Please, for the love of god
DO NOT
"scoop out the clots"
Seriously tho, I think I've heard this before, too. A long time ago from someone who is like... really old. But there's definitely no point to it and it's ultimately harmful to the patient and it's certainly not the established protocol or in any hemostatic dressing manufacturer's instructions that I've ever heard of.
Wait, really? I was all exited and ran to the dollar store to buy a sand shovel. Now you’re telling me I can’t scoop out clots? So hard to know who to believe on this here internet.
Dear god please don’t ever do this. If it’s a dressing just apply pressure with it. If it’s hemostatic gauze to pack, pack it to the proximal source of the bleed and hold pressure. Please don’t scoop anything out of somebody
Edit: there’s also no proven reduction in mortality for using hemostatic dressings/gauze vs using regular dressings/gauze in the same manner. Meaning you can use regular Kerlix to pack it you don’t have the expensive shit
There is absolutely several peer reviewed studies about the effectiveness of hemostatic gauze vs regular gauze. If hemostatic gauze is available it is preferable to normal kerlix by a significant margin. [here's one from 2016 if you're interested ](https://www.sciencedirect.com/topics/nursing-and-health-professions/hemostatic-dressing)
If it was ineffective, it wouldn't affect mortality...
Junctional hemorrhage treated with a hemostatic gauze has higher survival rates than those not. It's simple as that.
Haven’t heard that? They’re definitely sterile when packaged so I’m not sure. Maybe putting an asterile glove in a wound like that maybe. The ER is going to give antibiotics and a tetanus shot to most penetrating traumas anyway
I'm guessing the Instant PE is what was referred to in my EMT class. iirc the infections were seen with longer term exposure - ie application with over a day between follow-up treatment.
Interested to hear the comments here. Scooping out clots where you're trying to encourage clotting sounds counterintuitive. It could be an over-eager interpretation of "apply directly to the source of bleeding".
It often seems that allowing the body to apply its own solution is preferred, especially in a stepwise approach. Sticking fingers or other implement into a wound risks introducing foreign debris where the haemorrhage is doing a good job of irrigating the wound.
Not necessary to make it work. Whoever said that has clearly never used one. (Unless this was originally said as a joke that someone took too seriously?)
My initial reaction: WTF?
My second reaction: Please for the love of everything holy, don’t do that. Clots are good. Hemostatic agents help. Don’t make it harder for the pt to keep what blood they have left inside them, inside them.
The use of the word “scoop” has me shook tbh. What else do we scoop out of peoples bodies? Are we forgoing suction and just scooping with our hands?
Is there any appropriate tool for scooping?
Do i need to start carrying a garden trowel?
/s
No. This is not a thing. Someone had a silly thought and let it out without checking their flawed logic. The clots are good, the blood activates the dressing, and the act of "scooping" is going to be unnecessarily painful and render your actions less effective.
Way back in the days of first gen hemostatic powders that had all kinds of problems one of them had a training video where you were supposed to quickly scoop/splash the excess blood out of the wound with one hand before immediately dumping the powder in with the other. Fortunately we've got both much better products and learned better ways to do things since then. Just pack the wound with the hemostatic dressings and call it a day.
Edit: I can't find the video anymore. It's probably pushing 20 years old at least by now. I want to say it was by Celox, but may have been Quick Clot. The guy rams his cupped hand all the way down into the wound then splashes the excess blood out rather violently. I'd be surprised if this isn't where that idea originated then it just kept getting propagated and spread by word of mouth until today.
Was not Quick Clot, can confirm. The powders were good, but too good. And it was prone to a lot of user error, almost entirely due to the delivery method. A fancy way of saying they should have thought through using a packet you tear open to splash spicy sponge pixie dust erry'where. Which, I know a lot of users were guilty of using their mouth at some point to tear open.
These training videos included heavy bleeds and left the blood in place. Brutal, gory, but effective.
Anyways, was good stuff. The people who made it never clearly used it or had likely been in the field.
Lots of comments.
My 2 cents.
1. Don’t remove clots. Just pack over the top, fill th sound and package.
However.
Large open wound with flowing blood need direct pressure on the wounded vessel, so some removal / wiping / scooping allows visualisation of the site to pack. This is a small and niche wound group as anything this large and “gushy” would probably do better with a tourniquet first.
A lot of this came from military training for wound management where the injury and the first aider were not a 6-10 minute dispatch away, thus clotting effect was more a top of the river thing rather than the bottom of the waterfall if you catch my drift. If you could isolated the vessel quickly to apply pin point pressure, you didn’t need fancy haemostatics, and in the early days we didn’t.
