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12/11/2011

Cause de décès en afghanistan: Actualités canadiennes

Causes of Death in Canadian Forces Members Deployed to Afghanistan and Implications on Tactical Combat Casualty Care Provision

Pannell D et all. J Trauma. 2011;71: S401–S407

DeathCan.JPG

Ce document identifie par ailleurs l'importance de la formation des personels à la gestion des voies aériennes, des mesures de stabilisation du rachis en cas d'IED, du recours aux sondes de foley pour le tamponenment des hémorragies jonctionnelles en cas de non application possible de pansement hémostatique.

-------Morceaux choisis:

We recommend that combat medical technicians should continue to practice surgical airways in live-tissue laboratories. In addition, didactic teaching should continue to review the indications for cricothyrotomy on the battlefield. .........

...... Based on this review, we also feel that future Canadian TCCC courses may be improved by giving battlefield providers a treatment option for dealing with exsanguination from small wounds at junctional areas (groin, axillary, and neck). Currently, TCCC providers only have hemostatic dressings to deal with this difficult problem. However, unfavorable wound geometry can make utilization of these products unfeasible. In addition, TCCC providers have no option for treating carotid artery hemorrhage in the neck. We suggest that combat medical technicians also carry urinary catheters; these can be inserted into wound tracts of small wounds. Insufflation of the balloon may provide temporary hemostasis of junctional bleeding and buy enough time for evacuation to a definitive surgical facility. Another option would be to pack such wounds with ribbon gauze. These options may also be used for posterior packing of lifethreatening epistaxis associated with facial fractures.
On our review, we also noted that three casualties.....

....we recommend that spinal immobilization be considered for all casualties suffering from blunt trauma or IED-related incidents during “Tactical Field Care,” if the tactical situation permits, and if the medical technician deems the situation to be safe enough to proceed with this procedure.

 

02/09/2011

La sonde de foley: Pour l'hémostase

Une sonde de foley est utile non pour réaliser un sondage urinaire sur le terrain mais comme moyen d'hémostase.

 L'emploi de sonde à ballonet pour rélaiser un tamponnement de lésions hémorragiques est une réalité.

 

Ces techniques peuvent trouver un champ d'application au combat notamment pour la prise en charge des traummatisés jonctionnels.

 

Premier exemple: Un saignement d'origine thoracique.

 

Ffoley Thorax.JPG

Balloon Foley catheter compression as a treatment for intercostal vessel bleeding. Chao BF et all Injury, Int. J. Care Injured 42 (2011) 958–959

Autres exemples:

Les plaies sous-clavières

Foley Sous Clav.JPG

 

 

Les plaies cervicales,

neckfoley.jpg

les plaies inguinales,

les épistaxis

| Tags : foley

30/08/2011

Exacyl: Bon aussi pour le blessé de guerre !

Une étude à paraître conduite par une équipe US a mis en évidence l'intérêt de l'acide tranexaminique.

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Tranexamic acid decreases mortality following wartime injury: the Military Application of Tranexamic acid in Trauma Emergency Resuscitation Study (MATTERS) MAJ Jonathan J. Morrison, MB ChB, MRCS, RAMC(V), LT COL (sel) Joseph J. Dubose, MD, USAF MC, COL Todd E. Rasmussen, MD, USAF MC, SURG CAPT Mark Midwinter, BMedSci, MD FRCS RN

http://archsurg.ama-assn.org/cgi/content/short/archsurg.2...

