# New Treatments for Shock



## Jon (May 22, 2005)

Ok. I've got a project due on tuesday, and I'm looking for recent research on new (and old) methods of shock/trauma resucitation.

I've heard of PolyHeme, and heard something about hypertonic saline.

any suggestions?


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## rescuemedic7306 (May 22, 2005)

Back in the 80s, we used to use 1 -3  liters w/o of hemacell plasma expander for trauma rescusitation.


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## TTLWHKR (May 22, 2005)

Isn't Ringers Solution supposed to replace minerals and enzymes, as a fluid that is close to blood?


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## ECC (May 22, 2005)

Ringers is like Gatorade for your veins!

It does not leak out as fast as D5 or even NS.

But like anything else...too much turns your blood to Gatorade!

Anyone Remember Salt poor Albumin?!?


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## Luno (May 22, 2005)

check out oxycyte, it's experimental, but is supposed to move O2 at 5 times the amount, as blood, and entirely synthetic, rather than blood base.


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## rescuejew (May 22, 2005)

We're getting ready to start a clinical trial with PolyHeme in the prehospital setting but dont have any info on it yet...


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## Jon (May 22, 2005)

Ok. I've almost finished this assignment.

I'm trying to find out the current US Military posture on QuikClot, as I heard at EMS Today that the Marine Corps had yanked it from each solider's kit.

Also, I'm intrested in hearing about Polyheme and other trials occuring in each system.

Jon


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## Ridryder911 (May 24, 2005)

Try looking at :

www.defrance.org

Valarie has up-daes on Polyheme

Be safe, 
Ridryder 911


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## Summit (May 24, 2005)

> _Originally posted by MedicStudentJon_@May 22 2005, 09:10 PM
> * Ok. I've almost finished this assignment.
> 
> I'm trying to find out the current US Military posture on QuikClot, as I heard at EMS Today that the Marine Corps had yanked it from each solider's kit.
> ...


 They don't like Quick Clot

They do like the Hemcon hemostatic bandages.


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## ffemt8978 (May 24, 2005)

> _Originally posted by MedicStudentJon_@May 22 2005, 07:10 PM
> * Ok. I've almost finished this assignment.
> 
> I'm trying to find out the current US Military posture on QuikClot, as I heard at EMS Today that the Marine Corps had yanked it from each solider's kit.
> ...


 I heard the same thing at an EMS conference from one of the vendors.  He didn't say why they yanked it from the soldiers.


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## Jon (May 24, 2005)

> _Originally posted by ffemt8978+May 24 2005, 08:01 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (ffemt8978 @ May 24 2005, 08:01 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-MedicStudentJon_@May 22 2005, 07:10 PM
> * Ok. I've almost finished this assignment.
> 
> I'm trying to find out the current US Military posture on QuikClot, as I heard at EMS Today that the Marine Corps had yanked it from each solider's kit.
> ...


I heard the same thing at an EMS conference from one of the vendors.  He didn't say why they yanked it from the soldiers. [/b][/quote]
 Thermal burns, as the volcanic rock dust (yep... that's what QuikClot is) draws in water, it gets hot. Lot of water = Lot of heat. Caused 2nd and 3rd degree burns in some cases. Also hurt those who applied it, as their hands got bloody, then covered in the powder, then burned. QuikClot works by drawing water out of wounds, creating clots very fast.

If I'm bleeding like a stuck pig on Coumadin, use it on me. If I've skinned my knee... please don't... the burn would hurt more than the injury.


Jon


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## Summit (May 26, 2005)

I saw a consumer owie sized box o hemostatic bandaids at wally world the other day


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## rescuejew (Jun 2, 2005)

So the research materials just cae down the wore for the Poly-Heme study.  We have to do all the background research and testing and then they will start putting it on the trucks...once I use it, I'll let ya'll know.


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## wackermedic (Jul 3, 2005)

hello, I am new here. I am part o fthe PolyHeme study. I have been part of it for abut 6 months. Several people I know have used it with good results. I had 2 enrollments last week. 1 the control card was for Saline and the other the pt was pregnant. Both were great canidates with b/p below 90 and blunt trauma. It i sgood stuff and I hope that it will be standard for everyone soon. Be safe and have a great day. JC


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## Stevo (Jul 3, 2005)

interesting study

20 nationwide EMS agencies selected to participate in an important study on the effectiveness of a newly developed blood substitute called “PolyHeme®.

wow....

the nay-sayer don't like the lack of consent in the field, but how else does one studt trauma patients?


ah, here it is....


