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Old 08-23-2013, 18:16   #106
PiterM
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good point guys... next medical purchase. One TQ for trauma-pouch, and one to have in the car. You never know, indeed. It may save someone's life.
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Old 08-23-2013, 20:13   #107
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A tourniquet is probably the last device I'd ever need...
So thought everyone who has ever needed a TQ.
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Old 08-23-2013, 21:18   #108
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So thought everyone who has ever needed a TQ.
Just the subtle response I was expecting. Drives it home.
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Old 08-24-2013, 07:33   #109
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So thought everyone who has ever needed a TQ.
PERFECT!!!! anticipate the need, prepare for all.

Problem with granules is if you have a decent sized arterial or venous injury , they could and can get intra vascular and cause BIG problems which is why the US military and law enforcement no longer promote the use of granular products. Send me an address, I'll hook you up.
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Old 08-24-2013, 13:28   #110
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So thought everyone who has ever needed a TQ.
My kit now has 5 TQ's thanks to a SwatSurgeon sending a new Swat-T to go along with my conventional ones...

I have some granular clotting agent and some infused bandage clotting agent too...

direct pressure is best to start, if you have the time - The SWAT-T seems to be the most scalable item I have for that... start light, then go tight, if that don't work - stop the squirt. An 18D mantra from the old days.
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Old 08-24-2013, 13:43   #111
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As a 91B4S at one time and a physician I would say that paracord makes a lousy tourniquet . It is narrow. The wider the better when it comes to a tourniquet. Even with a stick is is hard to get sufficient pressure to stop arterial flow on a limb. Probably would work on a finger.
Read the highlighted comment again! Any TQ that I would carry would be a minimum of 1.5 inches and 2 would be better. Much wider and they become too big to carry and tighten (for a combat TQ)(also if one doesn't stop the bleed and you have two place a second one above the first to make a wider TQ... i.e. on a femoral bleed). As was said your paracord aka shoelace causes A LOT of pain and doesn't stop the bleeding, you would be better to use your shirt in an emergency. Always carry a cravat and you can fold it to be 2 inches wide. There are a ton of aftermarket TQs that work great. Research these as there are a lot of fakes and crappy TQs out there. There is a lot of info on this site about them.

If Quick Clot is all you can get, that will work in a pinch, but not preferred.
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Old 08-24-2013, 13:52   #112
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The older Quick Clot cooked the tissues and was a real bear to remove.

The granules get hot with any kind of water application, so rinsing them out during treatment was not possible without creating more damage.

The newer formulas are much better, as are the gauze products.

Most of the expedient TQs are hard to place and tighten with one hand. The better designs help with that problem.

TR
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Old 08-24-2013, 20:30   #113
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The older quik clot is the exothermic (granules). Their combat gauze does not cause any temperature change or tissue interaction and is the preferred clot promoting product in my book and I have used all products on the market presently. The gauze is impregnated with kaolin, it's benign and it works when packed correctly. If you go to the z-Medica website they have instructional videos and on line training for its proper use.
As far as tourniquets, the SWAT-T, SOF-T are the two I prefer with the CAT last for ease of use and appropriate apication under stress.
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'Revel in action, translate perceptions into instant judgements, and these into actions that are irrevocable, monumentous and dreadful - all this with lightning speed, in conditions of great stress and in an environment of high tension:what is expected of "us" is the impossible, yet we deliver just that.
(adapted from: Sherwin B. Nuland, MD, surgeon and author: The Wisdom of the Body, 1997 )

Education is the anti-ignorance we all need to better treat our patients. ss, 2008.

The blade is so sharp that the incision is perfect. They don't realize they've been cut until they're out of the fight: A Surgeon Warrior. I use a knife to defend life and to save it. ss (aka traumadoc)
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Old 08-25-2013, 09:25   #114
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Originally Posted by swatsurgeon View Post
The gauze is impregnated with kaolin, it's benign and it works when packed correctly. If you go to the z-Medica website they have instructional videos and on line training for its proper use.
Hmm, is a vendor's website really the most objective evaluation? Independent studies have shown that chitosan impregnated gauzes work faster than kaolin based products. Probably an important performance criteria - doesn't require the 2-3 minutes of constant pressure and when you are being shot at that could be critical. And as I said, I like the mechanism of action for chitosan over kaolin, but then again I'm a science geek.
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Old 08-25-2013, 13:46   #115
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Hmm, is a vendor's website really the most objective evaluation? Independent studies have shown that chitosan impregnated gauzes work faster than kaolin based products. Probably an important performance criteria - doesn't require the 2-3 minutes of constant pressure and when you are being shot at that could be critical. And as I said, I like the mechanism of action for chitosan over kaolin, but then again I'm a science geek.
True, but this is all based on personal use not vendors say so. The studies performed had their own issues, I know some of the authors and truthfully, they are both good products, it depends on how you bias the data and real world experience not laboratory data driven by man made lab wounds.........I have had better success in the operating room and trauma room with combat gauze as opposed to chitosan based products.....just my personal experience speaking here.

ss
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'Revel in action, translate perceptions into instant judgements, and these into actions that are irrevocable, monumentous and dreadful - all this with lightning speed, in conditions of great stress and in an environment of high tension:what is expected of "us" is the impossible, yet we deliver just that.
(adapted from: Sherwin B. Nuland, MD, surgeon and author: The Wisdom of the Body, 1997 )

Education is the anti-ignorance we all need to better treat our patients. ss, 2008.

