The debate has raged for years as to which is better for a “blowout” kit on a range (one designed to treat gunshot wounds): Celox or tampons. Each camp has their opinions and evidence to back them up. But as with most things in life, there’s a tradeoff when choosing one over the other. Neither is ideal. But a new product being introduced seems to bridge the gap between the two approaches, providing immediate wound-packing to prevent further blood loss as well as giving the blood something to use as a structure around which to form the clots necessary to stop internal bleeding. It’s called the Xstat . . .
For those wondering, the argument for the tampon is that it’s a commonly-available cylindrical object that works well when inserted into a gunshot wound and provides some packing material to try and stop the bleeding. While Celox doesn’t pack a would, it’s designed using tiny granules that give the blood a structure to use to start the clotting process, sealing things up pretty quickly. But with the Xstat, you get both the wonders of modern medicine and sanguination-sopping technology in one easy-to-use applicator.
From The Verge:
Xstat uses small, expandable sponges. The sponges — which are standard medical sponges that have been compressed and coated with a hemostatic agent called chitosan — take just 15 seconds to expand once they’re in the wound. They help with clotting and slowing blood flow, while providing enough pressure that no manual pressure is needed. Each sponge is also marked so that it can be seen by an X-ray and removed from the body, though RevMedx is also hoping to create a biodegradable version as well.
As I like to repeat often: immediate treatment is the best indicator of survivability. The sooner you start plugging holes, the better your chances of living are. And where before people needed to fumble with all manner of medical contraptions and tinctures to try and stop severe bleeding from a gunshot wound, now there’s a quick and simple method of getting the packing material where it needs to be quickly while still being able to find and remove it later. That said, it does look like actually using this instrument properly would be rather uncomfortable for both the patient and the medic. We’ll be keeping an eye on how the thing works as it continues testing.
Nick, are there any conditions or types of wounds in which you wouldn’t use Celox?
The one I’m waiting for is FDA approval of VetriGel for humans (counts as a “device” so they’re in trials last I heard).
http://geekologie.com/2013/03/college-students-invent-gel-that-instant.php
Based on a military training video showing how to use gauze lased with quick clot on a pig I would say this would be way more effective.
“Lased”? It uses a laser?
combat gauze, it works really well. smaller package than this appears to be.
‘laced’ with quick clot, I think. Or were you riffing?
Um… both!
I’ve not had any medical trainimg beyond first responder/lifeguard classes but it seems like quick clot or celox applied externally would allow bleeding to still happen internally in the wound where most of the damage had occurred. This seems like a great mix of both the quick clot and the tampon method…
I’m sure the e.r. docs won’t like picking out the pieces, and I’m sure jamming that bad boy into a bullet wound won’t be pleasant for anyone….but hey as long as your not dead…….
celox it to light and blows away. Quick clot is fairly tough to use and makes cleaning the wound tough in the OR. Quick clot is also old news not used my the military any more and burns the patient pretty bad. Combat gauze, is the best thing i have used so far, better than hemcon, celox, quick clot ect. Next best thing to combat gauze is straight up kerlex. tampons are a bad idea as you will most likely need like 3 or 4 a wound. wound cavities are big, deep, and muscle and other tissue are strectchy so you need to get a lot of packing in there. Just use a tourniquet and be done with it.
Combat Gauze is made by Quick Clot. The burning problem was with the old quick clot; as long as you’re not using expired stuff, none of the quick clot you have should be a problem.
The quick clot I used maybe 2 yrs ago was not expired but still burned. The other issue I have with quick clot it you have to get the blood out of a wound cavity first for it to work best. You also have to open the wound to pour it in. So it become a four step process. Open wound, scoop blood, pour in, apply pressure. Combat gauze, or even kerlex you just pack it in. The entire time keeping pressure.
For immediate release:
The Xstat wound packing system is now being used to affect the movement of MDMA capsules north of the border by Mex. narco groups and 5.56 rounds south of the border by freedom fighter support groups by inter-cavity methods.
