Wound Stat

[rcm_18d]

All of these different courses will vary by command and the individuals teaching it for obvious reasons. Medics all have a few or a ton of pet peeves. Kinda like the opinion analogy. TC3 is TCCC is Combat Causality Care and is pretty standard across the services. There are still some commands and organizations that teach the ABC's as they have been taught since before anyone was getting shot.

RFR has a lot more duress inflicted upon the operators (i.e. Loud music, bangs, harassment for the instructors, moulage, and settings in which conducted) than a typical CLS course. Not so much due to the curriculum but to the enthusiasm of the cadre. Most of these guys will understand the importance of gross vs fine motor skills and how these conditions will illustrate the tachy psychy effects induced by stress. Like the CLS course RFR teaches IV Saline locks. I am not a big fan of IV access at this level. RFR uses the acronym “Circulation Airway Breathing Disability(Mental Status) Exposure / Environmental control” for the primary survey.
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The cricothyroidotomy can be taught in all these courses, depending on the level of the operator receiving the instruction. When the course has the resources to run advanced topics along with the basic course of instruction, it is covered. This is still and should be an advanced skill. I am not saying non-medical personnel should not be taught this. I am just saying it needs to be selective. There are some 18d's that I would let do this procedure on my child, yet there are some I would shoot with the last bullet if they came to my aid. I am also a fan of the vertical incision. I don't care about the scar. I care about the ease of the procedure. This is an example of just one area all these courses can vary.

TFR typically does not include IV access but does include a painful and blah blah section on environmental injuries. The east coast uses “Situation/Self-aid Circulation Airway Breathing” for their primary survey. The west coast uses “Bleeding Airway Tension pneumothorax Shock” as their primary.

The common ground between these are the basic principles of TCCC. Basics are what saves lives and the military has realized this.

[Razor]

Originally Posted by rcm_18d

The west coast uses “Bleeding Airway Tension pneumothorax Shock” as their primary.

You know they did that so they could use the acronym BATPiSs.

[rcm_18d]

Sweet! Will have to use that one. Company of Navy dude's and I am the token Army guy. Up hill battle, but it is what it is. You give to much credit to the Seals though. They can't spell good enough to make up an acronym. Much less one that makes word(s)! I do, by the way, work with the Seal that was shot in the chest by Oscar in Bosnia. I am sure there are a few that remember the story. Bigs!! You just can't make this stuff up!!

[Pacer]

Swat Surgeon...

Doc

Thanks for the research data on the WoundSatat.

A few posts ago, you note you've got an "empiric" series of pateints in your OR.

What has been your personal experience with Chitosan (Celox)? Especially intruqued with the "Celox -A" prep that comes in a syringe type applicator for use (theoretically) in a puncture type wound with inaccessable vascular involvement. Kinda negates the reservation with a "tampon" completing the disruption of the vessel....IF it works while awaiting your magic hands/dissection, etc.

Again, what has been your experience.

(Dr) Pacer ()

[Pacer]

Does anyone have real world follow up on Celox A in deep muscle bed penetrating wounds? Specifically operative reports and post op or autopsy evidence?

Pacer

[swatsurgeon]

Originally Posted by Pacer

Swat Surgeon...

Doc

Thanks for the research data on the WoundSatat.

A few posts ago, you note you've got an "empiric" series of pateints in your OR.

What has been your personal experience with Chitosan (Celox)? Especially intruqued with the "Celox -A" prep that comes in a syringe type applicator for use (theoretically) in a puncture type wound with inaccessable vascular involvement. Kinda negates the reservation with a "tampon" completing the disruption of the vessel....IF it works while awaiting your magic hands/dissection, etc.

Again, what has been your experience.

(Dr) Pacer ()

I would Never put a free powder/granule product down where I could not see it...the risk of embolization of one of these "free" products that could lead to DIC is too much for me to ever attempt it or suggest it.
My use of celox has been limited to the hospital ED where I now work. They stocked it for use in the emergency department as a back-up hemostatic agent for injured patients. After introducing quik-clot (combat gauze and the "tea-bags") to all of the staff, celox was gone and quik-clot was ordered. Did it work, yea, it did, was it a mess, yes. My issue with it was a patient that had it under a huge myo-cutaneos flap had it "washed out" and not all of it was removed and to dig it out to debride it out was a PAIN IN THE BUTT. Natural history of this stuff stayng around???? does it 'de-activate'?
the rules of engagement are different for military vs civilian patients and based on intracorporial use of quik-clot, I'm a believer in the product as are a lot of military practicioners.
I have had people ask me if they could administer celox down a wound track via syringe....What you need is pre-hospital pressure/tourniquet application then a trauma surgeon. In the field, you need a medic that can identify the problem, and use whatever skills and brain power are necessary to get the hemorrhage arrested until casevac, etc to a surgeon......
my experience with 18D's is that they will understand the procedures necessary to make the wound more "cooperative", I have been told stories of them doing what I do: enlarge the wound, get the exposure necessary to better create a solution...let your imagination run with that one.
Celox is a product like other products: they have their followers and believers and most of that comes from stories, 1/2 truths and little personnal experience....I really try to believe none until I use it far beyond what is talked about/written about myself, then I become a fan on a product, I test it in the operative field as well as the pre-operative one....doesn't mean I'm any more qualified to tell anyone anything other than what I have seen with my own eyes and that I have NO financial/personal/ conflict of interest in ANY product I use...too many people out there that can not say the same thing who are some of the proponents of these products
ss

The Sunday lead story in the Baltimore Sun is about woundstat and a few other products.. interesting.

thanks bunches for this thread. I found it totally fascinating.

http://www.baltimoresun.com/news/nat...,7110366.story

edited to add: I think the article is decent, if a little sensationalistic..but it is the media.