A recent registry-based study of combat injured troops receiving blood in Afghanistan (January 2009 - December 2010) at the Bastion Role 3 facility has demonstrated findings supportive of TXA use in this population. In a review of 896 combat casualties treated at Bastion over this time frame, 32.7% (N=293) received TXA (mean ± SD dose: 2.3 ± 1.3g) while 67.2% (N=603) did not receive TXA. In the overall cohort, the TXA group was more severely injured (ISS: 25.2±16.6 vs. 22.5±18.5; p<0.001), required more blood (11.8±12.1 vs. 9.8±13.1 pRBC units; p<0.001), and had a lower Glasgow Coma Score (7.3±5.5 vs. 10.5±5.5; p<0.001) and initial systolic blood pressure (112±29.1 vs. 122.5±30.3 mmHg), but also had a lower unadjusted mortality than the no-TXA group (17.4% vs. 23.9%; p=0.028). In the massive transfusion cohort (N=321; 24 hour transfusion: 21.9±14.7 pRBC; 19.1±13.3 FFP and 3.5±3.2 apheresis platelet units), mortality was also lower in the TXA (mean ± SD dose: 2.4 ± 1.4g) compared to the no-TXA group (14.4% vs. 28.1%; p=0.004). In a multivariate regression model, TXA use in the massive transfusion cohort was independently associated with survival (odds ratio: 7.28; 95% confidence interval: 3.02-17.32. For all patients requiring at least one unit of blood after combat injury, patients receiving TXA had higher rates of DVT (2.4% vs. 0.2%, p = 0.001) and PE (2.7% vs. 0.3%, p =0.001), but were also more likely to have injury patterns associated with higher risk of thromboembolic events ; including higher mean ISS (25 vs 23, p < 0.001), more severe extremity injuries (extremity AIS >=3 66.6% in TXA group, 47.3% non-TXA, p < 0.001), and more commonly GCS < or = 8 (63.3% vs. 35.6%, p < 0.001). These survival benefit findings associated with TXA use support the hypothesis that the use of this adjunct, in conjunction with component-based resuscitation following combat injury, is associated with improved survival. This association is most prominent in those requiring massive transfusion.

 

e.jpg

L'article complet

 

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Exacyl 1g IV  au mieux dans l'heure et pas après 3 heures après la blessure

 

 

Les hémorragies jonctionnelles: Un nouvel outil, le CROC !

L'hémorragie jonctionnelle n'est pas garrotable, n'est pas forcément aisément comprimable directement. Parmi les solutions outre l'exacyl dans l'heure on peut avancer la compression des jonctions.

CROC.jpeg

 

Une recommandation d'emploi du CRoC ( combat ready clamp ) est hautement probable dans la prochaien version du TCCC. Lire ce document:  Hémorragies jonctionnelles.pdf . Regarder une vidéo d'entraînement.

 

l'alternative le femostop ?

26/07/2011

Un garrot: Oui mais surtout un garrot pneumatique

Un travail d'une portée majeure qui met en évidence l'importance de disposer de garrot pneumatique delfi dès que possible.

Les garrots du type du SOFTT ou du CAT doivent être posé à l'avant mais surtout doivent être doublé, associé à un pansement compressif et surtout  remplacé le plus tôt possible par un garrot pneumatique du type du garrot DELFI EMT.

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An Evaluation of Two Tourniquet Systems for the Control of Prehospital Lower Limb Hemorrhage.

Taylor DM et all. (J Trauma. 2011;XX: 000–000) DOI: 10.1097/TA.0b013e31820e0e41

Garrot.JPG

 

Background:

Hemorrhage remains the main cause of preventable death on the modern battlefield. As Improvised Explosive Devices in Afghanistan become increasingly powerful, more proximal limb injuries occur. Significant concerns now exist about the ability of the windlass tourniquet to control distal hemorrhage after mid-thigh application. To evaluate the efficacy of the Combat Application Tourniquet (CAT) windlass tourniquet in comparison to the newer Emergency and Military Tourniquet (EMT) pneumatic tourniquet.

Methods:

Serving soldiers were recruited from a military orthopedic outpatient clinic. Participants’ demographics, blood pressure, and body mass index were recorded. Doppler ultrasound was used to identify the popliteal pulses bilaterally. The CAT was randomly self-applied by the participant at midthigh level, and the presence or absence of the popliteal pulse on Doppler was recorded. The process was repeated on the contralateral leg with the CAT now applied by a trained researcher. Finally, the EMT tourniquet was applied to the first leg and popliteal pulse change Doppler recorded again.


Results:

A total of 25 patients were recruited with 1 participant excluded. The self-applied CAT occluded popliteal flow in only four subjects (16.6%). The CAT applied by a researcher occluded popliteal flow in two subjects (8.3%). The EMT prevented all popliteal flow in 18 subjects (75%). This was a statistically significant difference at p  0.001 for CAT versus EMT.


Conclusion:

This study demonstrates that the CAT tourniquet is ineffective in controlling arterial blood flow when applied at mid-thigh level. The EMT was successful in a significantly larger number of participants.

 

29/03/2011

Exacyl: OUI mais dans l'heure qui suit le trauma

L'exacyl est recommandé pour la prise en charge du traumatisé. L'étude Crash 2 l'a montré. Un complément d'analyse de cette étude précise cependant qu'il faut l'administer dans l'heure suivant le traumatisme.

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The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial

Findings

10 096 patients were allocated to tranexamic acid and 10 115 to placebo, of whom 10 060 and 10 067, respectively, were analysed. 1063 deaths (35%) were due to bleeding. We recorded strong evidence that the effect of tranexamic acid on death due to bleeding varied according to the time from injury to treatment (test for interaction p<0·0001). Early treatment (≤1 h from injury) significantly reduced the risk of death due to bleeding (198/3747 [5·3%] events in tranexamic acid group vs 286/3704 [7·7%] in placebo group; relative risk [RR] 0·68, 95% CI 0·57—0·82; p<0·0001). Treatment given between 1 and 3 h also reduced the risk of death due to bleeding (147/3037 [4·8%] vs 184/2996 [6·1%]; RR 0·79, 0·64—0·97; p=0·03). Treatment given after 3 h seemed to increase the risk of death due to bleeding (144/3272 [4·4%] vs103/3362 [3·1%]; RR 1·44, 1·12—1·84; p=0·004). We recorded no evidence that the effect of tranexamic acid on death due to bleeding varied by systolic blood pressure, Glasgow coma score, or type of injury.

Interpretation

Tranexamic acid should be given as early as possible to bleeding trauma patients. For trauma patients admitted late after injury, tranexamic acid is less effective and could be harmful.

Lire l'article

11/12/2010

Réduire l'hémorragie: IL FAUT ADMINISTRER DE L'EXACYL

Le consensus européen sur la prise en charge des hémorragies de cause traumatique évoque le recours à l'acide tranexaminique. L'exacyl a largement démontré son efficacité comme moyen pharmacologique d’épargne sanguine péri-opératoire. Son intérêt en traumatologie n'était pas jusqu'à présent bien documenté. L'étude Crash 2 publiée dans le lancet apporte un éclairage nouveau. 

Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with signifi cant haemorrhage (CRASH-2): a randomised, placebo-controlled trial

June 15, 2010 DOI:10.1016/S0140-6736(10)60835-5

10 096 patients were allocated to tranexamic acid and 10 115 to placebo, of whom 10 060 and 10 067, respectively, were analysed. All-cause mortality was significantly reduced with tranexamic acid (1463 [14·5%] tranexamic acid group vs 1613 [16·0%] placebo group; relative risk 0·91, 95% CI 0·85–0·97; p=0·0035). The risk of death due to bleeding was  significantly reduced (489 [4·9%] vs 574 [5·7%]; relative risk 0·85, 95% CI 0·76–0·96; p=0·0077). 

Il n'existe pas de protocole d'emploi bien formalisé. Dans l'étude crash 2, une dose de charge de 1 g est administrée en 10 minutes, suivie d'un entretien de 1 g perfusé en 08 h. De faibles posologies seraient efficaces. Certains proposent le régime suivant: bolus IV de 10 mg.kg-1 suivi d’une perfusion continue de 1 mg.kg-1 .h-1. Ce médicament est disponible en dotation. 

Pour en savoir plus  1  et  2  et  3 

22/11/2010

Quikclot Combat Gauze: Application

 

Cette version du quikclot est maintenant en dotation. Le manuel d'emploi est ici

| Tags : pansement

Tourniquet improvisé: Pas avec n'importe quoi !

Tourniquets improvisés: Avec les bons moyens

TQ_Post Accident_2

 
Points essentiels:

    1. Il vaut mieux avoir recours à des garrots prévus pour arrêter les hémorragies artérielles
    2. Les garrots doivent être portés sur soi et pas dans le sac
    3. Apprener les principes, et vous pourrez alors avoir recours à un garrot improvisé

Dans ce cas, il s'agit d'un accident sur un pas de tir

    Dans ce cas, il s'agit d'un accident sur un pas de tir

    1. La ceinture n'est pas une bonne idée
    2. Le garrot posé à la RACINE DU MEMBRE est ce qu'il faut faire, dans la mesure où il est correcement serré. L'hémorrgaie est arrêtée ET les pouls distaux ne sont plus perçus. Sinon il faut poser un second garrot.
    3. Vous pouvez utiliser comme garrot de fortune un bandage triangulaire, votre pansement israélien, toute bande compressive dont vous seriez porteur.
    4. Il est habituel de devoir associer rembourrage de plaie, pansement hémostatique, pansement compressif et garrot.

