Trauma month – haemorrhage control

Advanced trauma team

With the ongoing rollout of the new trauma equipment across the region, we want to recap on what equipment is available to help patients, as part of trauma month.

When it comes to haemorrhage control, please remember the following points:

  • the first clot is the best clot
  • minimise the amount of moving of the injured site to reduce the risk of further haemorrhage
  • pain management will be vital and good splinting can be as important as IV analgesia.

Tranexamic acid

Tranexamic acid (TXA) is administered in patients who have suffered a traumatic injury resulting in haemorrhage and is an anti-fibronolytic drug that inhibits the conversion of plasmin to plasma, the enzyme responsible for the breakdown of the initial clot formation after the injury phase. Given to patients within the first hour, evidence exists to show that the use of TXA is very beneficial, with improved outcomes in clinical trials in those having suffered a major haemorrhage incident.

It’s use is not just isolated to adults; it is admissible to patients of all ages from birth, adjusting dose to age, as per national clinical practice guidelines (JRCALC).

Ensure all other aspects of haemorrhage control are in place before TXA is administered. There needs to be a clot first for TXA to protect.

Combat Application Tourniquet

The Combat Application Tourniquet (CAT) can be applied to limbs for the arrest of arterial or venous bleeding that is time-critical or not controllable, or possible to control with direct pressure.

You should apply to the injured limb proximal to the wound but as close to the injury site as possible to minimise the potential for tissue loss. Please bear in mind that it ideally needs to be over a single bone and will hurt when applied to a conscious patient. Ensure you make a note of the time of application for the hospital and avoid releasing it if possible.

Celox gauze

This haemostatic dressing promotes clotting by concentrating the clotting factors directly at the injury site. It is used in cases of catastrophic haemorrhage where conventional methods have been unsuccessful, or as part of a haemorrhage control plan in line with other interventions.

Celox is particularly useful for the injury sites that are not easily compressed or that a CAT wouldn’t be able to be applied, i.e. axillas, arm pits, necks, groins. The celox needs to be applied directly to the wound site and compressed over the top. It is not to be used for open chest or head wounds and extra caution would be needed in open abdominal wounds, to ensure no viscera is showing that could be effected by the celox.

Blast dressing

This is basically a big emergency dressing used for control of haemorrhage on a large scale. Amputations, open abdominal wounds and mangled limbs can be treated with this dressing, which not only has the size to cope with almost all external haemorrhage sites, but aids in compression of the site using its elasticated ties.

Major haemorrhage is life-threatening, so good control is vital. Remember the basic premise of this is very simple; if a patient is losing blood, it needs to be stopped as quickly as possible. Clinical staff should remember that 24-hour advice is available via the clinical advice line or contact CCD for support.

Published 26th May 2015 

Leave a Comment
Name (required)
Email Address (required, never displayed)
Enter a message

(all comments are moderated - your submission will be posted on approval.)