Trauma Care 3: Use of Hemostatic Agents to Control Major Bleeding Portal
The fate of the severely wounded often lies in the hands of the first to touch the patient. The principal means to control major hemorrhage by external mechanisms include:
- Initial use of compression
- Early and aggressive use of tourniquets
- Use of hemostatic agents
Tourniquets:
The combat application tourniquet (CAT) is the most commonly used by
the military. The Soft Tactical (Soft-T) tourniquet is also effective.
Hemostatic Agents:
The hemostatic agents made by QuikClot (www.quikclot.com)
are presently the agents preferred by the military.
The old QuikClot, made of kitty litter, generated extensive heat and produced tissue damage.
Powder products made by different companies all have problems including the development of tissue-damaging heat and packages bursting in flight and/or being blown away by wind. Additionally, it is difficult to get the product into close contact with the site of the bleeding vessel.
Wound Stat is made of granules and is effective to stop bleeding but has been known to embolize to the brain and lung.
QuikClot®:
- QuikClot is made by impregnating gauze with Kaolin, a white alumina silicate. When exposed to human plasma, the Kaolin activates the clotting Factor XI and XII to initiate the clotting cascade to help form an active, natural, stable clot. Kaolin also fosters platelet adhesiveness at the bleeding site.
- QuikClot comes in a variety of dressing forms including:
- 2X2 gauze pads (hemostatic pads)
- 4X4 gauze pads (hemostatic pads)
- QuikClot Emergency dressings
- Combat Gauze – 4-yard-long rolls of three-inch gauze that can be packed into larger wounds.
- QuikClot is easy to train providers on how to get the product into the wound
- QuikClot will stay in the wound.
- QuikClot is easy to get to the bleeding site of the wound.
- With its application, it acts as a compression on the bleeding vessel.
Note: All patients who need a tourniquet or need the application of a hemostatic agent still need to go to the operating room for definitive treatment when possible. Nevertheless, use of both tourniquets and hemostatic agents are effective in reducing blood loss and buying time until definitive treatment of the major bleeding can be accomplished.
References
- National Trauma Institute Annual meeting in San Antonio, TX; August 30 – September 1, 2010.
- www.quikclot.com. Accessed September 7, 2011.