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EMSDoc
Guest
Hey everyone,
82ndTrooper asked in my introduction thread if I could start a discussion on the various hemostatic agents, and their effectiveness in controlling bleeding. So, here are my thoughts, open to the general discussion...
Hemostatic agents such as chitosan dressings (i.e Celox, HemeCon), zeolite-based (i.e. QuikClot) dressings, cellulose based dressings (i.e. Surgicel or ActCel), and potato starch based (i.e. TraumaDEX) dressings use a dehydrative mechanism in which the plasma is absorbed by the dressing, inducing rapid clotting of the blood by bringing platelets into direct contact with each other. The various dressings also can provide a matrix for the platelets to adhere to, which also helps to induce clotting. All of these materials are inert -- and therefore will not affect the blood elsewhere, and are non-toxic. Pure cellulose based dressings can be left in place, as they will be absorbed by the body over time. The other dressings must be washed out of the wound at the hospital, as they are not absorbable by the body and would lead to infection if left in place indefinately. There are also dressings available infused with either thrombin (clotting factor) or calcium (which induces the clotting cascade), but these are not widely available yet for general use and are still mostly in the testing phase.
To be honest, each company will provide for you a wealth of information where they claim that their product is much better than a competitor's. The only major difference between the various products is that the older versions of the zeolite-based (lava rock) dressings would cause a rapid exothermic reaction when contacting water/plasma. This could lead to burns. Since then these dressings have been redesigned to cause less of a reaction. All of the dressings currently marketed to the special operations and tactical arenas will control bleeding as advertised. It is best to choose one based on ease of use and carry, and cost to you or your department, and ensure each provider knows where it is and how to use it.
A few caveats on these products:
1. The MOST IMPORTANT steps to remember in bleeding control are DIRECT PRESSURE and a TOURNIQUET. All hemostatic agents should be considered secondary bleeding control.
2. Given that these agents must be washed out of the wound, and some can cause burns to the tissue, they should be used in life-threatening bleeding only.
3. If you have a life threatening bleed not amenable to direct pressure and/or a tourniquet (i.e. femoral artery close to torso) then hemostatic agents can absolutely be life saving.
4. Remember to place the agent AS LOW DOWN IN THE WOUND as you can -- ideally directly over the actively bleeding arterial vessel. If the hemostatic agent is only on top of the bleeding wound, it can seal off the top, but continue to bleed underneith.
So in summary...
1. Not a panacea
2. Works well in secondary bleeding control after direct pressure and tourniquet fail or are not practical
3. For life threatening wounds only
4. Place as low down into wound as possible, ideally directly over bleeding vessel
5. Depending on dressing used, burns to tissue and infection could be possible side effects
6. All commercially available dressings will control bleeding if used as directed
7. Base your decision on which dressing to use on cost, ease of carry/use, and its side effect profile
Hope that helps everyone.
EMSDoc :cool:
82ndTrooper asked in my introduction thread if I could start a discussion on the various hemostatic agents, and their effectiveness in controlling bleeding. So, here are my thoughts, open to the general discussion...
Hemostatic agents such as chitosan dressings (i.e Celox, HemeCon), zeolite-based (i.e. QuikClot) dressings, cellulose based dressings (i.e. Surgicel or ActCel), and potato starch based (i.e. TraumaDEX) dressings use a dehydrative mechanism in which the plasma is absorbed by the dressing, inducing rapid clotting of the blood by bringing platelets into direct contact with each other. The various dressings also can provide a matrix for the platelets to adhere to, which also helps to induce clotting. All of these materials are inert -- and therefore will not affect the blood elsewhere, and are non-toxic. Pure cellulose based dressings can be left in place, as they will be absorbed by the body over time. The other dressings must be washed out of the wound at the hospital, as they are not absorbable by the body and would lead to infection if left in place indefinately. There are also dressings available infused with either thrombin (clotting factor) or calcium (which induces the clotting cascade), but these are not widely available yet for general use and are still mostly in the testing phase.
To be honest, each company will provide for you a wealth of information where they claim that their product is much better than a competitor's. The only major difference between the various products is that the older versions of the zeolite-based (lava rock) dressings would cause a rapid exothermic reaction when contacting water/plasma. This could lead to burns. Since then these dressings have been redesigned to cause less of a reaction. All of the dressings currently marketed to the special operations and tactical arenas will control bleeding as advertised. It is best to choose one based on ease of use and carry, and cost to you or your department, and ensure each provider knows where it is and how to use it.
A few caveats on these products:
1. The MOST IMPORTANT steps to remember in bleeding control are DIRECT PRESSURE and a TOURNIQUET. All hemostatic agents should be considered secondary bleeding control.
2. Given that these agents must be washed out of the wound, and some can cause burns to the tissue, they should be used in life-threatening bleeding only.
3. If you have a life threatening bleed not amenable to direct pressure and/or a tourniquet (i.e. femoral artery close to torso) then hemostatic agents can absolutely be life saving.
4. Remember to place the agent AS LOW DOWN IN THE WOUND as you can -- ideally directly over the actively bleeding arterial vessel. If the hemostatic agent is only on top of the bleeding wound, it can seal off the top, but continue to bleed underneith.
So in summary...
1. Not a panacea
2. Works well in secondary bleeding control after direct pressure and tourniquet fail or are not practical
3. For life threatening wounds only
4. Place as low down into wound as possible, ideally directly over bleeding vessel
5. Depending on dressing used, burns to tissue and infection could be possible side effects
6. All commercially available dressings will control bleeding if used as directed
7. Base your decision on which dressing to use on cost, ease of carry/use, and its side effect profile
Hope that helps everyone.
EMSDoc :cool:
:doh:
