Wound Packing

[foszoe]

I recently got a trauma kit pack from AR500 and have been watching videos on how to use items in the kit. A while back, I took a trauma class but it's been a while back. Anyway, Celox came with the kit and while watching videos on it, I came across this...

Hemostatic dressings reduce tourniquet time while maintaining hemorrhage control - PubMed

Tourniquet application has become first-line treatment for extremity hemorrhage on the battlefield and has seen increased use in the civilian arena. We hypothesized that an effective windlass tourniquet could be removed after application of a hemostatic dressing in a swine model of peripheral...

pubmed.ncbi.nlm.nih.gov

Abstract​

Tourniquet application has become first-line treatment for extremity hemorrhage on the battlefield and has seen increased use in the civilian arena. We hypothesized that an effective windlass tourniquet could be removed after application of a hemostatic dressing in a swine model of peripheral vascular injury. A tourniquet was placed proximally in 50 forelimb-injured swine after 30 seconds of hemorrhage with cessation of hemorrhage in all cases. Hemcon, ActCel, Quikclot, Celox, or standard gauze was then placed over the wound with direct pressure for three minutes. The tourniquet was then removed. Success was determined if no bleeding was identified. Standard gauze resulted in a 100 per cent failure rate with active bleeding present after each application. Celox was successful in maintaining hemostasis in 6 of 10 (60%) subjects. Quikclot succeeded in 80 per cent of subjects. ActCel maintained hemostasis in nine (90%) subjects, whereas HemCon was successful in all instances (100%). All four hemostatic dressings were superior to gauze in maintaining hemostasis after removal of an effective tourniquet. Use of hemostatic dressings in conjunction with a tourniquet may reduce tourniquet times and improve outcomes in peripheral vascular injury and warrants further study.

From that blurb, it looks like HemCon was a clear winner over other hemostatic dressings.

Anyone here have first hand experience with these?

When trying to find the source of the bleeding to apply the gauze/pressure, how hard is that really in real life?

I can see packing a wound as "easy", but that initial finding the blood source seems like it would be pretty hard for someone without "real" training hands on with a pig or something.

Is hemostatic for places where a tourniquet can not be used?

Is a hemostatic to be applied to a wound after a tourniquet has been applied?

Should a Good Samaritan even try removing a tourniquet after a hemostatic has been used?

I am certain time is a factor in all the answers, but any guidance would be nice.

Finally, what are some recommended classes for trauma?

 

[MCgrease08]

Stop the Bleed: Bleeding Control for the Injured

www.in.gov

 

[MCgrease08]

A long and mostly useful thread about treating traumatic injuries, what to consider carrying in an IFAK.

Life saving First Aid in a mass casualty situation.

In light of recent attacks with mass casualties we need to think of the aftermath. EMTs and ambulances response times are no faster than police. Most of us think through GGWAG senarios, but it would be a good idea to plan on good guy with a band aid situations too. Are you prepared? I have...

www.indianagunowners.com

 

[foszoe]

Yeah, I watched some good videos on stop the bleed.

Finding the bleeding source seems like that would be hard for the average person.

Maybe I need to practice on a pig

 

[Ark]

That's an interesting finding. Probably worth keeping in the back of your mind for like a wilderness medical situation, but in regular life I don't anticipate being the person who has to worry about removing a tourniquet. It's there to bridge time for transport to an ER.

I understand the general principles of wound packing, but it's probably not something I would try except in a major junction bleed where there is simply no other option and death is imminent, and then it would be a brute force of packing and then kneeling on it.

I'd love to learn in much more detail and get more practice, but that's probably just not going to happen in my life.

 

[Brad69]

IME,
You normally will not have a problem finding wound. Look all over the person. Do you know which on to work on first?

Some wounds bleed a very small amount but can be deadly. Sucking chest wound comes to mind.

A quick clot is normally used for a junctional wound. Simple take you packing open wound start packing. You want the material against the source of bleeding.
BTW this gonna hurt like hell like screaming in agony hurt. Ignore it!

I personally would not remove a tourniquet in a normal situation let the Doc do that crap.

Do not forget your ABC’s of life saving! It would be shame to stop the bleed because they choked to death.

 

[Sylvain]

You don't want to remove a tourniquet in the field.
It needs to be removed by a physician in a trauma center.