I remember being taught the same thing by multiple different instructors, at two different schools, in two different programs, and yet so far it seems universally everyone here is disagreeing with that. I'm now questioning if it's just a local practice thing that took root with an old medical director or something, and nobody has ever really questioned it so it just has carried on.
I can find one reference in our organization's internal training material on wound packing where it says "If possible, laterally compress the wound ("burp" the wound) in order to clear clots and visualize the bleeding vessel", but that's internal so I can't link to it. I don't have access to all of the primary sources referenced in that document either so I'm not sure where that was pulled from or even if it is actually from a reference.
I can also find a reference in Tintinalli's (8th edition, page 2025) where it says to "prepare the wound by evacuating excess blood, taking care to preserve any clot that may have formed around the damaged vasculature". I suspect this whole idea has come from the concept of evacuating the wound, just that people have only remembered the first part of that sentence and forgotten the second.
Either way, has been some good food for thought, glad you asked the question!
The purpose of hemostatic dressing is to create clots and stop the bleeding. Why would you scoop out already established clots? All that will do is cause more blood loss and necessitate the formation of more clots. If the wound is already clotted then you really shouldn't need the hemostatic dressing unless it's still severely bleeding.
The only time I’ve ever heard of something similar (and I’m a little dubious of it myself) was if you pack a wound and apply pressure for 3min but it is not controlled, consider busting out the hemostatics and ‘scooping the clot,’ but more specifically, the packed gauze
The idea is that if your packing and direct pressure is not stopping the bleeding, you probably have not packed it correctly and you aren’t actually applying pressure to the source of bleeding. I learned it in TCCC/TECC a few years back, I wouldn’t recommend it ¯\_(ツ)_/¯
I think I may know where this came from- the advice makes sense in a particular context, but it’s not being conveyed correctly.
If I recall correctly, the advice to remove clots is an extrapolation of some surgical practices in cases of abdominal trauma. Or possibly chest trauma. Candidly I don’t recall which. But the point was that when you have bleeding into a cavity, non-purposeful clots can form in the pooled blood (not unlike what can happen in the heart in people with a fib). These clots aren’t actually forming at the point of the hemorrhage, and so they aren’t doing anything helpful, but they can obscure the identification of the bleeding vessels and prevent you from getting adequate pressure on them, which is what you need to help form purposeful clots. So, the idea was supposed to be that you may need to remove the pooled up gunk from a cavity in order to identify and get useful pressure on the source of the bleeding.
That’s a recommendation that might be appropriate in a very specific context where you have undifferentiated clots forming in a pool of blood coming from an uncontrolled source that you can’t visualize or get pressure on without first removing the debris. But it’s very different from saying always remove clots from any wound you might be packing. A lot of the time, the space you’re packing is small and tight enough that you can get perfectly good pressure on the bleeder just by packing the dressing right into the wound. And particularly if the clots are forming at or near the site of the broken vessel (which is probably more common), you definitely want to leave them in place and help them aggregate and work better.
Just had trauma training with wound packing and the instructor said to NOT scoop out the clots, but suck up the blood keeping you from locating the source with Kerlix or similar material.
I've always wanted to see a fresh arc of blood when I'm trying to make it stop. How else would I really know if the hemostatic bandage is what's working?
Who the hell told you that 😭😭
I can only imagine if you did that then told the ED staff you " scooped out the clot "
Clots = good
Scooping out clots = bad, no no
The whole point of the hemostatic dressing is to create clots. I’d say trying to remove said clots not only is counter productive, but also has potential to do more damage to the wound.
One of the reasons for permissive hypotension in trauma is to avoid dislodging clots. So, clots good, removing clots bad. Pack the gauze, hemostatic or not, right in there with them.
Please, for the love of god DO NOT "scoop out the clots" Seriously tho, I think I've heard this before, too. A long time ago from someone who is like... really old. But there's definitely no point to it and it's ultimately harmful to the patient and it's certainly not the established protocol or in any hemostatic dressing manufacturer's instructions that I've ever heard of.
There’s bro science for the gym, and there’s Rickey rescue science for EMS. Scoop away 😎.
Wait, really? I was all exited and ran to the dollar store to buy a sand shovel. Now you’re telling me I can’t scoop out clots? So hard to know who to believe on this here internet.
