How does combat gauze work

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Combat gauze is one of the most widely known, widely used, and easily accessible hemostatic agents in existence. It is responsible for a lot of saved lives. The junctions are areas where something meets the central point of the body, i. These junctions hold many large vessels that, should they be opened, will contribute to a life-threatening bleed.

You carry a combat gauze in a trauma kit to the range - excellent. Open in a separate window. Table 2 Pre-interventional data continued. Table 3 Summary of findings.

Discussion QCG is currently used by the US military and in many civilian sectors for management of massive hemorrhage in trauma casualties. Table 4 The ideal qualities of pre-hospital hemostatic agents.

The ability to rapidly stop large vessel arterial and venous bleeding within 2 min through a pool of blood. No requirement for mixing or pre-application preparation. Simplicity of application by wounded victim, buddy or medic. Light weight and durable. Long shelf life greater than 2 years in extreme environments.

Safe to use with no risk of injury to tissues or transmission of infection. Author involvement All of the authors were involved in the design of the study. References 1. Sauaia A.

Epidemiology of trauma deaths: a reassessment. J Trauma. Alam H. Hemorrhage control in the battlefield: role of new hemostatic agents. Mil Med. Combat casualty care research: from bench to the battlefield. World J Surg. Comparative analysis of hemostatic agents in a swine model of lethal groin injury.

Mabry R. United States Army Rangers in Somalia: an analysis of combat casualties on an urban battlefield. Champion H.

A profile of combat injury. Hess J. The coagulopathy of trauma: a review of mechanisms. Ward K. Comparison of a new hemostatic agent to current combat hemostatic agents in a Swine model of lethal extremity arterial hemorrhage. Care CoTCC. Tactical combat casualty care guidelines. November 30, QuikClot Combat Gauze. Johnson D. The effects of QuikClot Combat Gauze on hemorrhage control in the presence of hemodilution. Dubick M. Hemostyptic wound bandages: are there any differences? Wiener klinische Wochenschrift.

Kheirabadi B. Safety evaluation of new hemostatic agents, smectite granules, and kaolin-coated gauze in a vascular injury wound model in swine.

Determination of efficacy of new hemostatic dressings in a model of extremity arterial hemorrhage in swine. Arnaud F. Comparison of Combat Gauze and TraumaStat in two severe groin injury models. J Surg Res. Comparison of 10 hemostatic dressings in a groin transection model in swine. Schwartz R. Comparison of two packable hemostatic Gauze dressings in a porcine hemorrhage model. Gegel B. The effects of QuikClot Combat Gauze and movement on hemorrhage control in a porcine model.

Burgert J. The newest generation is impregnated dressings designed to simplify application and decrease complications. Kaolin is an inert mineral that promotes clotting by activation of factor XII FXII which in turn initiates the intrinsic clotting pathway via the activation of factor XI that ends with the formation of a fibrin clot.

In addition, kaolin promotes the activation of platelet-associated FXI which initiates the intrinsic clotting pathway resulting in a clot. There are limited data demonstrating the effectiveness of the QCG and kaolin. This study was a prospective, between subjects, experimental design using a porcine model. The minimum number of animals was used to obtain a statistically valid result.

Using the data from previous studies by Alam, Pusateri, and Sondeen, the investigators calculated a large effect size of 0. Using G-Power 3. The rationale for using this weight range was that it represents the average of the US Army soldier. The activated clotting time ACT , the body weights, core body temperatures, amount of 1 minute hemorrhage, arterial blood pressures, amount of blood volume, the amount of the NPO fluid deficit replacement, and the amount and percentage of total blood volume of the initial hemorrhage were analyzed using a multivariate analysis of variance MANOVA.

An MANOVA was also used to determine if there were significant differences relative to the amount of hemorrhage over a 5-minute period, amount of resuscitation fluid, and the number of movements before hemorrhage. A post hoc Tukey was used to determine where the significance was.