Besides the risk of having your patient bleed to death you're also dealing with toxins built up in the limb where the tourniquet was applied.
It all depends on how long the tourniquet was applied, it's why knowing the time when the tourniquet was applied is important.

There is no risk of losing a limb when a tourniquet is applied so there is really no reason to remove it quickly.

Usually we are told it's safe for up to 2 hours, the military even say it's good up to 4 hours.

In most situations it should be enough time for you to bring your patient to the next level of care.

 

[foszoe]

IME,
You normally will not have a problem finding wound. Look all over the person. Do you know which on to work on first?

Some wounds bleed a very small amount but can be deadly. Sucking chest wound comes to mind.

A quick clot is normally used for a junctional wound. Simple take you packing open wound start packing. You want the material against the source of bleeding.
BTW this gonna hurt like hell like screaming in agony hurt. Ignore it!

I personally would not remove a tourniquet in a normal situation let the Doc do that crap.

Do not forget your ABC’s of life saving! It would be shame to stop the bleed because they choked to death.

What I was trying to ask was, after you locate the wound, the videos I watched made it sound like you had to locate the source of the bleeding like find the artery underneath the blood pool and pressure that somehow.

The other way I was interpreting it was like when you dig a hole and you put the loose dirt back in, its never as solid as when you removed it and thats kinda what you are doing when you pack that hemostatic gauze in there. you pack it as full as you can and then keep pressure on it letting the gauze seal the artery.


NOt sure which way is right and that still probably doesn't make sense

 

[foszoe]

That's an interesting finding. Probably worth keeping in the back of your mind for like a wilderness medical situation, but in regular life I don't anticipate being the person who has to worry about removing a tourniquet. It's there to bridge time for transport to an ER.

I understand the general principles of wound packing, but it's probably not something I would try except in a major junction bleed where there is simply no other option and death is imminent, and then it would be a brute force of packing and then kneeling on it.

I'd love to learn in much more detail and get more practice, but that's probably just not going to happen in my life.

cavmedic, I think, was a member here and gave a class on it. It was basic, but informative.

 

[Sylvain]

What I was trying to ask was, after you locate the wound, the videos I watched made it sound like you had to locate the source of the bleeding like find the artery underneath the blood pool and pressure that somehow.

The other way I was interpreting it was like when you dig a hole and you put the loose dirt back in, its never as solid as when you removed it and thats kinda what you are doing when you pack that hemostatic gauze in there. you pack it as full as you can and then keep pressure on it letting the gauze seal the artery.


NOt sure which way is right and that still probably doesn't make sense

When you're dealing with a large wound you just want to fill the void (where tissue and other stuff once was) with your packing material (regular gauze, fancy hemostatic agent or event a sock) and add pressure (directly from your hand or from a pressure bandage).

You don't need to locate a specific artery or vein.
You just pack until you can't pack it anymore, then pack some more and keep pressure on the entire time.

 

[Brad69]

I agree with the French dude no real need to find what’s leaking inside the wound just packer full.

If you use quick clot or similar a surgeon will have to remove it. It really sticks to stuff.

The Doc or PA will figure the rest out. When you hand the unlucky person over make sure you note time of when you did what.

BTW hope they ain’t allergic to shellfish!

 

[fjw2]

I would recommend exploring skinny medics you tube channel. The answers to many of your questions can be found there.

 

[foszoe]

I would recommend exploring skinny medics you tube channel. The answers to many of your questions can be found there.

Watched some.

I've liked prepmedic better.

 

[Angrysauce]

Tourniquet conversion requires the loosening of the tourniquet, failure to do so will cause massive tissue damage and generally the loss of the extremity, if not death. (Read about compartment syndrome) Tourniquet conversion is also one of those things you will likely never need to do if you're not a medic. It is done to improve the post injury quality of life. If that casualty has to wait hours for care, would he be better off with a below the knee amputation or the good old "high and tight"?