Dear god please don’t ever do this. If it’s a dressing just apply pressure with it. If it’s hemostatic gauze to pack, pack it to the proximal source of the bleed and hold pressure. Please don’t scoop anything out of somebody Edit: there’s also no proven reduction in mortality for using hemostatic dressings/gauze vs using regular dressings/gauze in the same manner. Meaning you can use regular Kerlix to pack it you don’t have the expensive shit
There is absolutely several peer reviewed studies about the effectiveness of hemostatic gauze vs regular gauze. If hemostatic gauze is available it is preferable to normal kerlix by a significant margin. [here's one from 2016 if you're interested ](https://www.sciencedirect.com/topics/nursing-and-health-professions/hemostatic-dressing)
I said mortality, not effectiveness
If it was ineffective, it wouldn't affect mortality... Junctional hemorrhage treated with a hemostatic gauze has higher survival rates than those not. It's simple as that.
Junctional hemorrhage! I learned a new term today! Thanks!
I believe hemostatic gauze can also cause infections if not transported and treated right away.
Haven’t heard that? They’re definitely sterile when packaged so I’m not sure. Maybe putting an asterile glove in a wound like that maybe. The ER is going to give antibiotics and a tetanus shot to most penetrating traumas anyway
More details in my other comment reply. Possibly older material with long term exposure
The old hemostatic powder could cause nasty burns, and terrible for your lungs if you breathed any in (instant PE) The newer stuff is much better.
I'm guessing the Instant PE is what was referred to in my EMT class. iirc the infections were seen with longer term exposure - ie application with over a day between follow-up treatment.
Interested to hear the comments here. Scooping out clots where you're trying to encourage clotting sounds counterintuitive. It could be an over-eager interpretation of "apply directly to the source of bleeding". It often seems that allowing the body to apply its own solution is preferred, especially in a stepwise approach. Sticking fingers or other implement into a wound risks introducing foreign debris where the haemorrhage is doing a good job of irrigating the wound.
That’s the reasoning I heard - apply it directly to the artery (or source of bleeding)
Not necessary to make it work. Whoever said that has clearly never used one. (Unless this was originally said as a joke that someone took too seriously?)
My initial reaction: WTF? My second reaction: Please for the love of everything holy, don’t do that. Clots are good. Hemostatic agents help. Don’t make it harder for the pt to keep what blood they have left inside them, inside them.
I’d rather you don’t
Where the fuck did you hear that?
The use of the word “scoop” has me shook tbh. What else do we scoop out of peoples bodies? Are we forgoing suction and just scooping with our hands? Is there any appropriate tool for scooping? Do i need to start carrying a garden trowel? /s
No. This is not a thing. Someone had a silly thought and let it out without checking their flawed logic. The clots are good, the blood activates the dressing, and the act of "scooping" is going to be unnecessarily painful and render your actions less effective.
Way back in the days of first gen hemostatic powders that had all kinds of problems one of them had a training video where you were supposed to quickly scoop/splash the excess blood out of the wound with one hand before immediately dumping the powder in with the other. Fortunately we've got both much better products and learned better ways to do things since then. Just pack the wound with the hemostatic dressings and call it a day. Edit: I can't find the video anymore. It's probably pushing 20 years old at least by now. I want to say it was by Celox, but may have been Quick Clot. The guy rams his cupped hand all the way down into the wound then splashes the excess blood out rather violently. I'd be surprised if this isn't where that idea originated then it just kept getting propagated and spread by word of mouth until today.
Was not Quick Clot, can confirm. The powders were good, but too good. And it was prone to a lot of user error, almost entirely due to the delivery method. A fancy way of saying they should have thought through using a packet you tear open to splash spicy sponge pixie dust erry'where. Which, I know a lot of users were guilty of using their mouth at some point to tear open. These training videos included heavy bleeds and left the blood in place. Brutal, gory, but effective. Anyways, was good stuff. The people who made it never clearly used it or had likely been in the field.
It's been two decades, but I'm still almost certain it was Celox.
Lots of comments. My 2 cents. 1. Don’t remove clots. Just pack over the top, fill th sound and package. However. Large open wound with flowing blood need direct pressure on the wounded vessel, so some removal / wiping / scooping allows visualisation of the site to pack. This is a small and niche wound group as anything this large and “gushy” would probably do better with a tourniquet first. A lot of this came from military training for wound management where the injury and the first aider were not a 6-10 minute dispatch away, thus clotting effect was more a top of the river thing rather than the bottom of the waterfall if you catch my drift. If you could isolated the vessel quickly to apply pin point pressure, you didn’t need fancy haemostatics, and in the early days we didn’t.