WTF?
I think he’s imagining using the applicator as an enema to insert contraband for smuggling, or something. I don’t think it would make the process any more comfortable, though.
I thought at first he meant they were shooting the “mules” and packing drugs in the wound, and then sealing it with Xtat. Tough mothers!
Is that random collection of words supposed to mean something?
Joke mane! If there were no article words, what does it look like?
When will it be available to the public at a reasonable cost?
I watched the news on these the other night. It seems really neat. They grew while exposed to the air during the news report.
They started out the size of those little marshmallows you get for hot cocoa.
I’m trying to score a few samples since they’re made just a few miles away.
Don’t have Xstat? Use the little marshmallows!
And they are biodegradable!
I know the CEO. I will ask him on Tuesday if I can get you some samples.
” it does look like actually using this instrument properly would be rather uncomfortable for both the patient and the medic”
Yeah, kind of makes me want to pass out just thinking about it. (There’s a reason I chose to get a Ph.D. instead of an M.D.)
🙂
And you continue to steal content off tfb.
Actually no. I ran across this in an article at popsci.com three days ago via a Google alert and sent the link to Nick. Being and EMT and all, I figured he’s more qualified than I am to write these things up.
The net’s an awfully big place. Any other baseless accusations you’d like to make?
Any other baseless accusations you’d like to make?
I do!
Samuel LeLoon Suggs is a horse’s hindquarters.
Oh, wait, you said baseless. That statement is proven. Sorry ’bout that.
Hey I’m a petulant duckweed not a horses hind quarters.
Yeah. You guys got dat www. an dat .com thingie evebody iz uzin. Copycats!
Forgive my misinterpretation of the data presented too me.
The website says ‘Limited by Federal law to investigational use.’ That took an act of Congress, right? How did an “investigational” item or device get a federal law? And they’re sponges? So Congress passed a law that says sponges can’t be available to the general public. Sounds about right.
We can’t seal our border(s), but we can pass a law saying ‘No sponges for you! Come back, one year!”
From looking at the website, it’s likely because it is still considered “experimental” as in “investigating” if it is effective rather than for use in “investigations”.
I’d consider this case of being that there are some FDA approvals for these devices which this has not yet gone through. In the case of really innovative solutions, the hassle becomes “what is this thing?” sort of a problem – is it a bandage or a surgical tool or dispenser or something else. I’d bet that all those things have differing standards or criteria that need to be met.
A lot of government agencies have standards that apply to things that are sold as opposed to being developed or researched – my experience in this area is mostly with the FCC but I imagine it maps to other areas as well…
Until such time they deem to approve, it’s little marshmallows for us groundlings!
Yep, after I posted that, I got to thinking the FDA does have stringent regulations on ‘medical devices’ and makes them be tested, proven safe & efficacious, produced & packaged under sterile conditions, etc. and as you say, probably all kinds of other tests before allowing them to be sold to the general public. So it probably didn’t have its own law passed by Congress – it likely falls under blanket FDA administrative regs, with the backing of Federal law.
”It does look like actually using this instrument properly would be rather uncomfortable for both the patient and the medic”
Less uncomfortable than packing with gauze, and repacking if the first pack doesn’t work. I still think that in a SHTF/economic concern situation, tampons with plastic applicators are going to be your best go to.
http://www.rescue-essentials.com/celox-a/
This has been available for a few years, maybe you could do a comparison test?
What calibers does that applicator come in….sheesh!?
20mm, duh. 🙂
For non EMT types, is there any benefit in using this product over a tourniquet on an extremity wound? If we’re talking only about junctional wounds, then it makes more sense. If it’s a torso/abdominal wound, then I would imagine it difficult to keep the product from just dispersing into the chest cavity.
Not that I think it looks bad, just trying to figure out where this falls in the tool set.
tourniquets will be much faster and more effective. pinching off the artery further up stops bleeding immediately. hemostatic agents take several minutes to work and require direct pressure that entire time.