The blade is so sharp that the incision is perfect. They don't realize they've been cut until they're out of the fight: A Surgeon Warrior. I use a knife to defend life and to save it. ss (aka traumadoc)
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Old 08-25-2013, 18:13   #116
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I would take the word of a trauma surgeon that I knew for it every time, but that is just me.

TR
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"It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat." - President Theodore Roosevelt, 1910

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Old 08-26-2013, 10:06   #117
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I agree with TR, I'll go with the Trauma Surgeon I know and trust to give me the best guidance he can.
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Old 08-28-2013, 13:08   #118
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Quote:
Originally Posted by Trapper John View Post
Hmm, is a vendor's website really the most objective evaluation? Independent studies have shown that chitosan impregnated gauzes work faster than kaolin based products. Probably an important performance criteria - doesn't require the 2-3 minutes of constant pressure and when you are being shot at that could be critical. And as I said, I like the mechanism of action for chitosan over kaolin, but then again I'm a science geek.
Here is the latest article on hemostatis agents by the military: in Journal Of Trauma, August Supplement

Comparison of novel hemostatic dressings with QuikClot
combat gauze in a standardized swine model of
uncontrolled hemorrhage
Jason M. Rall, PhD, Jennifer M. Cox, BS, Adam G. Songer, MD, Ramon F. Cestero, MD,
and James D. Ross, PhD, San Antonio, Texas
BACKGROUND: Uncontrolled hemorrhage is the leading cause of preventable death on the battlefield. The development, testing, and application of
novel hemostatic dressings may lead to a reduction of prehospitalmortality through enhanced point-of-injury hemostatic control. This study
aimed to determine the efficacy of currently available hemostatic dressings as compared with the current Committee for Tactical Combat
Casualty Care Guidelines standard of treatment for hemorrhage control (QuikClot Combat Gauze [QCG]).
METHODS: The femoral artery of anesthetized Yorkshire pigs was isolated and punctured. Free bleeding was allowed to proceed for 45 seconds
before packing of QCG, QuikClot Combat Gauze XL (QCX), Celox Trauma Gauze (CTG), Celox Gauze (CEL), or HemCon ChitoGauze
(HCG), into the wound. After 3 minutes of applied, direct pressure, fluid resuscitation was administered to elevate and maintain a mean
arterial pressure of 60mmHg or greater during the 150-minute observation time.Animal survival, hemostasis, and blood lossweremeasured
as primary end points. Hemodynamic and physiologic parameters, along with markers of coagulation, were recorded and analyzed.
RESULTS: Sixty percent ofQCG-treated animals (controls) survived through the 150-minute observation period.QCX, CEL, andHCGwere observed
to have higher rates of survival in comparison to QCG (70%, 90%, and 70% respectively), although these results were not found to be of
statistical significance in pairwise comparison to QCG. Immediate hemostasis was achieved in 30% of QCG applications, 80% of QCX,
70% of CEL, 60% of HCG, and 30% of CTG-treated animals. Posttreatment blood loss varied from an average of 64 mL/kg with CTG
to 29 mL/kg with CEL, but no significant difference among groups was observed.
CONCLUSION: These results suggest that the novel hemostatic devices perform at least as well as the current Committee on Tactical Combat Casualty
Care standard for point-of-injury hemorrhage control. Despite their different compositions and sizes, the lack of clear superiority of any
agent suggests that contemporary hemostatic dressing technology has potentially reached a plateau for efficacy. (J Trauma Acute Care
Surg. 2013;75: S150YS156. Copyright * 2013 by Lippincott Williams & Wilkins)
KEY WORDS: Hemostatics; hemostatic: dressings; hemostatic: gauze; hemorrhage: swine.
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'Revel in action, translate perceptions into instant judgements, and these into actions that are irrevocable, monumentous and dreadful - all this with lightning speed, in conditions of great stress and in an environment of high tension:what is expected of "us" is the impossible, yet we deliver just that.
(adapted from: Sherwin B. Nuland, MD, surgeon and author: The Wisdom of the Body, 1997 )

Education is the anti-ignorance we all need to better treat our patients. ss, 2008.

The blade is so sharp that the incision is perfect. They don't realize they've been cut until they're out of the fight: A Surgeon Warrior. I use a knife to defend life and to save it. ss (aka traumadoc)
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Old 01-02-2014, 23:10   #119
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So thought everyone who has ever needed a TQ.
So, having lived thru what you have would you change you original list of items?
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