List Archives

Wed Aug 15 12:21:44 BST 2007

Dr. Wigle,
I'm finishing up a final revision of a literature review on tourniquets and
one of the things I have encountered is evidence that they can be left on
for several hours, I believe twelve hours being the longest I have seen
described without serious complications.  However that was in a cold
environment during WWII, so I don't know how well that could be extrapolated
to the deserts of the Middle East.  Most likely, whomever told you 24 hours
was either misinformed or at least relying upon evidence I do not have
access to.  Even I, one of the most staunch supporters of their use under
appropriate circumstances, would cringe at such a suggestion.  But then
again, I know how well the military takes to having inconsistencies or
errors being pointed out by people outside of positions of
authority.....that is a topic for another time though.

However, if you are familiar with the article by Rasmussen et al regarding
vascular injuries presenting to Balad, there were few, if any, cases of
extremely prolonged field times associated with those who presented with
tourniquets in place. The vast majority of patients were in the Theater
Hospital within an hour of being wounded. I don't have that paper directly
in front of me at the moment, so that is why I can't speak in absolute terms
regarding it.

Also interestingly I should point out that the one of my experiences with
QuikClot was a laceration on my thumb and I figured it was a good chance to
try out a sample of it that I had received on a half inch laceration without
arterial injury or other complicating issues.  It did not even seem to do
anything worthy of note.  However, your mileage may vary.

>
> ------------------------------
>
> Message: 2
> Date: Tue, 14 Aug 2007 05:03:05 -0700 (PDT)
> From: Richard Wigle MD FACS <rlwigle at yahoo.com>
> Subject: Re: Quik-Clot
> To: "Trauma &amp, Critical Care mailing list" <trauma-list at trauma.org>
> Message-ID: <43009.1129.qm at web38806.mail.mud.yahoo.com>
> Content-Type: text/plain; charset=iso-8859-1
>
> AS Far as I know Quikclot is still being used in the Iraqi
> theater. I've been retired about 5 months now and so have
> been out of the loop. My personal experience with it wasn't
> especially impressive other than having to clean it up, the
> thermal problems were, again in my experience, annecdotal.
>
> As Stephen notes I think one of the major problems with it
> and some of the other products is that they tend to become
> an excuse for incomplete training and, when introduced at
> the lowest levels, become a wonder cure for all that ails
> you. I saw the same thing with tourniquet use and, while
> there is absolutely no doubt that tourniquets have saved
> many lives in Iraq, they were being applied in place of
> proper dressing (granted that in the field proper dressing
> sometimes becomes a luxury). At any rate I was actually
> told as part of my training (same as the enlisted folks
> got- one size fits all but it was enlightening)that
> touriquets could be left in place for 24 hours and when I
> suggested that perhaps this was not the way to go I was
> told not to upset the apple cart.
>
> Anyway we have to remember that many of these products are
> being touted by people with a personal stake in there use.
> I recently pulled out a couple of reviews on all the
> products. I'm on the road at present and my computer has
> crashed so I'm relying on internet cafes and hotel access
> points but if anyone is interested once I get someplace
> stable I will be happy to forward them, they're not hard to
> find with google scholar.
>
> I'm sure others out there have had different experiences
> with all of these products
>
> R Wigle
> --- Stephen Richey <stephen.richey at gmail.com> wrote:
>
> > I am not certain if it is still being used in Iraq and
> > Afghanistan or not.
> > I have only anecdotal evidence (n= ~5) for the use of
> > Quikclot in my
> > personal experience (in civilian situations), but I have
> > to say I wasn't
> > that impressed by it.  It just seems to make one heck of
> > a mess of things
> > but not really do much in the way of hemostasis beyond
> > what you would
> > normally get from a pressure dressing.  I used to teach
> > the US Army combat
> > lifesaver course (last time I taught it was in 2003) and
> > I personally
> > deemphasized (I covered it but put a word of caution in
> > the presentation
> > about the hazards of relying upon such agents when more
> > efficacious methods
> > exist) the use of currently available hemostatic agents
> > in favor of
> > aggressive use of pressure dressings and tourniquets for
> > immediate
> > hemorrhage control on extremities, particularly in a care
> > under fire
> > setting.
> >
> > If I can offer any further information on the US
> > military's training, please
> > let me know.  If I don't have a solid answer for you, I
> > can put you in touch
> > with some contacts of mine who might be better positioned
> > to advise you.
> > Feel free to contact me off the list.  Have a nice day.
> >
> >
> > --
> > Stephen L. Richey, CRT
> >
> > "It is better to know some of the questions than all of
> > the answers."- James
> > Thurber
> > --
> > trauma-list : TRAUMA.ORG
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> >
>
>
>
>
>
> ____________________________________________________________________________________
> Be a better Globetrotter. Get better travel answers from someone who
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>
>
> ------------------------------
>
> Message: 3
> Date: Wed, 15 Aug 2007 08:39:06 +0100
> From: "JOSE SUAREZ PELAEZ" <josuarez at teleline.es>
> Subject: Re: Estimated fluid and blood losses classification.
> To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
> Message-ID: <002901c7df0f$5e3084d0$2501a8c0 at pc>
> Content-Type: text/plain; format=flowed; charset="iso-8859-1";
>         reply-type=original
>
> Thanks for  your help.
> Yes, that is what i was looking for but i just need to know where it was
> publiclated by the first time by American College of Surgeon.
>
>
> ----- Original Message -----
> From: "S Schecter" <schecters at gmail.com>
> To: "Trauma &amp, Critical Care mailing list" <trauma-list at trauma.org>
> Sent: Tuesday, August 14, 2007 12:40 PM
> Subject: Re: Estimated fluid and blood losses classification.
>
>
> Is that what you were looking for
>
> On 8/12/07, JOSE SUAREZ PELAEZ <josuarez at teleline.es> wrote:
> >
> > I can´t find the first publication of the "Estimated fluid and blood
> > losses" classification. Does anyone can help me?
> >
> > J.Suález-Peláez.
> > --
> > trauma-list : TRAUMA.ORG
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> >
>
>
>
>
> --------------------------------------------------------------------------------
>
>
> > --
> > trauma-list : TRAUMA.ORG
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
>
>
>
> ------------------------------
>
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
>
> End of trauma-list Digest, Vol 50, Issue 22
> *******************************************
>

-- 
Stephen L. Richey, CRT

"It is better to know some of the questions than all of the answers."- James
Thurber

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