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Discussion on trauma forum about tourniquets and haemostatic agents, and which if any is best?

From the thread, which I found very interesting and useful for those facing these types of wounds and injuries.
What do you guys think of the discussion below??

“There are several things that saves lives. Rapid transport of injured patients. Quick operative intervention when necessary is key. Outside of that, everything else is all relative.”

—> “I think that everything is relative even including the items you mentioned - all depends on the patient and the pathology.”

But to get back to the issue of this thread…

On Behalf Of Slava Kopetskiy> Some people told us: “Celox save lives”

—> When used appropriately, on suitable injuries, it is a very good external bleed-stopper

Is there any comparisons between hemostatic agents and tourniquets?”

—> “There are some principles to mention and I am sure others will chime in:
1. Tourniquets are only for limb injuries - amputations and others. No use on torso
2. Tourniquets are easy to train non-medical personnel to apply correctly and even to themselves using only one hand (if the other is injured) if you have the better sort of tourniquets. The better ones are easy to pack/carry; tough to disrupt; waterproof, etc…
3. When you know what you’re doing, once patient is being cared for at a forward point, the tourniquet can buy time for the injury to be inspected and managed and then a trial release may be attempted (by those who know how) and a re-application if required.
4. Tourniquet brings in a time limit for limb survival which is not applicable to Celox (which may also be used for some limb injuries). You now only have 2-3 hours to save the limb and often even less under typical military circumstances. This is a major “con”
5. Celox is very practical in multiple formats for the haemostatic dressing of wounds. It does not disrupt underlying circulation like a tourniquet. It’s your only option out of the two for torso
6. On a limb, Celox can also be used, but some amputations and extensive injuries may well exsanguinate during the time it takes to apply. So one (who knows what to do) might place a tourniquet first, then use the opportunity to apply Celox, splints and other bits, then trial-release tourniquet…7. Celox is also easy to pack/carry, but once pack is open… Possible to train lay people to apply.”

Nowadays amount of hemostatic agents is a lot bigger then tourniquets in ukrainian army…”

—> “The only WRONG decision you could make is to decide that you should find which of these two is “best” and only get that one! What you want is BOTH, with the correct algorithms as to when each one is used and how. Such algorithms exist in many forms. Don’t fall into the trap of thinking that even if there is a “best” then all other options must be ignored.

I can tell you from (extensive) experience on this matter that, as with many other aspects of Emergency Medicine, what you want is multiple options AND the knowledge on how to best individualise for each patient.”


Accelerated aging and organ damage with chronic alcohol abuse

The chemical we call “alcohol" is actually ethanol - one of many chemicals that are alcohols (which is any compound with a hydroxyl functional group).

It’s also one of the most ancient intoxicants; the fermentation of beer predates the domestication of horses (~6000 years ago vs. 5500 years ago), though the first recorded recipe (and definitive proof of intentional brewing) was not until 3900 BCE, in ancient Sumeria.

This illustration shows the accelerated aging, ulceration of the stomach, and cirrhosis of the liver in a man who has abused alcohol since he was a teenager. While the body has defenses against acute alcohol toxicity, such as vomiting the irritating alcohol from the stomach (as well as the negative mental associations we make with hangovers, of course), it does not have the same defenses against chronic excessive alcohol consumption. As one develops a tolerance for alcohol, and drinks more frequently, the brain becomes dependent upon it.

Alcohol is one of the few drugs that is absorbed directly through the stomach, for the most part. This can cause significant ulceration and scleroses (hardening) with chronic abuse. As the liver is where the alcohol and its by-products are processed, consistent abuse of the substance can cause significant organ damage.

Die Frau als Hausärztin
. Dr. Anna Fitcher-Duckelmann, 1911.

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