhage control is to tightly pack gauze up against the damaged vessel, and inside the wound, and hold it under pressure. Medical gauze is specifically designed for this purpose. It puts a significant amount of ‘surface area’ in the form of the gauze fibers in the area where the blood is leaking out. The (manual) high pressure is to minimize this leaking out by squeezing the damaged blood vessel(s) closed. Blood flow is slowed, and with the clotting factors in the blood activated, it becomes sticky, and hopefully sticks to the gauze fibers and all their surface area. With pressure maintained and minimal movement and disruption, hopefully, eventually a clot will form within the matrix of gauze fibers, over the hole in the damaged vessel(s) that will hold and prevent further hemorrhage.
Place a sanitary pad or diaper on a wound and it doesn’t put surface area in the form of gauze fibers in the wound. Rather, it actually wicks the blood away, almost sucking it out of the wound, leaving no clotting or clotted blood present in the wound to seal it. The blood is wicked into the core and clots inside the pad and away from the damaged vessel where it is actually needed to adhere to, to form the plug. Not the best conditions to promote clotting. So the next time someone tells you to use these devices, please educate them on the difference between their great theory of hemorrhage control, and the reality of physiology, physics and the design of these products.
Tampons
The other adjunct I’ll address is the tampon. The theory is that tampons soak up blood so they should be good for hemorrhage control. After all, that’s what they are designed for isn’t it? They come on a stick that seems like it should fit into a bullet wound track, so why wouldn’t it be effective in a gun shot wound for hemorrhage control.
If you understand ballistics, you know that when tissue is struck with a high velocity projectile, the kinetic energy transfer causes both a permanent and temporary cavity. Those cavities also disrupt tissue planes which creates access to potential spaces for blood to pool in internally, as well as following the permanent wound cavity out the entry and exit wound (if an artery is damaged).
Medical gauze sold for packing wounds is usually around 4 inches x 12 feet (144 inches). And a typical gunshot wound will easily eat that entire roll and possibly then some.
Does anyone know how much gauze is in a tampon? I didn’t, so I opened one up. I needed to soak it in water as it was compressed extremely tight and trying to open it dry, just pulled off little pieces. Little pieces that if they became loose and lost in a wound would be great infection beds.
A tampon is made of two 2 inch x 4 inch pieces of gauze-like material and a little string. And that’s it other than the applicator. Compare that to 12 feet of medical gauze.

A tampon is not designed to stop bleeding. It is not designed to clot blood from a wound. And I absolutely refuse to entertain any jokes whatsoever regarding the natural physiology of the female body. This is serious and respectful business. The bleeding source is not the vagina, but rather from the uterus, and blood flows out through the cervix then the vagina. The tampon is deigned to soak and hold a small amount of blood. The required function is very different. In the presence of a damaged artery, two 2″x4″ pieces of gauze is like throwing a rock at a tank. Let me leave you with this advice on managing massive traumatic hemorrhage; soaking blood does not equate to stopping bleeding. Once you get past that, you’re on your way to really understanding how clotting, and hemorrhage control works. You need to provide surface area (gauze fibers), including pro-coagulants and or muco-adhesives if available, in and against the actual wound, specifically the damaged vessel that is the source of the bleeding, under pressure, for an adequate duration, so that the minimal amount of blood that does leak out forms a stable clot. If you need to improvise, a cotton T-shirt can’t be beaten, except by a bamboo T-shirt. Leave the diapers, sanitary pads and tampons alone or else you could be ‘doing more harm’.

Brush Okie
02-01-2015, 11:20
Let me cut to the chase here. Your priority in a major bleeder for and trauma, GSW etc is get them to definitive care ie trauma surgeon as fast as possible. While you are jacking around with the perfect bandage etc that will not work you could be hauling ass to the surgeon. Get a bandage, something, anything that works reasonably and get going. I'm not saying don't try to control the bleeding or at least slow it down but lets face it with major trauma you are pissing in the wind.

Fonzy
02-01-2015, 11:32
Let me cut to the chase here. Your priority in a major bleeder for and trauma, GSW etc is get them to definitive care ie trauma surgeon as fast as possible. While you are jacking around with the perfect bandage etc that will not work you could be hauling ass to the surgeon. Get a bandage, something, anything that works reasonably and get going. I'm not saying don't try to control the bleeding or at least slow it down but lets face it with major trauma you are pissing in the wind.

Completely agree. Starting transport is the immediate need, and while I'm not advocating wasting time for the "perfect bandage", a TQ would be a much better option. Maybe I'm missing something, but a tampon/sanitary napkin doesn't seem like it would get much accomplished for packing a wound. Seeking clarity.