Heart rate, electrocardiography, blood pressure, oxygen saturation, end-tidal carbon dioxide, and rectal temperatures were continuously monitored for the remainder of the experiment. It was attached to a hemodynamic monitoring system Hewlett Packard, Palo Alto, CA for continuous monitoring of the arterial blood pressures. A central venous catheter was inserted using a modified Seldinger technique for fluid volume management and blood sampling.

Following line placement, the NPO fluid deficit was administered with 0. The investigators used an ACT test to screen all subjects for coagulopathy prior to procedures. Subjects were further monitored for 30 minutes to ensure hemodynamic stability prior to intervention. Body temperature was monitored via a rectal probe and maintained at greater than A complex groin injury as described by Alam and colleagues was generated to simulate a penetrating injury [ 23 , 24 ].

All swine were hemodynamically stable prior to intervention. Following the minute stabilization period, the exposed femoral artery and vein were transected with a scalpel blade.

The swine were allowed to hemorrhage for 1 minute simulating the response time of a battlefield health care provider. Blood was collected by gauze, absorbent pads underneath the animals, and in a suction canister by use of a suction tip catheter placed in the distal portion of the wound.

At this time, the QCG was packed into the wound followed by standard wound packing with a layer of petroleum gauze and the roller gauze Kerlix, Covidien, Mansfield, MA.

The control group received proximal pressure and standard wound packing. The TIF scale is precise within 0. After 5 minutes of direct manual pressure, a pound sandbag was applied to the wound for an additional 30 minutes.

After 35 minutes of pressure on the wound 5 minutes manual pressure plus 30 minutes with the sandbag , the standard pressure dressing was removed being careful to keep the clot intact. The rationale for using the petroleum gauze was that it allowed removal of the pressure dressing with minimal clot disruption. Blood loss was measured over two time periods: the initial injury to intervention and after intervention to the completion of the study.

Blood loss was calculated by weighing the dressings, absorbent pads underneath the animals, and blood suctioned from the distal portion of the wound before and after transection of the femoral vessels. For those pigs achieving hemostasis, 5 liters of crystalloid infusion were rapidly administered through the central venous catheter over 5 minutes to determine the amount of fluid at which rebleeding occurred. The purpose of this phase was to determine if there was a difference in QCG and the control groups relative to how much crystalloid fluid up to 5 liters they could tolerate before rebleeding occurred.

If rebleeding occurred during this intervention, the amount of intravenous fluid administration was calculated followed by the movement phase. For swine achieving hemostasis, the investigators systematically moved the leg on the side of the complex groin injury.

In a real battlefield or trauma scenario, personnel would take significant precautions when moving combat casualties. For purposes of this study, movement consisted of the following: flexion, extension, abduction, and adduction sequentially ten times or until rebleeding occurred. Flexion consisted of movement of the leg until it touched the abdominal cavity, while the extension consisted of movement of leg until it touched the litter. The abduction and adduction consisted of movement of the leg until no additional motion could be accomplished.

Each flexion was followed by an extension, and each abduction was followed by an adduction. There were no statistically significant differences between the groups 0. The ACT was within normal limits for all subjects. There were significant differences in the groups relative to the amount of hemorrhage over a 5-minute period, amount of resuscitation fluid, and the number of movements before hemorrhage. There was a significant difference in the groups relative to the amount of hemorrhage , the amount of resuscitation fluid before rebleeding , and the number of movements.

The number of movements for the OCG group ranged from 3 to 40 , , and for control group it ranged from 0 to 9 ,. See Tables 1 , 2 and 3 for a summary of the results. It recommends QCG as the first-line hemostatic agent for use in treatment of severe hemorrhage. There are limited data demonstrating the effectiveness of QCG. Pusateri et al. There are multiple retrospective studies of QCG that produced mixed results. According to Ran et al. Rhee et al. Devlin et al. Lastly, there is limited anecdotal evidence of the effectiveness of QCG.