Vous devez avoir tout cela dans votre équipement

 

21/11/2010

Pansements hémostatiques: Une vision US

Prehospital topical hemostatic agents – A review of the current literature

PHTLS Executive Council

Lance E. Stuke, M.D. MPH

Background: The 6th edition of the PHTLS textbook discusses three topical hemostatic agents which were approved by the U.S. Food and Drug Administration and available for prehospital use at the time: HemCon dressing, QuikClot, and TraumaDex. Data on these products was based primarily on anecdotal military reports and very little data was available on their use in the civilian prehospital setting. Several new products have arrived on the market after the release of the 6th edition of PHTLS and several important new studies have been published which will be reviewed here. The vast majority of these products have been researched and developed for use in the military setting in Iraq and Afghanistan although some limited civilian data is also available.

The perfect hemostatic dressing does not exist. Ideally, the dressing should be lightweight, easy to store, and able to be rapidly applied to a hemorrhaging wound. It should be conformable to the wound, allowing the hemostatic agent to reach areas of injury which are difficult to access with direct pressure (i.e. deep groin wounds). The dressing should cause minimal local tissue destruction, be easily removable from the wound, and not contain particles which can spread systemically. Finally, the dressing must not be washed away by rapid bleeding from high-flow blood vessels.

Manufacturers have tried various methods to deliver hemostatic agents into bleeding wounds. Some products are packaged into a granular form which can be poured directly into the wound. Others are incorporated into a dressing or mesh which allows the provider to apply direct pressure to the site of injury. This dressing can be formed either as a rigid bandage, a small bag, or a gauze which must be unrolled prior to application. Each method of preparation has distinct advantages and disadvantages depending on the location and type of injury being treated.

Literature and Product Review:

HemCon: HemCon dressing (Hemorrhage Control Technologies, Portland, OR), is composed of chitosan, a substance derived from arthropod skeletons. Chitosan dressings are thought to function by mechanically sealing the wound and adhering to surrounding tissue. HemCon is a dual-sided 4 x 4 inch rectangular bandage: a chitosan-containing active side which must be placed directly on the wound and a nonstick side which the provider uses to apply pressure. The efficacy of HemCon depends entirely on the bandage adhering well to the wound, which is difficult in wounds which aren’t flat and easily accessible. The bandage isn’t flexible and can break when forced into a wound. It is best applied to flat, superficial wounds which are easily accessible. HemCon has been studied in both the military and civilian settings. The military demonstrated a 97% success rate in controlling bleeding with HemCon.1,2 The civilian experience has been less optimistic, controlling bleeding in 27 of 34 cases studied (79%). Of the seven failures, six were felt to be due to user error, possibly due to less training by civilian EMS providers in the proper use of the product.3 An additional study using a complex groin injury model in swine noted an increase in the rate of rebleeding and mortality between those treated with HemCon versus QuikClot. The authors noted that application of HemCon was more difficult than other agents and all failures of HemCon were due to the bandage not adhering to the injured tissue to which it was applied.4

As previously noted, a disadvantage of the HemCon dressing is that it is relatively non-conformable and difficult to pack into deeper wounds. ChitoFlex is the latest development from HemCon Medical Technologies. It utilizes the same chitosan-based hemostatic agent but packages it into a gauze form. This allows the dressing to be packed into deep bleeding wounds for improved access to the site of hemorrhage. ChitoFlex is available in several sizes, including 1”x3”, 3”x9”, and as a 3”x28” roll. In one study, ChitoFlex was found to be equivalent, but not superior to QuikClot and Celox (a chitosan granule).5

WoundStat: WoundStat was an FDA-approved mineral-based agent consisting of granular smectite, a nonmetallic clay. When the granules were exposed to blood they absorbed water, swelled, and formed a clay paste with strong adhesiveness to the surrounding tissue. Initial studies were promising6,7,8 and it was used by the U.S. Army for a short time. However, later data demonstrated that the granules could cause injury to the blood vessels and make repair difficult. The granules were also shown to enter the circulatory system and cause thrombosis in distal organs.9 Because of these potentially serious side effects, the U.S. Army announced in April 2009 that WoundStat would no longer be used by their medical personnel.

