Sir:
In reply to Bill H.’s questions about Ferric chloride to stop bleeding. In the U.S. Ferric Chloride is recognized as a styptic in veterinary medicine and should be used at a concentration of 10%. Lower concentrations are progressively less effective as a styptic but become useful as an astringent. Ferric subsulfate is currently used in the U.S. in human medicine as a styptic. I see it used frequently in our hospital in the surgery department. The typical use is at full strength or 20%. Alum is another potential styptic used at 0.5 to 5% solutions (yes, the stuff for pickles). Bismuth subgallate powder is another styptic used in hospital surgery departments at full strength. These products can be obtained without a prescription. Try to acquire the highest purity possible for human use.
I fear that much of this olde tyme information is being lost to ultra modern medications. The old products still work. They have just lost favor in the brilliant light cast by the high pressure pharmaceutical sales promotions of newer glitzy products ( I was once on the dark side, selling such products). As a pharmacist, I would recommend that you befriend an older pharmacist or a compounding pharmacist where this knowledge still resides. Understand that since 1980 most pharmacy schools have shifted their emphasis to the new Pharm. D. (Doctor of Pharmacy) degree which has a greater focus on clinical issues. The older Bachelor of Science Pharmacy degree focused primarily on the older traditional pharmacy knowledge based on how to make the drugs. I work with two other pharmacists who are also survivalist minded and all of us are collecting selected textbooks. In a TEOTWAWKI situation, pharmaceutical plants will not be functioning. The olde tyme chemistry and pharmacy skills will be extremely useful to a family or local community during the hard times. I recommend that you try to acquire older (1940-1970) versions of the following texts to be able to refer to the older formulations: Remington’s Pharmaceutical Sciences, USP (United States Pharmacopoeia) and the NF (The National Formulary) as well as current and/or older copies of the Merck Manual, Merck Veterinary Manual, and the Merck Index. These texts will give you a good foundation to work with. Good Luck, – Yonah .
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Jim:
Goodness gracious, no, don’t use ferric chloride! Where do people get these ideas? It’s not even used in the so-called styptic pencils (aluminum sulfate or titanium dioxide). According to the Merck Index (which is not the same as the Merck Manual, it lists chemicals and some drugs with their chemical properties) Ferric chloride is an astringent, not a styptic…and it’s toxic, also.
If someone is willing to invest in very small quantities of expensive chemicals from the Radio Shack for first aid purposes, they should invest in the right stuff. It’s great to be able to ‘make do’ with a multi-tool and a rock, but I’ve found that I always do a better job with the right tools at hand.
Most bleeding will stop with the application of direct pressure, or elevation, or using a pressure point. Failing that (which works 99.999% of the time) a tourniquet can be used. The blood stopper products are for very rare, specific instances of certain injuries that don’t lend themselves to conventional treatment.
In a wood or metal shop? Make sure the guards are in place, “read, understand and follow all the safety rules” as that guy on television says, and get a real first aid kit.
On that subject, the only product like that, that has not only been FDA approved but actually tested in controlled, blinded medical research published in legitimate journals, is Quik-clot. It’s what I use. Disclaimer: I have no interests in the company of any sort, I just buy their stuff – at market prices.
But, something I’ve used on animals after cuts from wire or rocks, is instant potato flakes. Just put them on the wound, the effect is similar to that of some of the approved products that I don’t use…and it’s cheaper. I can’t suggest using it on a person, of course. – Flighter
Mr R
Quik-Clot is the best available product for instantaneous hemostasis
It’s available in both powder/packet, and impregnated-bandages. It works. I’ve seen it in action with my son, who lacerated an artery in the hand. www.z-medica.com
It’s even been used intracorporeally in a trauma case, written up in the Journal of Trauma Surgery. Although not recommended for this, it worked
It costs about $17 per packet, can be purchased in a coyote-brown trauma pack with compression bandages and a tourniquet for about $35, and is worth every penny. I don’t know the bandage cost, but the site would have it. This should be in everyone’s car and home medical kits.
THIS SHOULD BE IN EVERYONES’ CARS AND HOME MED KITS ….Off subject, I’d encourage everyone to get the books Ditch Medicine (by Hugh Coffee) and Emergency War Surgery ([Martin Fackler, et al], Desert Press ) And to just think about what they’d need to handle the kind of mundane and exceptional injuries that are likely in normal and extranormal circumstances. – MP
JWR,
Bill H. in Birmingham, Alabama wrote that using Ferric Chloride felt like a cautery iron, or worse. That was an ingredient of the older-style clotting agents.