That jives with my training too, which is not quite as extensive as yours.
This looks really neat, but I just can’t see a real situation where it would work better than stuff that’s already out there. Throw a tourniquet on, and get to the hospital, or pack it with gauze and get to the hospital.
And if it happens in an actual fight instead of a range accident, win the fight first.
unfortunately (or fortunately, depending on how you look at it!) my training isn’t backed up by any substantial real-world experience. other than what i’ve gotten at the fire department running on the medic, that is. i’ve tossed around the idea of joining the navy reserves to become a corpsman for some real world experience but i’m 30 and my wife wouldn’t approve. lol 🙂
for some background… i’m a paramedic and have had training in Tactical Combat Casualty Care (aka TCCC, the gold-star standard for battle-related trauma treatment right now).
my first impression – HOLY #@*& that’s big! you’re gonna do far more damage trying to fit that into any standard firearm caliber wound than is good for your patient.
the goal of hemostatic agents (BTW tampons are NOT hemostatic agents and no more useful than standard gauze) is to get the agent as close to the source of the bleeding (whatever artery was compromised) as humanly possible. that means DEEP wound-packing. granular agents float so whatever blood is already in the wound keeps the agent that much farther from the damaged blood vessel (as an aside, i believe celox makes a granular agent that is dispensed from a large – although much thinner – syringe, which is better but still not great). that’s why TCCC recommends hemostatic-impregnated dressings (quick-clot and celox are the two most common). hemostatic dressings are designed to be jammed as far into the wound as possible, filling all the nooks and crannies of the wound – which is why some come with radio-opaque strips so they can be seen on the x-rays.
even AFTER hemostatic agents are applied, VERY firm, direct pressure has to be applied for at LEAST 3 minutes to slow/stop the bleeding enough so the hemostatic agent has time to work and create a clot. in fact, some studies have shown that hemostatic dressings in the absence of proper wound care technique (i.e. packing and PRESSURE!!!) are virtually useless. those same studies show that regular old gauze is nearly as effective – if not just as effective – in the presence of proper application of direct pressure.
as far as application location, hemostatic dressings were designed for junctional wounds that tourniquets can’t treat, i.e. the inguinal areas (where your legs meet your torso) and shoulder areas. use of hemostatic dressings is somewhat controversial in the abdomen/chest but it is done.
i can see this being useful for GSWs if they shrink the syringe size. otherwise it will only be good for much larger crater-type wounds resulting from shrapnel or similar. either way, direct pressure is still KING.
Chris, what about packing the wound with the Quik Clot gauze, then applying an Israeli pressure bandage over it? Seems like a good idea based on my limited training, but I’d like your opinion, since you have much more extensive training.
Troutbum, Combat gauze and an Israeli is a great way to stop a bleed and dress a wound. That is what is taught at TCCC, OEM, TFR. That said I agree with chris, that regular roll gauze is very effective when used properly. And no matter what you use to stop a bleed and pack a wound you will need to dress it with a Israeli, H-bandage, or even an ACE wrap.
Celox has something similar to this, Celox-A, except it “injects” purely hemostatic agent granules.
I have used celox, it blows away in the wind, you have to assemble the injector, and it comes in small amounts. I don’t like it. I keep throwing the words “combat gauze” out there because it works and it works very well.
I know we’re talking about an actively bleeding, gaping hole where there shouldn’t be one, but doesn’t Celox have the potential to cause nerve damage? How does this compare?
And yes, I know it’s relative considering a vital bodily fluid escaping at an alarming rate….
i believe that was older generation stuff and was related to the heat produced by them. newer generation agents do not have those issues.
Correct – the first gen stuff burned. It was uncomfortable to the casualty, but was better than bleeding out.
Worse than a gunshot?