> *Therefore, the study will be conducted under federal regulations that allow for clinical research in emergency settings using an exception (21 CFR 50.24) from the requirement for informed consent.*



tell us more wackermedic

~S~


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## wackermedic (Jul 6, 2005)

I keep forgetting to bring my card home from work that has the do's and dont's for Poly Heme. I don't want to give anything inaccurate or misleading. There is a list that you follow for a canidate to be enrolled in the study. You must meet all, and there is a list that pulls you out of the study, if you get  1 you are out. If all that is Ok then you open the envelope, If it says Poly Heme then you use it if not than NSS or LR. Poly Heme can run thru any size needle, can be piggy backed or direct. I think it is good stuff and someday it will be on ambulances just like NSS. I will bring my card home and post the list of do's and dont's. Be safe and have a great day. JC


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## rescuejew (Aug 7, 2005)

So Polyheme...its been a slow summer for lots'o'trauma but Polyheme is on all DCEMS trucks now.  Its real hush-hush around here, like theres a conspiracy to do the research without discussing it amongst counterparts, therefore I will not be saying much of anything specific   
Weve had some enrollments, all with good outcomes, thus far.  Had 6 people shot last night but they were all under 18, which is exclusion criteria.  I seem slike it may work out well.  We'll be enrolled for 12-18 months, so I'm sure plenty of discussion will follow.


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## medicNsand (Aug 9, 2005)

Hi, I'm new here, like the forums.
 I'm in a pilot program for sternal IO use ( not that i'm getting stuck several times daily,..LOL)any details I'll let ya know. A few of my brothers are in a pilot synthetic-heme program in the neighboring city ( both are violent-heavy traffic metrop's). I would like to offer some info on the clotting agents.
#1. yes, they burn,..it's a powder that reacts to any blood fluid ( like a elastin/fibrinogen reactant on crack. I had the pleasure of talking with a combat Doc on these same issues. He came from a SpecWar Forward SurgUnit M.D.detachmentwho said " It's great for difficult axillary/femoral trauma, however,..given circumstance I'd still resort to a TK given location/ease of access to the wound".
Clotting agents have a catalytic reaction with a heat by-product that produces in some cases severe burns. There are a few case studies where the agents have produced enough heat to "cauterize" nearby nerve roots resulting in permanent paralysis. Most of these clotting agents have similar directions for example:
#1.  deep penetrating trauma,  remove all blood in deep wound, wipe away excess blood on surface tissue.Introduce powder to wound, apply pressure, re-evaluate/re-assess.
#2. Be careful not to inhale powder ( It'll clog your nostrils..) Open away from you,...
#3. It's an inert product, varying on element, per manufacturer.
#4. Some combat dressings for hemorrhage control contain "shrimp-shell particles" as an assistant clotting agent. However, what if your casualty, has an iodine allergy? Massive Hemorrhage Vs. Allergy?. shellfish/Iodine allergies can kill people. Now What?  ( IE. Kitosan/U.S. Military Wound Dressing Agents).

- I've seen quik-clot work the best,.....in my experience..
Just make sure you have:
1-removed ALL blood from wound ( as best as you can, lotsa blood and this agent will make Jelly)
2-If you have a " safe zone/cold zone" PLEASE take the time to change gloves, wipe away blood from surrounding (skin) area and your casualtie(s)/wound(s).
3- be careful with this powder,...It can cause sever burns,..watch wind direction,..powder VS. Eyes is bad.
Be Safe,..-- h34r:


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## rescuejew (Aug 12, 2005)

to the previous post:  Just got Sternal IOs in the ghetto here recently.  Had an opportunity to use one on a code last week.   They are SUPER-easy to insert and get ready, even in a code situation.  The hardest part for me was doing CPR around the bubble-thing.      (although, it was probably my fault, since I wasnt wearing gloves and my palms were sweaty, I kept sliding right into it.)  Its been used probably a dozen times since we got it, with great success.