The latest and greatest is Celox. This stops just as fast and doesn’t burn. There is a Group Buy [for Celox] in progress at WarRifles.com by Broadsword. He and his wife are great folks for the cause of survivalism. BTW, SurvivalBlog is well-followed by many of the readers at WarRifles.com. Keep up the good work, – Gilmore in Arizona
Mr. Rawles:
I’ll let doctors speak to treatment but as someone who worked in a famous lab researching blood coagulation let me make a few general statements about clotting. There are two clotting pathways, extrinsic and intrinsic. As an organism the body cannot allow uncontrolled bleeding either internally or externally. However the clotting cascade is fairly long and includes some check points because to have blood clot when it shouldn’t is also dangerous to the organism.
There is a substance in skin that starts the coagulation process when the skin is broken (this starts the extrinsic pathway). One thing a lot of people don’t know is that the clotting cascade involves a number of steps and the timing of these steps can determine the speed of clotting. We spent a lot of time researching the structure and action of
Factor VIII and Factor IX. Factor VIII is the classic hemophiliac factor, if you have a very low level of it you will have a lot of problems in any situation where you need for clotting to occur. But the distribution of Factor VIII is across the whole spectrum, some people have 100% of normal but many people do not. I measured my own level in an assay and found I have about 20% of normal. This means my blood will clot but slower than someone who has a higher level and that is what I have in fact observed when I get cut. So people should realize that there are wide variations in efficiency of clotting from individual to individual and they should expect that. – Karen L.
Jim:
No doubt, bleeding is scary, but bleeding in the vast majority of survivable wounds can be stopped with simple pressure or a pressure bandage. There are coagulants on the market (Quik-clot and Hemcon) but unless you are either a surgeon or can get to one (or a vet), if you can’t stop the bleeding with pressure alone (the scalp is an exception), you’re patient is probably not going to make it. Hemcon (unless a femoral or brachial artery for which Quik-clot is indicated) is preferred as Quik-clot burns like heck. The worst burning with Quik-clot is at the skin layer so try to keep it off the skin. Quik-clot should not be for surface/oozing bleeding. A great use for Hemcon bandages is for hard to control scalp bleeding externally. If you’re going to use one of these powder coagulants, get the versions that are in bandages (for Hemcon) or little sacks (for Quik-clot). The earlier versions where you just pour the powder into a wound can (if a femoral bleeder) get squirted out of the wound by the force of the arterial bleed before they can work.
In general, for bleeding you can:
1) Apply direct pressure
2) Apply a pressure bandage
3) Use pressure upstream on arterial pressure points
4) Cauterize (portable cautery devices are available, the Aaron Bovie change-a-tip is what I have)
5) Use the clotting agents as per above
6) You can use a tourniquet on the extremities (Write down the time it was applied and make sure anyone who takes over care knows about it).
7) Apply a hemostat or ligate the artery
If you’re more sophisticated and have the money, you can get Factor 7 (Novoseven), but it’s not without risk and has been associated with blood clots. The idea is that if you have a patient that is going to bleed to death, the clot is secondary.
Better to focus on not bleeding in the first place (body armor anyone?) and some advanced medical skills like surgical cricothyrotomy and airway management (anyone can learn to use a combitube) and decompressing a pneumothorax. Perhaps next would be learning to run an IV. If you give fluids IV, remember, if you water down the blood too much, it can make the bleeding worse by diluting the clotting factors and raising blood pressure. A little shock is a good thing. Getting more advanced, you need to manage the lethal triangle (hypothermia, coagulopathy and acidosis.) This will be done by (1) keeping the operating room at 100 degrees F (2) use of whole blood and (3) managing blood pH respectively. A contraindication to a hot emergency room would be in the case of cardiac arrest where you actually want to cool the patient to inhibit apoptosis.
If all you have is some sterile gauze, (heck you can use your clothing) just stuff the wound tight and apply pressure until you can get to more definitive medical care. If you have a wound packed tight, long term, you will decrease circulation in tissue that can be salvaged. (Causing it to die, increasing the need for debridement so if no help is coming, keep that in mind.) Quik-clot would be appropriate for a femoral or brachial artery but if you’re on your own, you’re looking at an amputation next, so I hope you have some muscle relaxants, painkillers, and sedatives. – SF in Hawaii
P.S. I’m not a doctor so if an emergency room doctor wants to criticize this response, have at it.
JWR Replies: I’m not doctor either, but I would recommend avoiding the use of a tourniquet unless everything else you have tried has failed and you still fear that your patient will die of blood loss before transport to a hospital. The simplistic guidance that the U.S. military has given on tourniquets for the past 25+ years is: “If you apply a tourniquet, chances are that the limb will be lost.” Yes, that is generalizing and overly simplistic, but overall it is still a good proviso.
I should also mention that in addition to the aforementioned Quik-Clot, Hemcon, and Celox, there is a competing product called TraumaDEX. From what I’ve read, it has proven efficacy, and does not cause a burning sensation. (It is a potato-based formulation.) It is sold by a number of Internet vendors including Ready Made Resources.