For the layman, bleeding control is simple.
If the tourniquet is controlling bleeding distal to it, LEAVE IT ALONE.
If the tourniquet is ineffective at controlling bleeding distal to it, TIGHTEN THAT **** AND PUT ANOTHER ONE IMMEDIATELY ADJACENT TO IT.
If the tourniquet is ineffective at controlling bleeding proximal to the body, DUH IT NEEDS TO BE BETWEEN THE WOUND AND THE HEART.
If a tourniquet isn't able to be placed, use other means. If the wound is in a junction (neck/shoulder, axilla, groin) pack it with hemostatic gauze. Find the source (dig, it's gonna hurt), pack it tight, hold pressure.
DO NOT pack or use hemostatics in the abdomen, genitals, mouth, etc. Anywhere with a mucous membrane or an open non-compressible cavity. Instead use bulky, preferably sterile dressing to control bleeding as best as possible. If you have wounds to the chest (above the navel) it's probably a good idea to put an occlusive dressing of sorts on it. Watch for difficulty breathing or respiratory depression/arrest. Generally speaking chest or gut theres nothing you can do to "stop the bleed", they need a surgeon.
Make sure all of these things continue to work, a lot of dudes have ripped their own tourniquets off or had them dislocated by moving.

As a Good Samaritan that's all I'd do. Simple, stupid. The more outside of scope interventions you do the more you open yourself up to civil liability.

Keep the goals simple. Red stuff inside, air going in and out, red stuff pumping inside. Your not the medic, surgeon, pt, or psych.

 

[Angrysauce]

You don't want to remove a tourniquet in the field.
It needs to be removed by a physician in a trauma center.

There is no risk of losing a limb when a tourniquet is applied so there is really no reason to remove it quickly.

This is not always true. Many tourniquets have been converted to packing in the prehospital setting.
As joe blow, no training, 15 minutes from a trauma center, it's mostly true.

 

[Double T]

I recently got a trauma kit pack from AR500 and have been watching videos on how to use items in the kit. A while back, I took a trauma class but it's been a while back. Anyway, Celox came with the kit and while watching videos on it, I came across this...

Hemostatic dressings reduce tourniquet time while maintaining hemorrhage control - PubMed

Tourniquet application has become first-line treatment for extremity hemorrhage on the battlefield and has seen increased use in the civilian arena. We hypothesized that an effective windlass tourniquet could be removed after application of a hemostatic dressing in a swine model of peripheral...

pubmed.ncbi.nlm.nih.gov

From that blurb, it looks like HemCon was a clear winner over other hemostatic dressings.

Anyone here have first hand experience with these?

When trying to find the source of the bleeding to apply the gauze/pressure, how hard is that really in real life?

I can see packing a wound as "easy", but that initial finding the blood source seems like it would be pretty hard for someone without "real" training hands on with a pig or something.

Is hemostatic for places where a tourniquet can not be used?

Is a hemostatic to be applied to a wound after a tourniquet has been applied?

Should a Good Samaritan even try removing a tourniquet after a hemostatic has been used?

I am certain time is a factor in all the answers, but any guidance would be nice.

Finally, what are some recommended classes for trauma?

Don't watch videos. Take training. If you need an IV or a foley, do you want someone with training to do it, or do you want someone watching a youtube video making you their guinea pig?

I personally would not use any form of quick clot. You may clot off a bleed superficially and have it missed on next assessment or handoff to a higher level of care, when the person has internal bleeding that could cause or mask other...potentialities which I won't go into here.

If you have these questions, seek out training or keep the stuff and hand it to someone who has had training if SHTF and it is needed.

 

[Double T]

I also want to point out, your study is 10 years old...and isn't considered current by standards of research

 

[Ruger_Ronin]

Please don't take this as snark,

But the idea here is to stop the bleeding. By any means necessary. (No necktie TQ's!). We can argue over technique, procedure, aftercare, etc. None of this matters if the victim bleeds out. Get the bleeding controlled and get them to a professional. Keep it simple.

 

[Sylvain]

This is not always true. Many tourniquets have been converted to packing in the prehospital setting.
As joe blow, no training, 15 minutes from a trauma center, it's mostly true.

Well yeah, it really depends on who you are, what type of training you have, what type of gear you have (and in which quantity), how far you are from the nearest ER, how long ago was the tourniquet applied etc.

In most situations if the tourniquet works don't mess with it.

In most situations it's always good to ask for guidance as well (calling 911 for joe blow on the site of the road, or your medical director if you work in EMS).

Hopefully someone with more medical knowledge should be able to tell you what to do.

 

[DadSmith]

I definitely need a refresher course. Luckily my Daughter is a paramedic so I can get my training free when she has some free time.