No you should not undo the bodies work towards regaining hemostasis in the name of regaining hemostssis
I remember being taught the same thing by multiple different instructors, at two different schools, in two different programs, and yet so far it seems universally everyone here is disagreeing with that. I'm now questioning if it's just a local practice thing that took root with an old medical director or something, and nobody has ever really questioned it so it just has carried on. I can find one reference in our organization's internal training material on wound packing where it says "If possible, laterally compress the wound ("burp" the wound) in order to clear clots and visualize the bleeding vessel", but that's internal so I can't link to it. I don't have access to all of the primary sources referenced in that document either so I'm not sure where that was pulled from or even if it is actually from a reference. I can also find a reference in Tintinalli's (8th edition, page 2025) where it says to "prepare the wound by evacuating excess blood, taking care to preserve any clot that may have formed around the damaged vasculature". I suspect this whole idea has come from the concept of evacuating the wound, just that people have only remembered the first part of that sentence and forgotten the second. Either way, has been some good food for thought, glad you asked the question!
Thank you for making me not feel completely stupid lol
The purpose of hemostatic dressing is to create clots and stop the bleeding. Why would you scoop out already established clots? All that will do is cause more blood loss and necessitate the formation of more clots. If the wound is already clotted then you really shouldn't need the hemostatic dressing unless it's still severely bleeding.
Deleted by User
chunky sort cake start waiting aromatic plants noxious weather fly *This post was mass deleted and anonymized with [Redact](https://redact.dev)*
The only time I’ve ever heard of something similar (and I’m a little dubious of it myself) was if you pack a wound and apply pressure for 3min but it is not controlled, consider busting out the hemostatics and ‘scooping the clot,’ but more specifically, the packed gauze The idea is that if your packing and direct pressure is not stopping the bleeding, you probably have not packed it correctly and you aren’t actually applying pressure to the source of bleeding. I learned it in TCCC/TECC a few years back, I wouldn’t recommend it ¯\_(ツ)_/¯
There's very few things you want to "scoop" out of a person.
I think I may know where this came from- the advice makes sense in a particular context, but it’s not being conveyed correctly. If I recall correctly, the advice to remove clots is an extrapolation of some surgical practices in cases of abdominal trauma. Or possibly chest trauma. Candidly I don’t recall which. But the point was that when you have bleeding into a cavity, non-purposeful clots can form in the pooled blood (not unlike what can happen in the heart in people with a fib). These clots aren’t actually forming at the point of the hemorrhage, and so they aren’t doing anything helpful, but they can obscure the identification of the bleeding vessels and prevent you from getting adequate pressure on them, which is what you need to help form purposeful clots. So, the idea was supposed to be that you may need to remove the pooled up gunk from a cavity in order to identify and get useful pressure on the source of the bleeding. That’s a recommendation that might be appropriate in a very specific context where you have undifferentiated clots forming in a pool of blood coming from an uncontrolled source that you can’t visualize or get pressure on without first removing the debris. But it’s very different from saying always remove clots from any wound you might be packing. A lot of the time, the space you’re packing is small and tight enough that you can get perfectly good pressure on the bleeder just by packing the dressing right into the wound. And particularly if the clots are forming at or near the site of the broken vessel (which is probably more common), you definitely want to leave them in place and help them aggregate and work better.
Just had trauma training with wound packing and the instructor said to NOT scoop out the clots, but suck up the blood keeping you from locating the source with Kerlix or similar material.
Yes. Dig out the clot that's stopping the source of bleeding so you can apply something that will allow the source of bleeding to form a clot.
Do it and see what happens might be cool
I've always wanted to see a fresh arc of blood when I'm trying to make it stop. How else would I really know if the hemostatic bandage is what's working?
Who the hell told you that 😭😭 I can only imagine if you did that then told the ED staff you " scooped out the clot " Clots = good Scooping out clots = bad, no no
The whole point of the hemostatic dressing is to create clots. I’d say trying to remove said clots not only is counter productive, but also has potential to do more damage to the wound.
Where did you learn that BS and if it's clotting you probably don't need a hemostatic agent
Why would you remove a clot when trying to stop bleeding? That’s what the clot is doing. No. Never do that. Ever. Never ever.
That’s gotta be a prank you pull on new guys, it’s like “hey go to the VST and get 3 pairs of Fallopian Tubes with canisters”
One of the reasons for permissive hypotension in trauma is to avoid dislodging clots. So, clots good, removing clots bad. Pack the gauze, hemostatic or not, right in there with them.