Go Back   Professional Soldiers ® > TMC 14 > Medical Pearls Of Wisdom

View Poll Results: Hemorrhagic Control Agents?
Yes - Quickclot 13 48.15%
Yes - Traumadex 7 25.93%
Yes - Other 3 11.11%
No - Bad JuJu 4 14.81%
Voters: 27. You may not vote on this poll

Reply
 
Thread Tools Display Modes
Old 04-11-2004, 12:31   #1
NousDefionsDoc
Quiet Professional
 
NousDefionsDoc's Avatar
 
Join Date: Jan 2004
Location: LA
Posts: 1,653
Hemorrhagic Control Agents

Are we going to use them? Which one? Why? under what conditions?
__________________
Somewhere a True Believer is training to kill you. He is training with minimal food or water, in austere conditions, training day and night. The only thing clean on him is his weapon and he made his web gear. He doesn't worry about what workout to do - his ruck weighs what it weighs, his runs end when the enemy stops chasing him. This True Believer is not concerned about 'how hard it is;' he knows either he wins or dies. He doesn't go home at 17:00, he is home.
He knows only The Cause.

Still want to quit?
NousDefionsDoc is offline   Reply With Quote
Old 04-11-2004, 13:03   #2
Jimbo
Guerrilla
 
Join Date: Jan 2004
Location: East Coast
Posts: 438
You hit on something that I have been thinking about lately. I was at Walter Reed the other day and saw a number of amputees. I saw one guy learning to walk again who was a triple amputee. While this soldier's MOI could have been anything, it got me thinking about tourniquets and their rate of employment on the battlefield. I saw a thread somewhere about new, earier to use tourniquets and that recalled someone's quote about when all you have is a hammer, all problems looks like nails.

So, are Hemorrhagic Control Agents a better alternative to a tourney? Does the level of basic first aid training need to be addressed?
Jimbo is offline   Reply With Quote
Old 04-11-2004, 13:33   #3
NousDefionsDoc
Quiet Professional
 
NousDefionsDoc's Avatar
 
Join Date: Jan 2004
Location: LA
Posts: 1,653
From the Special Operations Forces Medical Handbook (2001).

Circulation: Uncontrolled hemorrhage is the leading cause of preventable battlefield deaths. Rapid identification and effective management of bleeding is perhaps the single most important aspect of the primary survey while caring for the combat casualty.
Obvious external sources of bleeding should be controlled with direct pressure initially followed by a field dressing or pressure dressing. If bleeding is not controlled by the previous measures or if gross arterial bleeding is present, an effective tourniquet should immediately be applied. Clamping of injured vessels is not indicated unless the bleeding vessel can be directly visualized. Blind clamping of vessels may result in additional injury to neurovascular structures and should not be done.

NOTE: The current ATLS manual discourages the use of tourniquets in the pre-hospital setting because of distal tissue ischemia, tissue crush injury at the tourniquet site, which may necessitate subsequent amputation. This admonition is based on the civilian model of trauma care where most penetrating injuries are low velocity in nature and rapid evacuation to a trauma center is available. Withholding the use of tourniquets on the battlefield for patients with severe extremity hemorrhage may result in additional death or injury that might have otherwise been prevented.
---
NDD note - if you have a Palm and don't have this book in it, you should get it. It is searchable and you can cut and paste to memo and print. It is an absolutely excellent tool. The only complaint that I have is that the images don't show up on mine - the anatomy plates, etc. Small price to pay to have this reference in my hands at all times. No, I'm not telling you where I got mine. The dude did me a favor and I won't abuse him. If you seek, you shall find.
__________________
Somewhere a True Believer is training to kill you. He is training with minimal food or water, in austere conditions, training day and night. The only thing clean on him is his weapon and he made his web gear. He doesn't worry about what workout to do - his ruck weighs what it weighs, his runs end when the enemy stops chasing him. This True Believer is not concerned about 'how hard it is;' he knows either he wins or dies. He doesn't go home at 17:00, he is home.
He knows only The Cause.

Still want to quit?
NousDefionsDoc is offline   Reply With Quote
Old 04-11-2004, 15:52   #4
Surgicalcric
Quiet Professional
 
Surgicalcric's Avatar
 
Join Date: Jan 2004
Location: Wherever my ruck finds itself
Posts: 2,972
NDD:

Who would be the "we" you are referring to in your initial post 18-D, 91W, civilian medics, etc...?

And... The pictures do not show up for me either. I have been working on it though and will advise if I figure it out.
__________________
"It's better to die on your feet than live on your knees."

"Its not who I am underneath, but what I do that defines me" -Batman

"There are no obstacles, only opportunities for excellence."- NousDefionsDoc

Last edited by Surgicalcric; 04-11-2004 at 15:56.
Surgicalcric is offline   Reply With Quote
Old 04-11-2004, 15:58   #5
NousDefionsDoc
Quiet Professional
 
NousDefionsDoc's Avatar
 
Join Date: Jan 2004
Location: LA
Posts: 1,653
We, the members of this board. Under what conditions would cover "I might use this in UW, but not in my ambulance rescue unit truck thing." all points of view are valid.

