Clamping Bleeders

NousDefionsDoc · 10-17-2009, 18:33

What's the thinking on this now? Are they still teaching medics to tie them off?

**Team Sergeant** · 10-17-2009, 18:58

I just sent your question to a few trauma surgeons.

Onward · 10-17-2009, 19:00

NDD,

I went through 68W AIT a little less than a year ago, and nothing was taught about this. Our training on bleeding control pretty much focused on Combat Gauze as a hemostatic agent, with tourniquets and pressure dressings as appropriate. Whether or not clamping is covered in OEMS or any of those high speed classes, i don't know, as I haven't had the chance to attend yet.

I apologize if you were referring to the 18D or W1 course specifically, in which case I am hopelessly out of place here; back to lurking in my lane!

rwd · 10-17-2009, 19:19

(As of last year in the 18D course)

For an abdominal bleed of the viscera, when we're able to locate and identify, we're still taught to clamp and ligate. That was the only wound where we used this procedure, however.

adal · 10-17-2009, 20:03

NDD,
I was always taught to clamp and ligate. When I became a civvie and had to go through a civvie refresher course, I yelled "clamp and ligate" to annoy my instructor. Civvies are not taught this.
Now. PHTLS and ATLS are just getting on board with the whole "tourniquet first" idea. Again in my refresher (5years ago) I stated for a serious bleed I would either 1)clamp and ligate or 2) tourniquet. This was not looked upon favorablly. Now civvies are moving towards "tourniquet first" due to ongoing battlefield use.
I don't think civvies will ever move to clamp and ligate due to liabilty, but I may possibly still carry my hemostats. Old habits and all.

JEVapa · 10-22-2009, 21:49

I'll bring it up to my buddy over at SOMTC. Situation dictates I still believe. You won't do it during TCCC, but in your clinic or UW hospital setup you might have to.

Surgicalcric · 10-22-2009, 21:57

NDD:

As rwd previously stated, it is still being taught for mesenteric bleeders where other means of hem control arent adequate. It is a part of TCCC/trauma lanes, or was when I graduated a couple years ago.

swatsurgeon · 10-23-2009, 16:31

Field or operating room, emergency department....where?
Clamp with what: hemostat, vascular clamp, suture ligation?
Peripheral vessel or internal?

ss

Surgicalcric · 10-23-2009, 18:40

Quote:

Originally Posted by swatsurgeon

Field or operating room, emergency department....where?
Clamp with what: hemostat, vascular clamp, suture ligation?
Peripheral vessel or internal?

ss

In the field with hemostats to start then suture ligation as soon as possible on visceral bleeders. Clamping peripherals has been discussed but I have never utilized that technique. Instead, used TQ's or packing -mostly on groin/axial bleeders.

Crip

whocares175 · 11-01-2009, 16:52

i figure considering i just got done with TSS friday and start TCCC tuesday i've probably got the most current info on what JSOMTC is teaching. We are still taught clamp and ligate for mesentery bleeds, also for situations when we may have to hold on to a casualty for extended periods of time and we need to attempt to reduce a tourniquet it's "advised" to clamp and ligate bleeders to get all bleeding under control (although this is not actually demonstrated formally for extremity bleeds). hope this answers the question.

NousDefionsDoc · 11-01-2009, 17:09

Cool.

"Field or operating room?"

Silly swatsurgeon

whocares175 · 12-07-2009, 19:57

for mesentary bleeds ligate as soon as you have the chance. for extremity bleeds controlled by a tourniquet, when you get the chance. if can't get hemostasis with tq for whatever reason, ligate asap.

Debo · 04-21-2010, 16:54

They are still teaching it in the SOCM/SFMS course just like the other guys said. Making sure to leave long tails on the ligation so the surgeons can locate them easily during the lap is important they say. In CTM they wanted us to just clamp and dress without the ligation.

D.

Paramedic40 · 04-24-2010, 10:26

Conventional 68Ws are not trained to pinch off or ligate anything.
I was trained not to pinch anything off- packing and pressure dressings and tourniquets for positioning.
I personally carry a pair of hemostats for splinters and such, but in all honesty, I don't have confidence in my ability to correctly locate and close a bleeding artery in a relevant amount of time. Until I'm trained on it to my standards (which are at least as high as that of the certifying authority) and I'm certified to perform it, it's not a skill I'm going to use.

There is an exception to this- the off-chance of an umbillical cord. That I know how/where/why to clamp.

whocares175 · 04-25-2010, 18:52

debo, when ligating, yes, leave long tails so the surgeons can find them during exploratory surgery. that is taught in tss however, during ctm we are simply clamping the bleeders off. why instead of ligating i'm assuming is the clock. beyond that i don't know. in a real situation, once i was able to i'd ligate and then unclamp.
paramedic40, clamping bleeders isn't really that hard. i dont know what you do or where you're at but if you can find somone with any experience with it and work in a hospital i'm sure you can learn how very quickly. mesentary arteries can be confusing because they are so many of them but larger arteries are pretty easy to spot. if in doubt, follow the blood. haha. however, i do comend you for not simply trying something you've never done before without someone more experienced to guide you.