Found these two videos surfing around.
!!!Basically, dont try this at home kids!!!
Watching this will not teach you how to use this stuff, nor will it make you a medic, dont be a dink,leave it to the pros.
The thing that kinda makes me wonder is the fact that during the video ( besides beeing in a med environment and not beeing shot at etc) they have suction to aid them in getting the wound "dryer".
If your out in the field, Im seriously wondering how effectively you can just dump it in there, without it getting washed away.Just the pool that formed inside the wound right after beeing cut, looked like it was about a quart of a litre.
I used the point above in my discussion, but the come back was that the body goes into shock in a situation like this and one of the natural results of shock is that the arteries contract, i.e. close off the bleed. I would assume not stop the bleed altogether though. As yet I have not been in such a situation, so I can only go on those who have experienced this..
What you get in hypovolaemic shock is peripheral vasoconstriction, in other words, the arteries and veins in the extremities and skin contract and divert the majority of blood flow to the central circulation/organs. This would not affect the main arteries to any meaningful degree. If an artery is completely bisected then it may spasm and reduce blood loss, however an incomplete or oblique transection would leave it open to bleed. Either way the blood loss would still be significant.
Originally Posted by Vici VII
Again he pushed the toxin point. I believe that there was a victim in China (with the quakes) that was crushed and when they released the crushed debris off him, he died as the toxins surged through his body. According to others who saw the item on the news, the victim was talking fine, even though being crushed.
This is different to metabolite build up that you would see in prolonged TK use. Crush injuries involve acute, significant muscular damage which releases a large amount of potassium, which is normally in the muscle cells, when the circulation is restored to the affected area (ie when the crushing object is removed). Potassium (and calcium) transfer into muscle cells is part of the mechanism which causes the cells to contract. Having a large volume of potassium entering the blood stream can cause contractile problems in all of the muscles, but the most important is the heart. The intravascular potassium rise caused by a large crush/release type injury can cause fatal arrhythmias fairly quickly.
The 'toxins' produced by long TK use are the products of anaerobic respiration by the cells in the affected limb. This can cause a degree of acidosis, but is rarely a cause of acute arrhythmia and death as with true 'crush' injuries. People undergoing major joint surgery (ie knee replacement) have the blood pushed out of the leg by a large rubber tube and have a TK applied at the groin while the surgery happens, often up to 3-4 hours, sometimes more.
Originally Posted by Vici VII
Naturally my next question how would you overcome this. His answer was very slowly. use fluids to fight the toxins and release the debris slowly. Naturally this isn't a firefight and there is no added stress of being shot. Although he did also say that in some instances there is nothing they can do for a crushed victim, as the release will kill instantly and so they just give pain killers and talk to them until the inevitable happens.
What he says here is true, for crush injuries. However as I've said, TK use is different to crush injuries.
Originally Posted by Vici VII
By the way, if anyone is reading that this has happened to or they have experienced, I mean no disrespect in those situations.
I am asking to understand more.
Don't worry. The only way you can improve treatment for the next patient is by asking everything you can about the last. The most important thing to carry as a medic is up to date knowledge.
I haven't really used the LBT bag as yet, it's well built and the right size, but it could really do with more pockets and elastic to store kit in.
The STOMP is well designed (because it's a rip-off of an LBT bag, I bought it because it's MUCH cheaper than LBT) and holds all the kit I'd need for a vehicle patrol med pack, but weighs an absolute ton with all the kit in. It's basically a bergen.
That's left me using my original PLCE pouches after dropping the cash on the other two! That should be a lesson to us all. What I've done is use two side pouches, one for trauma and one for 'Primary Care'. So all the pills and potions and ointments go in the primary care pack in the bottom of my bergan, and the trauma pouch sits under the lid or in the daysack on an assault. As yet I can't find a better way of doing it with 'green' patrolling.
In addition to that kit, I keep my own FFD, Airway etc in my pocket and have a small blackhawk pouch with an FFD, Hemcon, airways, shears, etc in my webbing for immediate care without a daysack.
This is a good thread and would be happy to offer any input to questions or discussions. I'm a US Army medic and nurse, and also a civilian paramedic. In regards to TK use the biggest problem I've noticed is simply not tying them tight enough. You really have to crank them down because remember you are trying to occlude an artery that is lying beneath layers of skin, fat, and muscle. Usually the big strong guys tend to put them on correctly. You know if it is tight enough if the victim is screaming how much the TK hurts!. There is just no subtle way to do it. Take enough time to make sure it doesn't slip. And recheck it often. Vasoconstriction doesn't last long, and requires lots of energy on the part of the body to maintain. I've always said better to lose a limb than die. The CAT is a good TK, but make sure you use the one with the metal twist. I've seen the plastic ones break, and the only thing better than one good TK is two good TK's. ..........CW 68W/M6 NREMT-P 345th CSH.
I met a guy who was with me in the same medics course.
He told me he treated an amputation above the knee caused in a car accident. He used the CAT to stop the hemoraging but it didn't apply enough pressure to stop the blood flow from the Femoral and he needed to add the good old screw tourniquet in order to get the wanted result.
Every situation is different, the CAT is as good as any other tourniquet. I've seen every TQ failure in the book, from materials failure to application failure - every brand has it's vulnerabilities. As pointed out above, the best thing to do is apply the TQ until bleeding stops, check for clinical response and continue to recheck the TQ in repeat surveys as you treat other problems.
I carry two TQs in my leg rig, along with other trauma kit so that I always have basic emergency kit on my person. For the NZed medic, I feel for you mate. No matter what you do, there will be times when you don't have what you need at hand. Separate your kit into what you need immediate access to when the emergency happens right in front of you (cargo pocket, leg rig), what you need access to in minutes to hours (small med ruck) and what you need access to in hours to days. No need to hump sick call meds around with you on patrols.
Anyone who is still carrying hemostatic powders or granules, change as quickly as you can to impregnated dressings. Please don't use Quick Clot, it's rubbish.
Vici, use TQs. As Sabre points out there are issues with the metabolic waste build-up in an ischemic limb. But that problem is for the surgeons and anaesthesiologists to deal with when it's time to let the TQ down. Keep your patients with massive extremity trauma alive by using good hemostatic resuscitation techniques! This includes the use of tourniquets.
I've used and been around QC since 2003 and have dozens of examples of its misuse, downsides and ineffectiveness - and not one of it saving a life or limb. While grateful that military trauma research led us in the direction of hemostatic agents because we now have some very useful products, QC is rubbish and was never the panacea it was billed or received as.
1. It's highly exothermic and damages surrounding tissues.
2. It doesn't "peel away" from the wound as its originators designed/described. At least some, usually most, of it remains granular in the wound and it acts as a foreign body. It is a royal pain in the ass to get out, sometimes require additional debridement of undamaged tissues.
3. You can't pour a powder into a hole (as noted above), so it's nearly useless in the situations in which it is most needed: bleeding that can't be reached.
Whilst very happy this other forum member is still with us, I submit that either:
1. QC wasn't truly needed, or
2. He would have been better served by any of the currently-available agents.
I understand that QC may have been the only available tool at the time and place of his injury - granted. But that is no reason to persist in using it when there are clearly superior products available. Plenty of men well-served by lances and swords in the history of warfare, but how would you feel if you got handed one by the QM before a deployment?