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## medicNsand (Aug 13, 2005)

to 
Previous Post-
HAHAHAH, Been there,..LOL,...we are looking into an automatic CPR device for patients. Just saw a  demo (on a mannikin) yesterday. looks good in theory, I'm wondering about Real Life Practicality. Anyone else fumbled with one of those yet?
h34r:


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## Jon (Aug 13, 2005)

> _Originally posted by medicNsand_@Aug 13 2005, 04:56 AM
> * to
> Previous Post-
> HAHAHAH, Been there,..LOL,...we are looking into an automatic CPR device for patients. Just saw a  demo (on a mannikin) yesterday. looks good in theory, I'm wondering about Real Life Practicality. Anyone else fumbled with one of those yet?
> h34r: *


 Yeah.... autopulse.... I played with a demo.... it never got on the street at our squad.... noone ever remembered to grab it for a code   .

When I was doing my ride time, one of the medics was looking into the autopulse. I said it is nice, but REALLY expensive.... he asked how much... I told him what I've been quoted... $10,000-$15,000. Poor guy almost fell out of his chair, saying that he could buy a lifepak 12 with all the bells and whistles for that price....

Jon


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## rescuejew (Aug 14, 2005)

Duke had a presentation on a new "CPR backboard" that Zoll is coming out with that does a circumferential chest compression.  It has 12 lead, 4lead and TCP capability.  It looked pretty cool, but it is brand new so I dont know when they will start trials with it...


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## Luno (Aug 14, 2005)

MedicnSand, I've been following the synthetic for a while, any words from the bros on how it holds up on the street?  Is it oxycyte?


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## Jon (Aug 15, 2005)

> _Originally posted by rescuejew_@Aug 14 2005, 04:21 PM
> * Duke had a presentation on a new "CPR backboard" that Zoll is coming out with that does a circumferential chest compression.  It has 12 lead, 4lead and TCP capability.  It looked pretty cool, but it is brand new so I dont know when they will start trials with it... *


 Really? another one???

Reviviant / Zoll Medical has had one FDA approved for over two years, I think.... Just a big cloth band across the chest.... makes the dummies bounce when you use it on a CPR dummy.... (Really powerful).... I've never seen or heard anything about a version with built-in ECG or Defib ability.... the only downside to the current version is that you MUST use hands-free pads to defib, and they must go on before you activate the unit (or you turn it off and open up the band).

Zoll also has the AED Plus and AED Pro... which use an enhanced version of zoll's "Stat Padz"... they have a CPR censor that evaluates your CPR and provides feedback... When ALS shows up with a Zoll Defib/ monitor... you unplug from the AED and plug the pads into the ALS monitor (dual conector for the AED... standard Zoll handfree defib plug as part of the larger connection (that way it works for both))

Jon


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## rescuejew (Aug 16, 2005)

Definitely NOT the same peice of equipment Jon, I guess Zoll is just on their game with these little machines!!!  They did a demo at Duke around February, if I remember correctly.  

Luno:  We've used Polyheme here twice, and it has had good results.  So much so that staff in the ED did not believe the pt was as hypotensive as EMS had said.  Polyheme is essentially a whole-blood derivative with oxygen-carrying capability.  Apparently some uber-smart scientists isolated this enzyme within the RBC that allows the O2 to bind to the hemoglobin and were able to recreate this enzyme synthetically without using the call itself.  No danger of Rh cross-reaction, religious objection or exposure to disease.  Definitely a cool product if it is shown to work.


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## Jon (Aug 17, 2005)

> _Originally posted by rescuejew_@Aug 16 2005, 11:41 PM
> * No danger of Rh cross-reaction, religious objection or exposure to disease. *


 all GREAT reasons to have this product.....


Jon


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## rescuejew (Aug 17, 2005)

I think so too, I hope it works as well as it is claimed to...


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## medicNsand (Oct 4, 2005)

Rescuejew,...are you in Israel? tell me about your assessments "Situation Vs. patient(s)". How do you work a " command system" so you have accountability for all your team members?  Can/Do you do advanced airway procedures on-scene?
do you decompress chests? pericardiocentesis? for a tamponade? What do you do?- I love talking with other medics 
" on the front line" since WE invent the new face of emergency medicine.!! -Rob


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## Chimpie (Oct 4, 2005)

> _Originally posted by medicNsand_@Oct 4 2005, 01:50 AM
> * Rescuejew,...are you in Israel? tell me about your assessments "Situation Vs. patient(s)". How do you work a " command system" so you have accountability for all your team members?  Can/Do you do advanced airway procedures on-scene?
> do you decompress chests? pericardiocentesis? for a tamponade? What do you do?- I love talking with other medics
> " on the front line" since WE invent the new face of emergency medicine.!! -Rob *


 She's from Durham, NC.


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