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by Paul Auerbach, M.D.
Once of the major recent advances in trauma care has been the
evolution of topical substances that can be applied to wounds in order to limit
or stop hemorrhage (bleeding). This is very important in wilderness medicine,
because uncontrolled bleeding is a leading cause of death from injuries. When
the bleeding site can be approached in such a manner as to stop the bleeding,
then something very valuable may possibly be done for the patient.
In article entitled “Comparison of Celox-A, ChitoFlex,
WoundStat, and Combat Gauze Hemostatic Agents Versus Standard Gauze Dressing in
Control of Hemorrhage in a Swine Model of Penetrating Trauma,” Lanny
Littlejohn, MD and colleagues used an animal model of a complex groin injury
with a small penetrating wound, followed by completely cutting the femoral
artery and vein, to determine whether there was any benefit to one or another
hemostatic (stops bleeding) agent in comparison to each other and to standard
gauze dressing. To cut to the chase (no pun intended), the results showed that
no difference was found among the agents with respect to initial cessation of
bleeding, rebleeding, and survival. In this study, WoundStat was inferior with
respect to initial cessation of bleeding and survival when compared to Celox-A.
The authors point out how important it is to control severe
bleeding early in the course of a patient’s therapy, because at a certain
point, bleeding leads to organ failure and a vicious cycle of severe acid-base
imbalances, more bleeding, and the complications that might occur from blood
transfusions. The different hemostatic agents, be they free granules poured
into a wound or gauze impregnated with active substances, need to be readily
available, easy to deploy, effective in a short period of time, not painful,
and without complications. There are more than a few agents that fit the bill,
so it’s important to be objective about the pros and cons of each agent. In
this study, it was confirmed that they all work roughly equally effectively, so
the choice often comes down to comfort of the user with a particular product
and personal preferences.
What was surprising as an outcome in the study was the
observation that a standard (nonmedicated) gauze dressing was as effective as
any of the hemostatic agents. That contradicts some of the current rhetoric
that I have heard at medical meetings from experts on wound care, who are
beginning to swear by the use of hemostatic agents. If it is true that there
are circumstances in which hemostatic agents do not add any benefit to the
clinical process of stopping or limiting bleeding, we need to know, so that we
don’t waste precious time and money deploying these agents. Obviously, if these
agents are beneficial, we need to know about that as well.
A practical observation of this particular study was that a
rolled, impregnated (with hemostatic agent) gauze introduced into a bleeding
wound should first be unrolled prior to application, to avoid creating a
congealed mass of gauze and blood that cannot be properly manipulated and
positioned within the confines of the wound.
Copyright Paul Auerbach
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