I think the pic thing is a memory issue at point of origin. I have my book on a 128MB chip, so its not an issue there. No big deal, much better to have without the plates than not have. Great resource. It even has a SOAP note section with examples.
__________________
Somewhere a True Believer is training to kill you. He is training with minimal food or water, in austere conditions, training day and night. The only thing clean on him is his weapon and he made his web gear. He doesn't worry about what workout to do - his ruck weighs what it weighs, his runs end when the enemy stops chasing him. This True Believer is not concerned about 'how hard it is;' he knows either he wins or dies. He doesn't go home at 17:00, he is home.
He knows only The Cause.

Still want to quit?
NousDefionsDoc is offline   Reply With Quote
Old 04-11-2004, 16:49   #6
Surgicalcric
Quiet Professional
 
Surgicalcric's Avatar
 
Join Date: Jan 2004
Location: Wherever my ruck finds itself
Posts: 2,972
Re: Hemorrhagic Control Agents

Quote:
Originally posted by NousDefionsDoc
Are we going to use them? Which one? Why? under what conditions?
1.) Yes I think we will/should, but only after every other avenue of treatment has been utilized.

2.) TraumaDEX is 1st choice with Quickclot second.

3.) TraumaDEX can be used on both adult and peds w/o the complication of burns that Quickclot tends to produce. Not that I would not use Quickclot, I would. I firmly believe a 2nd or 3rd degree burn is better than losing a limb or a life.

4.) After bandaging, direct pressure, pressure points, and elevation has proved unsuccessful in hemorrhage control leaving the only other alternative, a tourniquet.


Jimbo:

Hemorrhage control agents are a much better alternative to the tourniquet. It controls the bleeding without denying tissue distal to the injury of much needed oxygenated hemoglobin.

The additional training necessary to use HCA's is not very extensive.
__________________
"It's better to die on your feet than live on your knees."

"Its not who I am underneath, but what I do that defines me" -Batman

"There are no obstacles, only opportunities for excellence."- NousDefionsDoc
Surgicalcric is offline   Reply With Quote
Old 04-11-2004, 16:50   #7
Surgicalcric
Quiet Professional
 
Surgicalcric's Avatar
 
Join Date: Jan 2004
Location: Wherever my ruck finds itself
Posts: 2,972
Quote:
Originally posted by NousDefionsDoc
...It even has a SOAP note section with examples.
Just had to bring that back up did ya.
__________________
"It's better to die on your feet than live on your knees."

"Its not who I am underneath, but what I do that defines me" -Batman

"There are no obstacles, only opportunities for excellence."- NousDefionsDoc
Surgicalcric is offline   Reply With Quote
Old 04-11-2004, 17:09   #8
Jimbo
Guerrilla
 
Join Date: Jan 2004
Location: East Coast
Posts: 438
Re: Re: Hemorrhagic Control Agents

Quote:
Originally posted by Surgicalcric
Hemorrhage control agents are a much better alternative to the tourniquet. It controls the bleeding without denying tissue distal to the injury of much needed oxygenated hemoglobin.
Right. But I don't know if basic battlefield first aid has reflected this advance. I see new, easier to use tourniquet devices being marketed to troops. I think under stressful conditions, a non-medic type might be less able to distinguish hemorrhagic bleeding from severe bleeding and just slap a tourney on it. The result is more amputations than necessary. That is bad.
Jimbo is offline   Reply With Quote
Old 04-11-2004, 17:18   #9
NousDefionsDoc
Quiet Professional
 
NousDefionsDoc's Avatar
 
Join Date: Jan 2004
Location: LA
Posts: 1,653
Jimbo,
Arterial bleeding is a - fairly easy to distinguish and b - very impressive. In my modest experience, there is very little doubt about when to apply a tourniquet. The problem is people usually wait too long, not apply it too soon.

Crip, how long do you have after applying a touniquet before you start having irrepairable damage?
__________________
Somewhere a True Believer is training to kill you. He is training with minimal food or water, in austere conditions, training day and night. The only thing clean on him is his weapon and he made his web gear. He doesn't worry about what workout to do - his ruck weighs what it weighs, his runs end when the enemy stops chasing him. This True Believer is not concerned about 'how hard it is;' he knows either he wins or dies. He doesn't go home at 17:00, he is home.
He knows only The Cause.

Still want to quit?
NousDefionsDoc is offline   Reply With Quote
Old 04-11-2004, 20:55   #10
Surgicalcric
Quiet Professional
 
Surgicalcric's Avatar
 
Join Date: Jan 2004
Location: Wherever my ruck finds itself
Posts: 2,972
Jimbo:

I cant comment on battlefield training. But use of either adjuncts, HCA or tourniquet, is only considered after the other methods (bandage, direct pressure, pressure point, and/or elevation) have failed to stop the bleeding here in the EMS world. Whether to use it would not be dependant on whether it is venous or arterial in nature, but by the degree of hemorrhage.

