I hate austere medicine

Veneficus

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For the record.

The only secret to it is being really knowledgable in mechanisms and desired effects of standard treatments. You learn that by being involved in the academic ivory towers of medicine. Not by a short course on "if you see this then please do that."

However, today when engaged in yet another conversation about it, the use of hemostatic agents came up again.

But in today's conversation, I had what is sometimes described as a "eureka moment" thanks in large part to the good people in the military who were kind enough to publish the active ingredients in hemostatic agents.

"Rub some dirt on it you wimp."

For probably the better part of 100 or more years, barbers have used styptic pencils or more recently liquid to stop minor bleeding. The concept is not new.

However, much to the chagrin of some civilians who want to pretend like they are military combat medics on the streets of the modern world and the medical device manufacturers who want to charge outrageous prices for this stuff, making you believe that it is going to be the solution to that core bleed that is refractory to pressure and not amiable to a tk, that you will see once a shift if not more often.

I would point out that in the military field surgery guide, hemostatic agents are considered a last ditch effort, after some surgical interventions have failed. It even goes on to warn about routine usage, as well as an order of preference to use them.

So, I wonder, what is the appeal to EMS other than "the military uses it..." or "just in case..."

Some of those procedures are balloon tamponade by inserting a foley and inflating the balloon and cross clamping vessles, as well as manipulating wounds. (aka flaps, etc)

So, while we are certainly not going to be permitting or training civilian medics to use these techniques, should we even be considering treatments that are suggested for after these procedures fail?

In the AHA first aid manual, there are two types of life threatening bleeding listed:

"Bleeding you can see and bleeding you can't see." to make ourselves seem more important, we sometimes use fancier words like "internal and external" bleeding.

Since the use of damage control surgery techniques is not widely accepted in the civilian world, what is the likelyhood that agents meant to be used in such a system may actually do more harm than good in a system that functions in the exact opposite manner?

Where are the supposed "EMS professionals" calling for civilian trials prior to adopting or advocating such measures?

Where are the number needed to treat vs. number needed to harm in the civilized western world studies?

Why is a last ditch effort in war even considered outside of such an environment without evidence except from war?

So let me tell you what you might be considering?

Shrimp shell polysaccharide and vinegar. (sugar and vinegar)

Volcanic ash. (aka quality chinchilla dust)

Fibrin/thrombin. (blood products)

Should instead we consider teaching medics more invasive procedures?
Afterall, they will rarely be used, and in situations where the outcome is likely death?

It would be far cheaper.

Why do we think using the last ditch effort in war is somehow a good idea outside of it, or worse a first choice simply so we can do "something?"

Might be cheaper to keep some sugar and chinchilla dust on the ambulance. "just in case..."
 

Luno

OG
Premium Member
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Why do we think using the last ditch effort in war is somehow a good idea outside of it, or worse a first choice simply so we can do "something?"

I almost spit coffee all over my keyboard, you sir, are a poet... ;) Well stated however...
 

RocketMedic

Californian, Lost in Texas
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Vene, do you differentiate between hemostatic compound-impregnated gauze/Quickclot/etc or are we talking craziness like tranexamic acid? I am a wholehearted supporter of the gauze, for the simple reason that is is somewhat more effective than ordinary gauze, it can be applied quickly and competently with no more training than "pack this in that hole until I can bounce a quarter off of it", and it's fairly safe (I'm told) in terms of any possible reactions (not the old powder, but the new gauze).

EMSA is reportedly getting tranexamic acid in the future, and I don't know what to think about it. I don't know enough about it, that's for sure.
 

Aidey

Community Leader Emeritus
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My short answer to this is that I think that using hemostatic agents like quickclot makes more sense than teaching paramedics 10 different ways to stop bleeding.
 
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Veneficus

Forum Chief
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Vene, do you differentiate between hemostatic compound-impregnated gauze/Quickclot/etc or are we talking craziness like tranexamic acid? I am a wholehearted supporter of the gauze, for the simple reason that is is somewhat more effective than ordinary gauze, it can be applied quickly and competently with no more training than "pack this in that hole until I can bounce a quarter off of it", and it's fairly safe (I'm told) in terms of any possible reactions (not the old powder, but the new gauze).

EMSA is reportedly getting tranexamic acid in the future, and I don't know what to think about it. I don't know enough about it, that's for sure.

I am suggesting that the quick clot and hemostatic gause may be completely over-rated in the civilian environment.

TXA will come and go. It is the emergency med flavor of the month. Surgery has done just about all that can be done with it and it is still limited to a very small patient population that it actually helps.

Even if you stop bleeding with it, it has been shown to cause AKI and renal failure, so it might make you feel good to stop the bleeding, but it doesn't mean the patient is going home.
 
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