If all else fails, pack the wound with tea bags. This is something I learned back in the 70’s when I was a dental asst in the Air Force. The tannic acid in the tea causes blood to clot pretty darned quick. We’d always ask the patients if they had any tea bags at home and told them if the bleeding doesn’t stop using gauze (this is following an extraction of one or more teeth) to shove a couple of tea bags where the teeth used to be and bite down. Usually takes only a couple of minutes to coagulate the blood.
It can also be used as an effective treatment for diarrhea.
-D
Because a ton of sh*t backing up inside the body is so much better!
Nah, they’re going to come out with another technology to deal with that next year.
I’ve come to expect better of TTAG. You know, full product test reviews with honest evaluations of the product. Not press releases. Come on! Get out there and test it!
/sarc
All we need is a volunteer. Hmmmm.
Just looked at the website. They have 2 other sizes. Looks like about .30 and .45. The big one might be intended for the exit wound, which is gonna be bigger and need more packing material.
My two cents. I am a military medic, have been for 5.5 years, leave it at that.
Celox-light blows away in wind, you end up packing the wound with gauze after you dump celox in. Still 2 packages for 1 wound in your bag. you have two open those two very well seal packages with slippery blood on your hand and stress, wastes time and space.
Hemcon- has to be placed directly on source of bleed, maybe usefull in OR but the field, dislike, and you need to pack wound with gauze anyway, 2 packages 1 wound.
Quickclot- another one where you need to mop blood out and pack wound with gauze anyway. you can also spill the granules then you are SOL, this kind of stuff happens under stress.
Combat gauze/celox gauze- gauze impregnated with hemostatic agents. This stuff works. Just start packing. You can pack, then ball up the left over so your final dressing puts plenty of pressure on the wound.
Tampons- Stupid, wouldn’t pack one, but i would use one. IE wreck car and a menstrual women says “how can i help?” I guess people assume well gun shots are round and so are tampons! well they aren’t gunshot wounds are big nasty cavities with pulped up muscle tissue around them so even if you plug the tiny entrance wound there is a lot of bleeding out to be done inside.
Kerlex- this is just roll gauze, highly underrated. It works really well, pack the wound deep and hard, the bleed will stop. If it doesn’t you’re doing it wrong.
Xstat- I have not used it so this is just my thoughts and questions. Does the applicator come fully assembled? (celox does not) In the picture the plunger is depressed but contents still inside? so do you pull to activate or is this bad boy longer than they are showing it? Probably have to pull the plunger to extend then depress to despense, which would be a neat way of keeping it assembled and keeping size down.
Also look how fat it is, some wounds are skinny than what? just put it on top press and pray? Where as gauze i can use my fist, my finger, or even a stick to pack the gauze in. OK lets say they make it in different sizes, still more shit you have to carry. I shoot xstat in, need more pressure before i trow my ace wrap/h-bandage on there, well i probably can’t leave a pile of these pellets on top and wrap around that, so i will need to open up a roll of gauze than put my final dressing on. More packages, more crap for one wound.
Final thoughts, if you don’t want to get your hand deep inside someones wound to pack it, and this is why you resort to tampons and fancy applicators, let someone else pack the wound.
Quick question. Do you stuff the guts or make a taco?
I don’t stuff, hook fingers in the wound pull apart and up. Then shake a bit, the viscera typically get sucked/pulled/fall back in. Temp suture to close, staple, safety pin what ever you have. Understand this is in a combat setting to ready a PT for transport. Don’t be putting guts back in at a range or in a car wreck.
We call the hook method stuffing, so with you on that. Curious why you don’t feel putting it back into the gut for the range or car wreck. No matter what, the surgeon is going to cut the guy up and have the doc go thru all the intestines looking damage.
Because I am only allowed to work on military members since i am not an EMT or Paramedic. I will stop bleeds and fix airways since that will kill the PT pretty quickly. But an evisceration can wait until the EMTs get there. So for fear of being sued in this crazy world we live in.
Do you know what elephants use for tampons?