QuikClot: QuikClot (Z-Medica, Wallingford, CT) is a granular product consisting of kaolin, which is a combination of inert minerals such as silicon, aluminum, magnesium, and sodium found in volcanic rock. When placed in a bleeding wound, it absorbs water thereby increasing the local concentration of clotting factors, platelets, and red blood cells to stimulate clot formation. A byproduct of its mechanism is a severe exothermic reaction, with heat generation of up to 70̊ C (158o F). This heat generation causes local tissue destruction and even burns. QuikClot has been studied in both the military and civilian sector, with up to 92% effectiveness in stopping hemorrhage.10 QuikClot was issued to U.S. soldiers in the Iraq and Afghanistan conflicts. Civilian use has been by a wide range of providers, including EMT/firefighters, paramedics, and police. Examples of civilian use include treatment of severe lacerations, gunshot wounds to the neck and even hemodialysis catheter dislodgement. Trauma surgeons have also used QuikClot for successful treatment of bleeding during surgery in the chest, abdomen, and pelvis. QuikClot was noted to have two significant weaknesses. Since it is a granular powder poured into a wound, it had limited usefulness in high-pressure bleeding (i.e. femoral artery bleed)as the granules were washed away by the bleeding before they were able to form a clot. Furthermore, the heat generated from its use was associated with several burns.

QuikClot production was stopped after development of several newer generation products. These newer generation products have minimal heat production and are packaged both as gauzes and in a bagged form. Currently Z-Medica sells QuikClot packaged in 2”x2” and 4”x4” gauze pads for use on superficial lacerations which don’t have severe bleeding. QuikClot has also developed a small kaolin-impregnated pad (QuikClot ACS+) and as a laparotomy pad (QuikClot Trauma Pad) for use by trauma surgeons in the operating room for cases of severe bleeding during surgery. This later product remains in the research phase and is not yet approved for widespread use.

QuikClot Combat GauzeTM is a 3”x4 yard long roll of nonwoven gauze impregnated with kaolin. Combat Gauze has all the advantages of normal gauze (easy application, flexible, large coverage area, and easily removable) with the additional advantage of hemostatic function from the kaolin. It is designed for packing into deep wounds which are actively bleeding (i.e. arterial injury in the groin). Prehospital personnel can also use combat gauze as they would any standard Kerlix gauze. Combat Gauze was recently compared to several newer generation products, including the HemCon RTS, and found to be superior and had no apparent side effects.11 Currently, QuikClot Combat Gauze is the only product endorsed by the Tactical Combat Casualty Care Committee and they recommend it as first line treatment for life-threatening hemorrhage on external wounds not amendable to direct pressure and tourniquet placement.

Summary:

- Numerous topical hemostatic products have been developed and released onto the market.

- Some of these products have since been discontinued, while others are widely used.

-Economic and medical considerations continue to make this a rapidly evolving and growing area of prehospital care. It is important for the EMS provider to remain cognizant of these products and their advantages, disadvantages, and complications as they continue to evolve.

PHTLS Recommendation: Topical hemostatic agents may be used to control hemorrhage occurring in sites not amenable to tourniquet placement and which cannot be controlled by direct pressure alone.

 

 

Bibliography

  1. Achneck HE, Sileshi B, Jamiolkowski RM, et al. A comprehensive review of topical hemostatic agents: Efficacy and recommendations for use. Annals of Surgery 2010; 251: 217-228.

  2. Mabry R and McManus JG. Prehospital advances in the management of severe penetrating trauma. Crit Care Med. 2008:36(7);S258-266.

  3. Brown MA, Daya MR, Worley JA. Experience with chitosan dressings in a civilian EMS system. J Emerg Med. 2009;62:239-243.

  4. Kozen BG, Kircher SJ, Henao J, et al. An alternative hemostatic dressing: comparison of CELOX, HemCon, and QuikClot.Acad Emerg Med. 2008; 15:74-81.

  5. Devlin JJ, Kircher S, Kozen BG, et al. Comparison of ChitoFlex, CELOX, and QuikClot in control of hemorrhage. J Emerg Med. 2009 Apr 1 (Epub ahead of print).

  6. Ward KR, Tiba MH, Holbert WH, et al. Comparison of a new hemostatic agent to current combat hemostatic agents in a swine model of lethal arterial hemorrhage. J Trauma. 2007;63:276-284.

  7. Kheirabadi BS, Edens JW, Terrazas IB, et al. Comparison of new hemostatic granules/powders with currently deployed hemostatic products in a lethal model of extremioty arterial hemorrhage in swine. J Trauma. 2009;66:316-328.

