Blood coagulant during internal bleeding

[BrushBunny91]

Can medic's do or push anything to help with internal bleeding? Such as a coagulant.

 

[JPINFV]

Like fresh frozen plasma? No.

 

[Handsome Robb]

Nope. Well NS/LR for volume replacement thats about it haha but how are you going to control where the blood coagulates and where it doesn't?

Surgery is the definitive intervention to control internal bleeding.

 

[BrushBunny91]

With any med I'd hope it sticks
How about a blood thickener? I'd assume it would put undue stress on the heart but could it help?

 

[Handsome Robb]

Not that I'm aware of. Like you said your adding stress to a heart that already is working hard.

There's a whole clotting cascade that has to happen.

 

[JPINFV]

...again, paramedics aren't going to carry fresh frozen plasma around.

 

[BrushBunny91]

...again, paramedics aren't going to carry fresh frozen plasma around.

My apologies, I didn't know if there was something out there that could substitute plasma or not.

 

[JPINFV]

The thing about FFP is that it contains the coagulation factors (albeit not the platelets, but platelets already have an insanely short half life). The problem with other IV solutions is how do you get the clotting to occur only at the site of the injury, instead of systemically, while also bypassing the clotting cascade?

 

[BrushBunny91]

I've got a number of lucrative ideas on how, and half involve nanorobots, but I have no intelligent idea on how to direct the clotting factors.

 

[DV_EMT]

qwik-clot.... but thats usually internal/external bleeding.

What about albumin?

 

[JPINFV]

Albumin isn't involved with clotting. It's involved with maintaining oncotic pressure and as a carrier protein.

 

[DV_EMT]

Albumin isn't involved with clotting. It's involved with maintaining oncotic pressure and as a carrier protein.

I knew you'd have a good answer for that. ^_^

 

[systemet]

I've got a number of lucrative ideas on how, and half involve nanorobots, but I have no intelligent idea on how to direct the clotting factors.

Awesome!

There's the option in the hospital to try and reverse anticoagulants, e.g. protamine for heparain, or vitamin K for warfarin / coumadin. I'm not sure how often this is done. I don't know if it affects the risk for DIC.

These medications aren't typically carried in EMS, probably due to the low incidence of life-threatening internal bleeding, and the lack of point-of-care testing to see if the patient's anticoagulants are even therapeutic.

 

[mycrofft]

Well, try these:

1. Minimize movement so any clotting will take hold and not be shifted around, then go to step 2 ASAP.
2. Apply tincture of throttle and beat feet to definitive care.

What sort of "internal bleeding" are you thinking about? Subperiostial hematoma, intracranial bleed, ruptured spleen, punctured liver, ruptured esophageal varix?

Hypothetically speaking, anything that would clot a major bleeder fast enough to save the life on scene would probably clot everything else solid. Plus, on scene you will probably not know if there is the dreaded "internal bleeding", you will see someone with signs of shock, maybe be able to get allergies-meds-and some history before the pt is out of it and you have them in your ambulance.

 

[boingo]

Tranexamic acid, although not a clotting agent per se, may see a role in the EMS environment sometime in the near future.

 

[Tigger]

qwik-clot.... but thats usually internal/external bleeding.

What about albumin?

How is quick-clot useful for internal bleeding?

 

[DV_EMT]

How is quick-clot useful for internal bleeding?

I was refering to an open arterial bleed...

 

[mycrofft]

My old professor drove ambulances during The Blitz.

They would kneel with one knee firmly in the gut to hopefully narrow the descending aorta to "buy time" for horrific lower extremity wounds. Didn't work much.

 

[KellyBracket]

Like Boingo said, aminocaproic acid may be used in the future, especially with this massive trial done recently:

http://www.ncbi.nlm.nih.gov/pubmed/21249666

 

[BrushBunny91]

Two trials with a combined total of 20,451 patients assessed the effects of TXA on mortality; TXA reduced the risk of death by 10% (RR=0.90, 95% CI 0.85 to 0.97; p=0.0035).:censoredata from one trial involving 20,211 patients found that TXA reduced the risk of death due to bleeding by 15%

Some pretty interesting stuff!