Hemostatic agents: Difference between revisions

Latest revision as of 21:39, 16 February 2018

Types

Plant-Based	Oxidized cellulose (OC) and oxidized regenerated cellulose (ORC)
Gelatin-based	Purified pork or bovine skin; absorbs 45 times its weight of its initial volume causing hemostasis. Excessive swelling can lead to nerve compression
Collagen-based	Derived from tissue; shows cell compatibility, adhesion, growth and migration.
Fibrin-based	High concentrations of fibrinogen, thrombin and additional components (clotting factors)
Thrombin-based	Directly participate in the coagulation cascade process that promotes and modulates coagulation. Provides a lattice for platelet aggregation and thrombus formation.
Chitin-based	Polysaccharide biopolymer produced naturally by algae through fermentation. Also known as chitosan in its deacetylated form. Chitosan has been shown to be more effective that chitin in controlling severe hemorrhage.

Characteristics^[1]

Charateristic	QuikClot ACS+	HemCon	Celox	WoundSat	Combat Gauze
Hemostatic efficacy	+	+	+++	++++	++++
Side effects	No	No	No	Yes	No
Ready to use	Yes	Yes	Yes	Yes	Yes
Training requirement	+	+	+	+++	++
Lightweight, durable	+	+++	+++	+	+++
2-year shelf life	Yes	Yes	Yes	Yes	Yes
Stable in extreme conditions	Yes	Yes	Yes	Yes	Yes
Cleared by FDA	Yes	Yes	Yes	Yes	Yes
Biodegradable	No	No	Yes	No	No
Cost ($)	~30	~75	~25	~30	~25

Use

For compressible hemorrhage not amenable to tourniquet use or as an adjunct to tourniquet removal (if evacuation time is anticipated to be longer than two hours), use Combat Gauze
Celox Gauze and ChitoGauze may also be used if Combat Gauze is not available.
Hemostatic dressings should be applied with at least 3 minutes of direct pressure.

References

↑ Kheirabadi B. "Evaluation of Topical Hemostatic Agents for Combat Wound Treatment." The Army Medical Department Journal. April – June 2011. Pages 25-31

Authors:

[1] Kheirabadi B. "Evaluation of Topical Hemostatic Agents for Combat Wound Treatment." The Army Medical Department Journal. April – June 2011. Pages 25-31

[1]

@@ Line 1: / Line 1: @@
-==Active Agents==
+==Types==
 {| class="wikitable"
 | align="center" style="background:#f0f0f0;"|'''Plant-Based'''
@@ Line 15: / Line 15: @@
 |}
-==Types==
+===Characteristics<ref>Kheirabadi B. "Evaluation of Topical Hemostatic Agents for Combat Wound Treatment." The Army Medical Department Journal. April – June 2011. Pages 25-31</ref>===
+{| class="wikitable"
+| align="center" style="background:#f0f0f0;"|'''Charateristic'''
+| align="center" style="background:#f0f0f0;"|'''QuikClot ACS+'''
+| align="center" style="background:#f0f0f0;"|'''HemCon'''
+| align="center" style="background:#f0f0f0;"|'''Celox'''
+| align="center" style="background:#f0f0f0;"|'''WoundSat'''
+| align="center" style="background:#f0f0f0;"|'''Combat Gauze'''
+|-
+| Hemostatic efficacy||+||+||+++||++++||++++
+|-
+| Side effects||No||No ||No||Yes||No
+|-
+| Ready to use||Yes||Yes||Yes||Yes||Yes
+|-
+| Training requirement||+||+||+||+++||++
+|-
+| Lightweight, durable||+||+++||+++||+||+++
+|-
+| 2-year shelf life||Yes||Yes||Yes||Yes||Yes
+|-
+| Stable in extreme conditions||Yes||Yes||Yes||Yes||Yes
+|-
+| Cleared by FDA||Yes||Yes||Yes||Yes||Yes
+|-
+| Biodegradable||No||No ||Yes||No||No
+|-
+| Cost ($)||~30||~75||~25||~30||~25
+|}
 ==Use==
-#Assess for unrecognized hemorrhage and control all sources of bleeding. If not already done, use a CoTCCC-recommended tourniquet to control life-threatening external hemorrhage that is anatomically amenable to tourniquet application or for any traumatic amputation. Apply directly to the skin 2-3 inches above wound.
+*For compressible hemorrhage not amenable to [[tourniquet]] use or as an adjunct to [[tourniquet]] removal (if evacuation time is anticipated to be longer than two hours), use Combat Gauze
-#For compressible hemorrhage not amenable to tourniquet use or as an adjunct to tourniquet removal (if evacuation time is anticipated to be longer than two hours), use Combat Gauze as the CoTCCC hemostatic dressing of choice. Celox Gauze and [[ChitoGauze]] may also be used if [[Combat Gauze ]]is not available. [[Hemostatic dressings]] should be applied with at least 3 minutes of direct pressure. Before releasing any tourniquet on a casualty who has been resuscitated for hemorrhagic shock, ensure a positive response to resuscitation efforts (i.e., a peripheral pulse normal in character and normal mentation if there is no [[traumatic brain injury]] (TBI). If the bleeding site is appropriate for use of a junctional tourniquet, immediately apply a CoTCCC-recommended junctional tourniquet. Do not delay in the application of the junctional tourniquet once it is ready for use. Apply hemostatic dressings with direct pressure if a junctional tourniquet is not available or while the junctional tourniquet is being readied for use.
+*Celox Gauze and ChitoGauze may also be used if Combat Gauze is not available.
-#Reassess prior tourniquet application. Expose wound and determine if tourniquet is needed. If so, replace tourniquet over uniform with another applied directly to skin 2-3 inches above wound. If a tourniquet is not needed, use other techniques to control bleeding.
+*Hemostatic dressings should be applied with at least 3 minutes of direct pressure.
-#When time and the tactical situation permit, a distal pulse check should be accomplished. If a distal pulse is still present, consider additional tightening of the tourniquet or the use of a second tourniquet, side by side and proximal to the first, to eliminate the distal pulse.
-#Expose and clearly mark all tourniquet sites with the time of tourniquet application. Use an indelible marker.
 ==See Also==
 *[[Bleeding treatments]]
+*[[Tactical combat casualty care]]
 ==References==
+<references/>
 [[Category:Trauma]]
 [[Category:EMS]]
-[[Category:Milmed]]
+[[Category:Military]]

Hemostatic agents: Difference between revisions

Latest revision as of 21:39, 16 February 2018

Types

Characteristics[1]

Use

See Also

References

Characteristics^[1]