# ABD pads in Prehospital Trauma?



## Roy51 (Dec 25, 2013)

Having found the search function to be fruitless due to the shortness of my term, here's a question.

In all my penetrating trauma experience I've used either 4x4's (whether few or stacked) or a multitrauma pad (hemostatic packing aside). I confess I have never understood the purpose of ABD pads in EMS, and would like whatever wisdom you may have. Is there some advantage, or personal preference?  The reason I've not understood is that they are advertised for draining wounds, and our goal is to make them... not draining.

Are there other indications such as smaller burns?

Thanks in advance for addressing this minutia.


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## Anjel (Dec 25, 2013)

I've used them post childbirth. And for long lacerations that are profusely bleeding.


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## Brandon O (Dec 25, 2013)

They're bulky, which can be nice. Don't have to stack up fifty gauze squares.


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## Household6 (Dec 25, 2013)

We've used ABDs to secure flail segments, and I've used them in scalp lacerations.. Much easier to hang onto than a billion stacked 4x4s..


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## unleashedfury (Dec 26, 2013)

Ive used them for profuse bleeding. beats having to stack up 4x4's or smaller trauma dressings.


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## mycrofft (Dec 26, 2013)

Look at a combine dressing 5X9. It is identical to a basic female sanitary napkin ("Kotex"). It closely resembles a disposable diaper. It has a thin non woven fabric cover which helps wick fluids into the hyperabsorable materials  held together by them.

The manufacturer says they are for _*exudative wounds*_, not bleeding ones. 

 If you throw a gauze compress on before the ABD (5X9 combine dressing) you will get faster wound clotting. If you depend upon the combine dressing alone the clotting blood is wicked into the interior. Clotting works faster on a chemical or physical "scaffold" (hence clotting agents varying from kaolin clay, to shrimp shells, to spider webs). Gauze seems to work far better at that than a combine dressing.

As organisms we are conditioned to cover up bleeding and wounds, they upset us. As medical techs and professionals we must make homeostasis, then antisepsis, our goals, not simply concealing wounds or "soaking up the blood". Use combine dressings for padding, to back up a gauze compress, to start an emergency camp fire, whatever. 

Cooled burns do well with them. They make great eye patches. I have used them to pad soft hand splints etc. I keep a couple 5X9's in my kit but not to stop bleeding.

Side note: Teflon coated compresses ("non-stick" or "Telfa") do not promote clotting but they can help keep the loose blood in one vicinity for initial clotting if backed up properly. After that they trap moisture on the wound and cause maceration. The only Telfa in my kit is the bandaids.

PS: if you bandage and it keeps bleeding, remember for basic first aid: MORE PRESSURE.


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## Brandon O (Dec 26, 2013)

Conceptually, I think you can make a case that the absorptive capacity of the abd pad is either a good or a bad thing for hemostasis. If it's pulling platelets and clotting factors from the site of injury, it's bad. But if it's pulling away serum and leaving that stuff behind, it's actually concentrating the clotting precursors, which would be good.

On the other hand, you could argue that the fine non-stick weave of the abd pad is a less effective substrate for platelet aggregation than a rough gauze pad.

On the gripping hand, you could argue that any thick padding will impair your ability to delivery targeted pressure.

And on the pope's nose, there's no evidence (as far as I know) investigating any of this, so it's pure theory no matter what.


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## EMSTeen (Dec 26, 2013)

They are called abdominal pads. Can they be used for a a smaller abdominal evisceration? Or are 10x30 trauma dressings still the go to?


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## mycrofft (Dec 26, 2013)

Treat what you see.
Whatever happened to saline-dampened sterile dressing to any eviscertion? If you dampen a combine dressing sufficiently to feel wet, it will leak.


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## EMSTeen (Dec 26, 2013)

mycrofft said:


> Treat what you see.
> Whatever happened to saline-dampened sterile dressing to any eviscertion? If you dampen a combine dressing sufficiently to feel wet, it will leak.



You got a point there


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## NBFFD2433 (Dec 29, 2013)

It's better than using tons of 4x4s.


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## mycrofft (Dec 29, 2013)

If it is taking tons of 4X4's there isn't enough pressure being exerted, or you need a tourniquet.

ABD's are not designed for bleeding wounds, they are designed for weeping seeping pusing lymphing wounds and to pad things.

If a wound stops bleeding promptly when a combine compress is applied, unless it has QuickClot or something on it, remember that all bleeding eventually stops. No matter what we do.

There's an art to grabbing four or five packets of sterile pairs of 4X4's and ripping them open simultaneously.


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## Roy51 (Jan 10, 2014)

mycrofft said:


> If it is taking tons of 4X4's there isn't enough pressure being exerted, or you need a tourniquet.
> 
> ABD's are not designed for bleeding wounds, they are designed for weeping seeping pusing lymphing wounds and to pad things.
> 
> ...



Exactly the reasons for my question.  Thanks for the input.


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## mycrofft (Jan 10, 2014)

roy51 said:


> exactly the reasons for my question.  Thanks for the input.



10-4


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