[rcm_18d]

USSOCOM standared is currently Combat Gauze, or a least last Dec '08 at SOMA! Has anyone used this or heard of it being used on a human patient?

[swatsurgeon]

yes, I used it this past friday night in a patient.....hit by a bus, cracked the pancreas in half, split a 'horseshoe' kidney in half, splenic injury, colon injury, renal artery and vein injuries....could not get to the renal vessels well during the damage control phase of my operation so asked the nurse to open my bag and open the combat gauze and put it on the operative field.....worked like a charm....gave me hemostasis where pressure/surgicel and flo-seal didn't work. Came back to the site after dealing with all of the other injuries, fixed the artery but had to ligate the vein. It was nicely controlled with the combat gauze! My first use of it inside. Have used the 'tea bags' inside the body before with excellent results as well.

ss

[rcm_18d]

Thanks for the report swatsurgeon. I have had the same results on the patient models. I really like the impregnated gauze concept.
I have also had great results from Celox as well.
When we did the invasion for OIF I all the 18 series medics in 10th Group were issued a dressing called the HD. We had to all sign waivers and every operator had a green tag on their dog tags representing the waiver. Have you ever heard of these? We were briefed that they were made from the clotting factors of human blood products impregnated onto a 4 X 4. They were real expensive, ($1000 ea.), were briefed to take 32 man hours, a piece, to make, and were produced by the Red Cross. I have not seen them since and I know of only one use on a patient.

[swatsurgeon]

Yes I know the dressing. Much too expensive and the Red Cross could not guarantee no transmission of viral particles since it was made from human serum. It was like having FFP and cryoprecipitate on a gauze pad. Other products achieve the same goal.

[Pete]

Here is the Stars & Stripes Story

http://www.stripes.com/article.asp?s...&article=62221

[swatsurgeon]

it's amazing that there is still press about quik-clot burning patients when that formula is no longer manufactured (x 2 yrs) and the new formula doesn't get above 105 degrees.
Clay in the blood stream is a bad thing hence why all free granular formulas are frowned upon by civilian and military docs.

ss

[ReconDoc242]

Originally Posted by swatsurgeon

it's amazing that there is still press about quik-clot burning patients when that formula is no longer manufactured (x 2 yrs) and the new formula doesn't get above 105 degrees.
Clay in the blood stream is a bad thing hence why all free granular formulas are frowned upon by civilian and military docs.

ss

I think a big reason for this is that a few units have not phased out the old quik-clot yet. I have personally ran into the older stuff in country a few times, only way to discern it is recognition of the old package....and obviously the date.

[Doc Dutch]

Originally Posted by ReconDoc242

I think a big reason for this is that a few units have not phased out the old quik-clot yet. I have personally ran into the older stuff in country a few times, only way to discern it is recognition of the old package....and obviously the date.

All,

This is a great thread. I wish all in the US military dealing with the injured / bleeding could read this. The reason for my post is to bolster what ReconDoc 242 mentioned.

I am just back from a course in CONUS. There the combat medic held up the Quikclot dressing and showed the other health care professionals the first generation, olive drab, tear top package of Quik Clot. I just about cringed. The medic told about 90 of us that the military had these new hemostatic bandages for patients "bleeding to death". Well, this was bad information as we are now into the "3rd generation" of hemostatic bandages with a major decrease in exothermic reactions. The medic had even mentioned how severe the burning could be. I realized that the medic was incorrect as we no longer use that formulation and that those that would actually be treating in theater and might see these sorts of bandages would be significant number, but they would potentially come in contact with some form of these dressings applied as previously listed here in this thread. I also know that the military surgeons know better than to use the first generation QuikClot having just been through the EWSC (Emergency War Surgery Course).

If there is any "older stuff" laying around like the first generation QuikClot that can seriously injure the badly wounded even more, we need to pull it ourselves and destroy those products in theater or tell those medics to get rid of it. Quik Clot (first generation) is great from a historical perspective but that is it. I doubt anyone would use a muzzle loaded rifle in today's armed conflicts, and I would not use the first generation QuikClot. Medicine has pushed to newer heights with what we learned earlier in OIF and OEF. By the way, I have no financial ties to QuikClot or any of the others. I do believe in tourniquets though, in theater and in the civilian world, but again no financial ties here either.

At this course, I was asked finally if I had any comments (where do you start) and I did mention that newer products were available and that if you see this older product, do not get it in your eyes, mouth or sinuses. I told them to cover it with a moist bandage and pack it until you are in the OR, especially when there is rotator wash from any helicopter or other aircraft.

If there is anyone going into theater, please educate people on these fine points. People need to get caught up on these new products (problems and dangers, risks and benefits). I wish every medical personnel going over to Iraq or Afghanistan and beyond could join this site and read this thread.

Anyway, ReconDoc 242, you are completely correct.

My best to all,

Dutch