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Old 09-07-2013, 14:35   #1
Odin21
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Abdominal Aortic Tourniquet

Does anyone have any experience with this? Thoughts?

"Some special operations medics in Afghanistan now have a new device that helps save soldiers with the most common cause of preventable death in combat: a traumatic pelvic wound.

Unlike a hemorrhage in the arm or leg where a tourniquet can be used to shut off bleeding, there was no way until recently to do the same for wounds in the lower torso, which can kill a person in a matter of minutes.

It was “a noted capability gap on the battlefield: How do we treat bleeding where we can’t use tourniquets?” said John Croushorn, a former Army doctor.

After serving as a flight surgeon in Iraq, Croushorn and former combat medic Richard Schwartz devised an inflatable tourniquet that buckles around a victim’s abdomen, and when pumped with air becomes a wedge shape that puts about 80 pounds of pressure on the abdominal aorta, cutting off blood flow to the pelvis. Ted Westmoreland, a former medic with U.S. Army Special Operations, then helped devise the windlass that twists to tighten the device so it stays in place.

One person with minimal training can have it out of the bag and applied in about 60 seconds, and it doesn’t need to be done by a medic, Croushorn said, because the device doesn’t require precise positioning.

In 2007, they applied for a patent, which is pending, and the FDA approved the Abdominal Aortic Tourniquet in 2011.

Junctional tourniquets like the AAT started hitting the market in recent years. Despite that short period of time, the scientific research backing up its use is “reasonably well established to date,” according to retired Col. John Kragh, of the U.S. Army Institute of Surgical Research. “The AAT in particular has a good scientific foundation. The very limited use in care is due to the fact that the service has yet to field them widely.”

Only a few American and foreign special operations units have bought the Abdominal Aortic Tourniquet. In Afghanistan, it was used in combat for the first time in April, saving the life of an Afghan soldier, according to the Journal of Special Operations Medicine.

The soldier, whose legs were nearly severed, was put onto a medevac helicopter “floppy and lifeless” with no pulse. The abdominal tourniquet was applied and his breathing increased substantially. Upon arrival at the hospital, he had a pulse again.

“The AAT did things we didn’t even know it would do, like improve the lung’s ability to oxygenate blood,” Croushorn said.

This summer in Birmingham, Ala., a man came into the emergency room where Croushorn works with a gunshot through his upper arm, and was bleeding profusely. The bullet had pierced the armpit, destroying one of the body’s largest arteries.

“It’s really a death wound,” Croushorn said, because it’s often not possible to stem the bleeding enough to get the victim to surgery alive. “I’ve treated a number of them and they all died.”

He applied the abdominal tourniquet and persuaded a wary nurse to remove her hands from the wound. There was no bleeding. Croushorn said the patient made it to the operating room, where a shocked vascular surgeon repaired six inches of torn artery. The man lived.

“It was a game changer,” Croushorn said.

In that moment, he said, he learned the tourniquet could also be used to stop upper extremity hemorrhaging.

His next move? He immediately sent out an update to units in Afghanistan."

http://www.stripes.com/news/game-cha...lives-1.235791
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Old 09-08-2013, 15:24   #2
Eagle5US
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We have (as of yet) had no success with this VERY EXPENSIVE piece of equipment. Bright idea faery at a H U G E cost that (of course) was sucked up by cubicle clowns almost immediately and mandated to be placed in battlefield circulation. Even after testing, and report of results, "they" bought more and said "you WILL use it"...

Matter of fact, when utilizing patient models, we have had more success with other methods (BP Cuffs / compressable bladders / etc...)
But; what do we know. We don't wear a suit to work
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Old 09-08-2013, 15:52   #3
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That's too bad Doc, still, can't see how that'd work without squeezing your guts out.
Hard watching a guy bleed out, better to try something rather than just being an observer I guess.
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Old 09-08-2013, 15:57   #4
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Quote:
Originally Posted by PRB View Post
Hard watching a guy bleed out, better to try something rather than just being an observer I guess.
No argument there...
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Ain't no one getting out of this world alive. All you can do is try to have some choice in the way you go. Prepare yourself (and your affairs), and when your number is up, die on your feet fighting rather than on your knees. And make the SOBs pay dearly."
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Old 09-08-2013, 19:31   #5
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MAST garment?

At the risk of showing my ignorance, I thought that the MAST garment was supposed to help with otherwise non-compressible abdominal/pelvic hemorrhages, much like this. My basic understanding is that they are unwieldy, time consuming, have issues removing the device quickly in the OR, and no one uses them anymore. Would just an abdominal version of the MAST work any better for this type of injury than the full set of pants? Is there a better way to use the same air bag compression type technology than the MAST?

If you have any time I would be very interested to hear in how you were using other devices like the BP cuff for this type of injury. It sounds like this device does not work well even if somehow the National Guard ever could afford it. Thank you very much for your time and expertise.
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Old 10-15-2013, 10:07   #6
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expensive paperweights

Last time I went to refresher there was one of these there and we couldn't find a guy who could deal with the pain of it inflating long enough to cut off blood flow. Although an interesting design, did not seem practical. Currently we have been pushed the JETT tourniquet at the team level and this is another monstrously poor design. If any one is looking at those, don't buy them we were unable to achieve adequate compression even using an ultrasound. I know I'm about a month late on this one but maybe someone out there will read and heed.
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Old 10-15-2013, 14:11   #7
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ok -- full disclosure -- I was a co-inventor of the JETT. So my bias established, I am no longer with the company and have no financial ties to it. I waived all IP rights when I left.

The signature injury addressed is a bilateral extremity bleed with one (at least) too high on the leg for a tourniquet and an open book fracture. So we addressed with a pelvic bind while using trapezoids to screw down that wedge into the inguinal crease to stop the bleed. Courty -- I am surprised at the issue of not stopping the pulse. We did the cadavers and used it on each other testing with a doppler and always occluded. It has also been used by Houston paramedics and the field and saved 5 lives so far.

The abdominal seems extreme. Just reaching down in a cadaver to press the aorta and I cannot imagine compressing someone with that level of injuries and not have respiratory distress or necrosis of vital organs. Furthermore, any pneumatic seems counter intuitive going up/down in varying air pressures. The CRoC was the right idea, but a c-clamp with a rounded ball to a small pressure point is hard to keep steady and needs to be applied exactly to work. And of course -- you may need two and the pelvic bind.

Nothing is perfect for these injuries yet, but I think each round of products improve on the last. To the credit of all the companies trying, they are spending more money in R&D than they are making in revenue. It is a small market. They are all doing it because they want to save lives. Hopefully, the next great idea will beat all of these. IED's aren't going away.
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Old 10-15-2013, 21:47   #8
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98G- There is a chance that we were using the JETT incorrectly, although I dont believe so, the problem we had was even with the straps cinched down very tightly the screwing down on the trapezoidal pads effectively lifted the straps and wasnt getting the proper amount of pressure on the patient. Now we were using this in a clinical setting and it might work a bit differently on a traumatically compromised patient but thats just the problems we addressed.
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