Flagg
02-01-2015, 13:29
I'm not an 18D(so you've been officially warned, take my post with a kilogram of salt), but I've got a reasonable level of formal medical training and some real world first responder experience.

I used to carry tampons, but after a few real world situations I've binned them.

For me, my first responder experiences have all been a bit like jumping out of a plane for the first time. I was scared absolutely shitless.

While I now enjoy jumping out of airplanes on the odd occasion, I don't enjoy the first responder experience. I enjoy trying to help, but the "scared absolutely shitless" hasn't changed for me.

When I think of items like tampons used for gun shot wounds or other penetrating trauma like knife wounds, I think of the loss of fine motor skills due to my arousal level/heart rate going to maximum and my cognitive performance going off the bad/far end of the upside down "U".

So I stick with the basics to which I have been well trained and practice and leave the esoteric(or improvised esoteric) stuff to the full time dedicated professionals.

Another consideration is, are tampons used for wound packing able to be seen on X-Ray?

I have some wound cavity packing material I've been trained on(but never used real time) that I've been told has some material in it to ensure it is more easily identified via medical imaging.

I would think tampons in actual use for entry/exit/cavity might present a problem down the track.

Just my thoughts from a similar-ish level of training.

Once again....I'm NOT an 18D, so I defer to their greater training/experience.

Eagle5US
02-01-2015, 13:46
Perhaps you should clarify your question....

-do pads and vag rockets soak up blood...of course they do

-does a pile of 4x4's soak up blood...of course it does

-do wither of these control hemorrhage...absolutely not.

Example I pointed out to my idiot nurse in the ED the other day.

69y/o guy on coumadin came in after a fall with a head laceration with blood RUNNING OUT OF HIS HEAD WOUND LIKE A FAUCET. She meets him in triage and slaps a 6in stack of 4x4's on his head and walks him back to me in the trauma bay.

Me: "Why all the 4x's?":confused:
Her: "To stop the bleeding!"
Me: :rolleyes: As blood continues to POUR out from around, under and through the 4x4's...

I remove the bloody "stack" take ONE FINGER and put it on various points around the wound until "POOF" the bleeding STOPPED. A figure 8 suture and 14 staples later (along with some monitoring due to his coumadin)...he ended up leaving the ED.

My point??? pads, pons, 4x4's contraceptive sponges, mom's finest linens, grandma's cheesecloth...none of these things control hemorrhage. Which should be your ultimate goal.

If you find someone down and bleeding in the local minimart or 7-11 and want to do the cool guy MaGyver thing -> grab the stay free and go for it. IT really makes no difference.

I will ADD this one tidbit though...if ising a tampon to control an anterior nasal bleed...be CERTAIN it is UNSCENTED. The chemicals used to provide that "flowery fragrance" have a tendency to burn the nasal mucosa and cause significant issues later on.

Fonzy
02-01-2015, 14:08
Eagle,

Thank you for your insight. Your logic and mine follow the same path; a tampon may be "field expedient" but isn't the be all end all in care. I really feel that a lot of people get hooked on the "high speed field expedient" answer instead of utilizing what they have. I was always taught that field expedient means "when what you wanted to do is broken or missing, this will sort of work...".

Eagle5US
02-01-2015, 15:35
I was always taught that field expedient means "when what you wanted to do is broken or missing, this will sort of work...".
I couldn't agree more.

Fonzy
02-02-2015, 09:23
I very much appreciate the responses gentlemen.

Maybe it's just the regular leg mentality of "oh man, SOF is doing it! It's a great idea, we need to!".

I've kept hearing that over and over but I've never heard of a unit that actually used it as a TTP. Has anyone? Or is this more of the rumor mill?

twocan
01-08-2017, 08:44
Superb advise, Fonzy and Eagle5US

Cuts through the noise and gets right to the point: stop the bleeding.

Thank you.

SF_BHT
01-08-2017, 16:31
Superb advise, Fonzy and Eagle5US

Cuts through the noise and gets right to the point: stop the bleeding.

Thank you.

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tom kelly
01-13-2017, 15:49
Severe bleeding from a torn or cut major blood vessel can cause death in a matter of a few minutes. Severe bleeding from a jugular vein in the neck, the brachial artery in the armpit, or the femoral artery in the thigh. The advanced trauma life support for a person who has lost about 40% of their blood volume this could be @ 3 to 4 pints of blood recommends that the flow of blood be stopped eg clamped, or use of another hemostatic agent eg Celox gauze, or a tourniquet and replacement of lost blood volume via transfusion.The surgical repair of the damaged vessel is the final step.

Tom Kelly

CloseDanger
01-13-2017, 21:28
I recall being told that it does absorb blood, but when it fills, it helps it clot. I chalk this up to who knows.

Apply direct pressure.