Quote:
Originally Posted by Doc Dutch
They had two large bore IV's and the air crew was starting a third just in case. The patient was on hundred percent O2 by FM. At the referring ED, they stated that he had breakthrough bleeding and they had to reinforce the bandage twice. The air crew stated that after he arrived to us he had lost at least 2 liters of blood in the ED and on the gurney in their helicopter. The patient had a RR of 40 breaths per minute and was cold and sweating. The air crew was calling stating that they were giving more fluid boluses and starting the blood. They also notified us that they were going to apply a tourniquet to the thigh.
We upgraded the patient from consult status to our highest level of activation and the trauma team was waiting for the patient on arrival in the trauma bay.
Thoughts? What about the blood? Would you or would you not transfuse? What are your triggers?
Tourniquet? Yes? No? Maybe?
Another adjuncts? Hemcon? Quikclot? Other topicals?
I am going to post two photos I took in the midst of the fray. I have blocked out the patient's face and doctor's partially masked face so not to reveal identities or give identifying information.
Dutch
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he had breakthrough bleeding and they had to reinforce the bandage twice.
This is a classic case of uncontrolled hemorrhage with what people fondly refer to as a pressure dressing ....in reality it is nothing more than a "sponge" that soaks up precious blood and doed very little to slow/stop the hemorrhage...I really belive that these people dream in technicolor when they think a "pressure dressing" applied to a wound does something useful. The tourniquet should have been applied at this point, not when they are in the air. Where was it placed on the thigh by the air crew, was it tight enough to stop the bleeding, what tourniquet type was it?
Just for fun, I am adding a link to what has become my preferred tourniquet because it acts both as a pressure dressing that actually has physiologic results as a true pressure dressing and if wrapped as directed acts as a tourniquet.....by releasing 2 'wraps', it changed from tourniquet to pressure dressing when I tested it in the vascular lab.
The case report was my patient here.....it worked great.
http://swattourniquet.com/casereport.html
ss
__________________
'Revel in action, translate perceptions into instant judgements, and these into actions that are irrevocable, monumentous and dreadful - all this with lightning speed, in conditions of great stress and in an environment of high tension:what is expected of "us" is the impossible, yet we deliver just that.
(adapted from: Sherwin B. Nuland, MD, surgeon and author: The Wisdom of the Body, 1997 )
Education is the anti-ignorance we all need to better treat our patients. ss, 2008.
The blade is so sharp that the incision is perfect. They don't realize they've been cut until they're out of the fight: A Surgeon Warrior. I use a knife to defend life and to save it. ss (aka traumadoc)
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