A couple of weeks ago I had the privilege attending a meeting with a few representatives from the company QuikClot. QuikClot is one of a few different manufactures that produces impregnated gauze that is used for wound packing. In this Medical Monday we will discuss the correct way to perform wound packing as well as the areas in which wound packing can be performed.
One thing that sets QuikClot apart from other manufactures is that QuikClot is impregnated with kaolin as the agent that assists with faster clotting of blood. The Committee of Tactical Combat Casualty Care also recognizes QuikClot as a superior product. An long conversation ensued discussing the two methods approved by QuikClot when using their product. One theory is that if you have used an entire roll of QuikClot inside of a wound, and the wound is still bleeding, you pull all of it out and place a fresh pack of QuikClot into the wound.
The rationale behind that theory is that the fresh kaolin will make contact with the blood and provide a better clot to slow down and stop the bleeding. In my entire career I have always been taught that you should never remove gauze from the wound once the wound is packed with gauze.
If the bleeding continues, add fresh gauze on top of the existing gauze and hold pressure. I brought this point up to the QuikClot representatives who after a long discussion agreed that EITHER method would be acceptable. The tactical physician in the room advised that he personally would just add gauze, he would not remove what was already in place. This is what I recommend as well. My thought process says that if you remove the gauze that has already become soaked, you are removing any clot, or beginning of a clot that has already formed, and you are starting back at square one.
This brings me to my next point. When you encounter a wound with a large amount of bleeding in a place that is not amendable to tourniquet use, it is imperative to try to pinpoint exactly where the bleeding is coming from. To do this, if blood has pooled within the wound, use your hand and “scoop” the blood out to assist you with finding the source. Once you find the source, begin packing the wound using your finger to hold pressure directly on the source of the bleeding. Ensure that you fill ALL of the voids of the wound cavity. Especially in the case of a gunshot wound, the energy that enters into the body with the bullet will cause tissue to expand and tear. It is important to pack all areas of the wound that were affected.
Let me clarify a few things. Wound packing is most generally performed in the junctions of the body. Your arm pits, groin, and the base of your neck are a few examples. Do NOT put QuikClot or any other type of gauze into major head trauma, the chest, or the abdomen.
QuikClot offers several different sizes of gauze for different applications. The packaging will look different, but the product itself is the same. No longer is quikclot the granules that used to cause burns. I have used the current quikclot product and it is absolutely incredible how well it works. A friend of mine took a sim round to the nose during SWAT school last year and his nose would not stop bleeding. I used a small piece of the QuikClot gauze to place into his nose, and the bleeding stopped immediately. If you have any questions or comments, please let me know.
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