Written by: Alex Ireland, MD (NUEM PGY-3) Edited by: Andrew Moore, MD (NUEM Alum ‘18) Expert commentary by: Joseph Posluszny, MD
The above summary of the mechanism of actions, indications for and limitations of topical hemostatic agents is comprehensive and thorough.
As with most summaries of hemostatic agents, we focus on the mechanism of action or aspect of coagulation by which the agent works. Clinically, it may be easier to take a different approach.
Sometimes, the most difficult aspect of applying a topical hemostatic agent is determining the appropriate agent given the clinical scenario- all work in some fashion, but which will work best?
To help approach this, an initial question to help frame what to do in the trauma bay or ED would be: does this wound require just a hemostatic agent as a covering/dressing to promote hemostasis or are both assisted hemostasis and pressure needed to control the bleeding? For superficial, low volume, but persistently bleeding wounds, topical agents like Dermabond, thrombin (with gelfoam) and Surgicel are ideal. For deep, complex wounds that require hemostatic agents and pressure, QuikClot Gauze, Ativene and Combat Guaze are more effective.
Hospitals and EMS systems purchase a variety of topical hemostatic agents. It is imperative to become familiar with these agents and be prepared for their indications before you are presented with bleeding uncontrolled by conventional dressings or pressure.
Joseph Posluszny, MD
Assistant Professor of Surgery
Trauma and Critical Care, McGaw Medical Center of Northwestern University
How to Cite this Post
[Peer-Reviewed, Web Publication] Ireland A, Moore A (2018, December 10). Topical Hemostatics [NUEM Blog. Expert Commentary by Posluszny J]. Retrieved from http://www.nuemblog.com/blog/topical-hemostatics