hemostatic agents - fcfra.camp9.orgfcfra.camp9.org/resources/documents/ems/ems protocols... ·...
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HEMOSTATIC AGENTSHEMORRHAGE CONTROL
WOUND CARE
MARY HART, LIEUTENANT, NRP
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HEMOSTATIC AGENTS
• “An area of increasing concern is lethal hemorrhage from
sites that are not suitable for application of tourniquets
or compression dressings.”
• Hasan B. Alam. “Hemorrhage control in the battlefield: Role of new hemostatic agents”
Military Medicine, 170(1):63-69
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CHARACTERISTICS OF AN IDEAL HEMOSTATIC AGENTS FOR PREHOSPITAL USE:
• Capability to stop large vessel arterial and venous bleeding
within 2 minutes of application when applied to an actively
bleeding wound through a pool of blood.
• No requirement for mixing or pre-application preparation;
• Simplicity of application by wounded victim, buddy, or medic;
• Lightweight and durable
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CHARACTERISTICS OF IDEAL HEMOSTATIC AGENTS
• Long shelf life in extreme environments;
• Safe to use with no risk of injury to tissues or
transmission of infection;
• Inexpensive
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HOW BLOOD CLOTTING AGENTS WORK
• Blood clotting granules are actually
very high surface area flakes. When
they come in contact with blood, it
swells, gels, and sticks together to
make a gel like clot, without
generating any heat. The Agents do
not set off the normal clotting
cascade, it only clots the blood it
comes directly into contact with.
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HOW BLOOD CLOTTING AGENTS WORK
• There are a number of major benefits:
• Works in hypothermic conditions
• Clots blood containing Heparin* or
Warfarin (Coumadin)
• No heat generated
• Leftover material is naturally absorbed by
the body.
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HOW DO THEY WORK ON HYPOTHERMIC BLOOD?
• Severe traumatic blood loss quickly
leads to the victim becoming
hypothermic, irrespective of the outside
temperature. Hypothermic blood is
coagulopathic and so becomes harder to
stop. The effectiveness of Celox blood
clotting agents in hypothermic conditions
has been tested independently.
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BLOOD THINNERS (ANTICOAGULANTS)
• The granules work even where there is
Heparin or Warfarin in the blood. An
increasing number of people are on
anticoagulants, presenting an extra
challenge if they are injured. The
granules have been tested and shown to
clot heparinized blood.
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HEMOSTATIC AGENTS
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NORMAL ADULT BLOOD VOLUME – 5 LITERS
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CAN YOU FIND THE BLEEDER?
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CAN YOU FIND THE BLEEDER? STEP 1
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COMPRESSION - STEP 2
•Once bleeding source identified, apply direct pressure to
tamponade flow
• Place a dressing on the wound when available (initially, use your
gloved hand)
• Add dressings until bleeding stops
• Continue direct pressure until bleeding stops (at least 3 min, may
need 10 min)
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HEMOSTATIC DRESSING - STEP 3
• Elevation helpful
• Pressure points technically near impossible to properly apply
• Pressure dressings beneficial
• Hemostatic dressings VERY helpful
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HEMOSTATIC AGENTS/DRESSINGS
• The latest and greatest surgical advance
• Continually evolving
• Including in PHTLS, ATLS, EMR, EMT and
ITLS
• Available OTC
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COMBAT GAUZE DIRECTIONS – APPLY DIRECT PRESSURE
• Apply pressure until bleeding stops
• Hold pressure for 3 minutes
• Reassess to ensure bleeding is controlled
• Combat Gauze may be repacked or a
second gauze used if initial application
fails to provide hemostasis
• Wrap and tie bandage to maintain
pressure.
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COMBAT GAUZE DIRECTIONS – PACK WOUND COMPLETELY
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COMBAT GAUZE TM
• 3-inch x 4-yard roll of sterile gauze
impregnated with kaolin. Activates
clotting factors and platelets, absorbs
water (increasing concentration of
platelets and clotting factors at
bleeding site) REQUIRES TRAINING
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STEP 4 - TOURNIQUET
• May be placed immediately:
• Short handed or alone
• Adverse conditions (hostile fire…)
• Multiple priorities (airway, breathing)
• Apply before s/s shock ensue
• “first resort,” not “last resort”
• 2 – 3” above wound, avoid joints