Texas-made trauma clamp being discussed at CoTCCC

[The Annoyed Man]

That’s pretty slick, although you’d still want to combine that with a tourniquet for control of major arterial bleeds, like femoral or brachial arteries. I wonder how much they cost, and where one can get them. I’d be OK with adding 3 or 4 of those to our big med bag.

[puma guy]

Those are pretty slick. I email the link to my S-I-L who's a Paramedic/FF in Comal County ESD.

[Charles L. Cotton]

I'm very interested. Here's a link to some short videos. I have to admit that I'd like to shoot the guy that did that to the dog.

Chas.

https://www.innovativetraumacare.com/itclamp

[crazy2medic]

Interesting, but typically arteries are fairly deep! Only a few places are they near the surface! What I was taught that a tourniquet is last ditch effort to keep the patient from bleeding to death! When placing a tourniquet you are sacrificing the limb below the tourniquet!

[teraph]

That is a pretty cool idea, and if it functions well, it’d be even better.
As for a tourniquet being considered a last ditch effort, that is no longer the case. Matter of fact, it is currently being taught to be the very first things one does to control severe extremity bleeding.
We no longer have the golden hour. We now have 6 hours or so to get the victim to (in my case) a field hospital, in order to preserve both life AND limb. With minimal damage caused by the tourniquet.

Warning! Graphic images in the following link!
https://www.naemt.org/docs/default-sour ... 813fc892_2

[suthdj]

Not a bad price
https://combatmedical.com/shop/prod_mar ... m_itclamp/

[Daddio-on-patio]

The EMS agency I work for have been using the IT Clamp for almost 3 years now. They work well for scalp lacerations that are difficult to dress with bandaging and for avulsions. The patients have tolerated them well. The idea is not to clamp and artery or vein. It holds he skin in place allowing a hematoma to develop. This creates pressure controlling blood loss. I have used it several times on scalp wounds. Once on a large avulsion of inner bicep. ER staff thought they were greatness.

[Mike S]

The EMS agency I work for have been using the IT Clamp for almost 3 years now. They work well for scalp lacerations that are difficult to dress with bandaging and for avulsions. The patients have tolerated them well. The idea is not to clamp and artery or vein. It holds he skin in place allowing a hematoma to develop. This creates pressure controlling blood loss. I have used it several times on scalp wounds. Once on a large avulsion of inner bicep. ER staff thought they were greatness.

Daddio,
The use you described makes sense to me. I can see how it can work with lacerations, or puncture wounds to the abdomen (to just close the wound, since abdominal bleeds aren't amenable to fixing in the field anyway).

However, I'm having a hard time wrapping my mind around just closing a wound with an arterial/venous bleed sans a tourniquet, wound packing, etc to stop the actual bleeding. I know the video on their website shows what appears to be a cut femoral in the junctional area, but it blows my mind that just closing the wound would result in clotting quick enough to prevent hemorrhagic shock.

And what about compartment syndrome developing from bleeding inside a limb for extremity wounds? (Or, is some degree of compartment syndrome what causes the pressure to tamp the bleeding artery, allowing this device to work?).

I'm looking forward to seeing what the CoTCCC has to say.

[The Annoyed Man]

Interesting, but typically arteries are fairly deep! Only a few places are they near the surface! What I was taught that a tourniquet is last ditch effort to keep the patient from bleeding to death! When placing a tourniquet you are sacrificing the limb below the tourniquet!

Apparently, you can maintain a tourniquet in position for several hours before risking the limb. I was just now reviewing the notes I wrote down back then (April of 2016) during Caleb Causey’s 2-day Medic 1 class, and he told us that you can leave a windlass type tourniquet (i.e. CAT or SOFTT-Wide) on for up to 6-8 hours before tissue starts dying. The principle thing is that, once applied, it should be left in place until medical personnel with better equipment remove it. The beauty of the windlass-type tourniquet is that you can tighten it only as tight as needed, without overtightening it. You crank on the windlass until the arterial bleeding stops, and no further than that. My guess as to why tissue doesn’t die sooner is that this method allows for some collateral circulation to still provide some blood to the distal tissues, without routing it through the damaged major artery....but that’s just my guess.

Anyway, 6-8 hours is how long you can leave a tourniquet on before tissue death occurs. And beyond that, I’d rather lose a limb to amputation than to bleed out into the dirt. So, I could be wrong, but if that’s the yardstick, my guess is that most people would take amputation over death too.

I’ve also been told that having a tourniquet applied to a limb for REAL hurts like the very devil. But pain ain’t nothin’ but a thang, and it’s transient. I’ll take the pain for as long as I have to, if I know that there’s a morphine light at the end of the pain tunnel. In class, we did put tourniquets on one another and tighten them down, but not to the point of loss of pulse in that extremity. It was more about the mechanics of application than actually achieving hemostasis, but even so, it was pretty uncomfortable.

