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Thu Aug 16 19:34:01 BST 2007

I doubt there was any evidence at all to back up the 24
hour claim. Agreed that what we saw was seldom left on for
more that an hour or two-- I was just commenting on what
was being presented to the field soldiers
--- Stephen Richey <stephen.richey at gmail.com> wrote:

> 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
> > knows. Yahoo! Answers - Check it out.
> > http://answers.yahoo.com/dir/?link=list&sid=396545469
> >
> >
> > ------------------------------
> >
> > 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";
> 
=== message truncated ===

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