Prehospital and Retrieval Medicine – THE PHARM dedicated to the memory of Dr John Hinds

We all want to stop bleeding. Here’s a quick review from Dr Alan Garner of a paper coming out of Iran that looks at haemostatic dressings. 

Hatamabadi HR et al. Celox-Coated Gauze for the Treatment of Civilian Penetrating Trauma: A Randomized Clinical Trial. Trauma Monthly. 2014;20:e23862. dii: 10.5812/traumamon.23862

There is not a lot of data on haemostatic dressings in the civilian context and human data from the military context is not randomised for obvious reasons. It is therefore nice to see a RCT on this subject in humans. In the study they compare the time to haemorrhage control and amount of haemorrhage in stab wounds to the limbs between 80 patients treated with Celox gauze versus 80 patients treated with normal gauze.

The study is from an emergency department in Tehran and is pragmatic in design. There are some limitations of the study worth mentioning. It was open label, and…

47 ysr old male collapsed on the field. First ALS unit found him arrested in VF.
Shocked 3 times he regained a palpable central pulse.
When we arrived the patient arrested again. VF on the monitor. Shocked 4 times. Mechanical chest compression and tracheal intubation on board. He received Epi, Amio (300+150), Calcium Gluconate and Bicarb (suspected iper K in kidney insufficiency) before the ROSC.
15 minutes passed from the collapse to ROSC,  7 of wich were of “no flow” (no chest compressions, no AED from bystanders).
PMH: Hypertension, kidney insufficiency, heavy smokers. Medication history unknown.
He had chest pain before collapsing, as referred from bystanders.

Vitals at ROSC: GCS 3 T, RR 10 MV, SaO2 100%, EtCO2 35,  HR 70 bpm. NIBP 100/70 12 lead EKG at ROSC is shown below

An echo of the heart performed on the field (in the ambulance running to the ED, so I…