Crazy2medic, does that information more or less match your own training?

Abuse to the dog aside, when I was watching that particular video, I thought that this new clamp would probably not work to stop a femoral bleed. It would be extremely valuable for penetrating trauma to tissues - chest, abdomen, arms, legs, etc. - but if someone has a clipped femoral or brachial artery, they’re gonna bleed out without a tourniquet.

[Daddio-on-patio]

The EMS agency I work for have been using the IT Clamp for almost 3 years now. They work well for scalp lacerations that are difficult to dress with bandaging and for avulsions. The patients have tolerated them well. The idea is not to clamp and artery or vein. It holds he skin in place allowing a hematoma to develop. This creates pressure controlling blood loss. I have used it several times on scalp wounds. Once on a large avulsion of inner bicep. ER staff thought they were greatness.

Daddio,
The use you described makes sense to me. I can see how it can work with lacerations, or puncture wounds to the abdomen (to just close the wound, since abdominal bleeds aren't amenable to fixing in the field anyway).

However, I'm having a hard time wrapping my mind around just closing a wound with an arterial/venous bleed sans a tourniquet, wound packing, etc to stop the actual bleeding. I know the video on their website shows what appears to be a cut femoral in the junctional area, but it blows my mind that just closing the wound would result in clotting quick enough to prevent hemorrhagic shock.

And what about compartment syndrome developing from bleeding inside a limb for extremity wounds? (Or, is some degree of compartment syndrome what causes the pressure to tamp the bleeding artery, allowing this device to work?).

I'm looking forward to seeing what the CoTCCC has to say.

Compartment syndrome, generally, is caused by pressure from fluid build up inside the fascia of muscles or that of bones causing insufficient blood flow. Over time this can cause serious complications. It is not necessarily an acute condition needing immediate attention but it will be necessary to correct. A hematoma developed by the clamp, in theory, provides the pressure to control bleeding. This does not create compartment syndrome, per se. The IT Clamp is not perfectly suited to all hemorrhagic circumstances. Another tool in the box, so to say. I have used them probably 4 times in the last couple of years. Used tourniquets just as often or more. My agency administers tranexamic acid IV push for non-compressible bleeds. It assist the clotting agents your body produces. These along with packing, bandaging and immobilization are standards of care in many EMS and emergency departments.

Well thought out question. There is always layers of things to consider when treating patients. That is why medicine is considered a practice, LOL. And why so many procedures we do are evidence based.

[The Annoyed Man]

Compartment Syndrome is nothing to fool around with. I know two people it happened to, and both ended up losing significant amounts of tissue from their affected leg. One was a friend of mine who had been in a terrible on-track motorcycle accident at Willow Springs Raceway, and her lower leg had been crushed between the front of the engine block and the forks as they were being bent backwards by impact with the ground as she and the bike were tumbling. I can’t remember the nature of the other person’s accident, but it was a guy who was a patient in the hospital I worked at for a time, and his was a lower leg injury too. When I was a motorcycle accident myself a few years later, in which my lower right leg was crushed between the side of my engine block and the bumper of the car that hit me, compartment syndrome was my biggest fear. Fortunately, it didn’t happen, but that was some of the worst pain I’ve ever felt. Crushing injuries are no joke - compartment syndrome or not.

[Daddio-on-patio]

Compartment Syndrome is nothing to fool around with. I know two people it happened to, and both ended up losing significant amounts of tissue from their affected leg. One was a friend of mine who had been in a terrible on-track motorcycle accident at Willow Springs Raceway, and her lower leg had been crushed between the front of the engine block and the forks as they were being bent backwards by impact with the ground as she and the bike were tumbling. I can’t remember the nature of the other person’s accident, but it was a guy who was a patient in the hospital I worked at for a time, and his was a lower leg injury too. When I was a motorcycle accident myself a few years later, in which my lower right leg was crushed between the side of my engine block and the bumper of the car that hit me, compartment syndrome was my biggest fear. Fortunately, it didn’t happen, but that was some of the worst pain I’ve ever felt. Crushing injuries are no joke - compartment syndrome or not.

Absolutely agree it is a dangerous condition. I was answering the question about compartment syndrome with regard to controlling blood loss utilizing the IT Clamp and consideration of possible unintended affects of its use. Folks be aware. Compartment syndrome may occur after an injury that you "walked off". If later you develop increased pain, get yourself in to an ER to be evaluated.

On a side note. I really enjoy this community. I don't think there are many other forums, not related to medicine, where so many people have considered that they may have an opportunity to save a life. Let alone prepare and train to do so.