The only problem I see with the HCA's is them being used as a first level treatment of hemorrhage instead of as a next to last resort.
__________________
"It's better to die on your feet than live on your knees."

"Its not who I am underneath, but what I do that defines me" -Batman

"There are no obstacles, only opportunities for excellence."- NousDefionsDoc

Last edited by Surgicalcric; 04-12-2004 at 06:43.
Surgicalcric is offline   Reply With Quote
Old 04-12-2004, 00:16   #11
Maya
Guest
 
Posts: n/a
As I understand the promo for these agents, they are best used in partiatial amputation, hard to control area (groin), and as a last resort to the ABCD's, pressure/elevation/arterial pressure, warmth, and packing. Has there been a change in that algorythem? In an emergent situation has the thinking changed as to new tech products like TraumaDex/QuickClot replacing the above mechanics of hemorrhage control.

I was taught the touniquets were the means of hemmorage control only while in an emergent/tactical condition or if no other means could control blood lose, once removed from direct action/controlled location/time, the ABCD's would be applied, pack/warm/fluid, and transport ASAP. Always looking for better ways of treating the pt, is this a better way?

Looking to the pros for answers. Thanks.

Maya
  Reply With Quote
Old 04-12-2004, 06:41   #12
Surgicalcric
Quiet Professional
 
Surgicalcric's Avatar
 
Join Date: Jan 2004
Location: Wherever my ruck finds itself
Posts: 2,972
Maya:

I can only speak from what I have read and from my expereince on the civilian streets.

That being said, the algorhythm for hemorrhage control is the same with the addition of the HCA's before application of a tourniquet.
__________________
"It's better to die on your feet than live on your knees."

"Its not who I am underneath, but what I do that defines me" -Batman

"There are no obstacles, only opportunities for excellence."- NousDefionsDoc
Surgicalcric is offline   Reply With Quote
Old 04-12-2004, 06:47   #13
Maple Flag
Auxiliary
 
Join Date: Mar 2004
Location: Canada, when I have nowhere else to be.
Posts: 91
Quote:
Originally posted by NousDefionsDoc

Crip, how long do you have after applying a touniquet before you start having irrepairable damage? [/B]
I thought I would chime in here , seeing as I just learned the answer to that in a class a month ago. I was taught (by WMA) that it takes about 2 hours for a limb to become unsalvagable. I believe that the "unsalvagability" (new word - put it in Webster's) is due to tissue necrosis.

The other danger with removing a tourniquet is reintroducing blood with lots of waste products back into the system. I'm not sure how long the waste build up needs to become a life threat on re-introduction. I'm guessing here, but the toxic blood threat may be the real reason for the civilian EMS rule of "never remove a touniquet".

Cheers.
Maple Flag is offline   Reply With Quote
Old 04-12-2004, 07:42   #14
Surgicalcric
Quiet Professional
 
Surgicalcric's Avatar
 
Join Date: Jan 2004
Location: Wherever my ruck finds itself
Posts: 2,972
NDD:

My apologies. I somehow looked over that question. Knocking them out for lack of ATD.


Maple flag:

Your reasoning for not removing the tourney once applied is what I was taught.
__________________
"It's better to die on your feet than live on your knees."

"Its not who I am underneath, but what I do that defines me" -Batman

"There are no obstacles, only opportunities for excellence."- NousDefionsDoc
Surgicalcric is offline   Reply With Quote
Old 04-12-2004, 08:32   #15
NousDefionsDoc
Quiet Professional
 
NousDefionsDoc's Avatar
 
Join Date: Jan 2004
Location: LA
Posts: 1,653
How long does it take for somebody to bleed out from say a severed femoral?
__________________
Somewhere a True Believer is training to kill you. He is training with minimal food or water, in austere conditions, training day and night. The only thing clean on him is his weapon and he made his web gear. He doesn't worry about what workout to do - his ruck weighs what it weighs, his runs end when the enemy stops chasing him. This True Believer is not concerned about 'how hard it is;' he knows either he wins or dies. He doesn't go home at 17:00, he is home.
He knows only The Cause.

Still want to quit?
NousDefionsDoc is offline   Reply With Quote
Reply


Currently Active Users Viewing This Thread: 1 (0 members and 1 guests)
 
Thread Tools
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is Off
HTML code is Off

Forum Jump

Similar Threads
Thread Thread Starter Forum Replies Last Post
Whither Gun Control? The Reaper General Discussions 26 03-23-2007 14:00
Remote control Sacamuelas The Comedy Zone 1 08-11-2004 22:16
Iraqi's slowly taking control Sacamuelas Insurgencies & Guerrilla Warfare 0 08-03-2004 09:50
Birth Control Surgicalcric The Comedy Zone 0 02-09-2004 12:49



All times are GMT -6. The time now is 06:45.



Copyright 2004-2022 by Professional Soldiers ®
Site Designed, Maintained, & Hosted by Hilliker Technologies