  8. Arnaud F, Parreno-Sadalan D, Tomori T, et al. Comparison of 10 hemostatic dressings in a groin transaction model in swine. J Trauma. 2009;67:848-855.

  9. Bheirabadi BS, Mace JE, Terrazas IB, et al. Safety evaluation of new hemostatic agents, smectite granules, and kaolin-coated gauze in a vascular injury wound model in swine. J Trauma. 2010;68:269-278.

  10. Rhee P, Brown C, Martin M, et al. QuikClot use in trauma for hemorrhage control: case series of 103 documented uses. J Trauma. 2008;64:1093-1099.

  11. Kheirabadi BS, Scherer MR, Estep JS, et al. Determination of efficacy of new hemostatic dressings in a model of extremity arterial hemorrhage in swine. J Trauma. 2009;67:450-460.

| Tags : pansement

06/11/2010

Point sur les pansements hémostatiques

Un article récent fait le tour des pansements hémostatiques.

Review

Pre-hospital haemostatic dressings: A systematic review

J. Granville-Chapman, N. Jacobs and M.J. Midwinter

Academic Department of Military Surgery & Trauma, Royal Centre for Defence Medicine, Birmingham, UK

Accepted 28 September 2010. 
Available online 28 October 2010.

 

Abstract

Background

Uncontrolled haemorrhage is a leading cause of prehospital death after military and civilian trauma. Exsanguination from extremity wounds causes over half of preven military combat deaths and wounds to the anatomical junctional zones provide a particular challenge for first responders. Commercial products have been developed, which claim to outperform standard gauze bandages in establishing and maintaining non-surgical haemostasis. Since 2004, two advanced haemostatic dressing products, HemCon and QuikClot have been widely deployed in military operations. Newer products have since become available which aim to provide more efficient haemostasis than and thus supersede HemCon and QuikClot.

Aim

To conduct a systematic review of clinical and preclinical evidence to compare the relative efficacy and safety of available haemostatic products, which are of relevance to pre-hospital military and civilian emergency medical providers.

Method

An English language literature search was performed, using PubMed® and Web of Knowledge® Databases, with cross-referencing, focussed product searches and communication with product manufacturers. For studies employing animal models, the injury model was required to produce fatal haemorrhage. Products were categorised by primary mode of action as either factor concentrators, mucoadhesive agents or procoagulant supplementors.

Results

From 60 articles collated, 6 clinical papers and 37 preclinical animal trials were eligible for inclusion in this review. Products have been tested in three different types of haemorrhage model: low pressure, high volume venous bleeding, high pressure arterial bleeding and mixed arterial-venous bleeding. The efficacy of products varies with the model adopted. Criteria for the ‘ideal battlefield haemostatic dressing’ have previously been defined by Pusateri, but no product has yet attained such status. Since 2004, HemCon (a mucoadhesive agent) and QuikClot (a factor concentrator) have been widely deployed by United States and United Kingdom Armed Forces; retrospective clinical data supports their efficacy. However, in some recent animal models of lethal haemorrhage, WoundStat (mucoadhesive), Celox (mucoadhesive) and CombatGauze (procoagulant supplementor) have all outperformed both HemCon and QuikClot products.

Conclusion

HemCon and QuikClot have augmented the haemostatic capabilities of the military first aid responder, but newer products demonstrate potential to be more effective and should be considered as replacements for current in service systems. These products could have utility for civilian pre-hospital care.

Keywords: Dressing; Battlefield; Haemostatic; Combat; Prehospital; WoundStat; QuikClot; HemCon; Celox; Combat Gauze

 

 

 

 

| Tags : pansement

12/10/2010

Tourniquet: Un algorithme

Le concept du garrot tactique est basé sur le fait que la pose d'un garrot est le moyen le plus simple pour arrêter une hémorragie des membres mais que l'indication doit être validé le plus tôt possible. Un algorithme visible ici peut être proposé.

11/10/2010

Contrôle préhospitalier des hémorragies externes

L'arrêt des hémorragies fait appel à la mise en oeuvre d'un ensemble de moyens représentés par la compression directe des plaies, la mise en place de pansements et de bandage compressifs, la rembourrage de plaie, l'emploi de pansements hémostatiques et la pose de garrrôts. (lire ce document)

07/12/2008

Au sujet des garrots

Forum garrot