A gel that can stop severe bleeding instantly | Hacker News Reader

A gel that can stop severe bleeding instantly

humansinvent.com

225 pointsleojkent57 comments

There are many blood stopping agents out on the market. Many of them were originally developed by/for the military in the Iraq/Afghanistan wars, and are now available to civilians.

Here's a list of some of these products:

Bleed-X, TraumaDEX - http://www.bleed-x.com/ http://www.bydezignproducts.com/bleedx.html

BloodSTOP - http://www.lifescienceplus.com/

Celox - http://www.celoxmedical.com/

HemCon - http://www.hemcon.com/

RDH (Rapid Deployment Hemostat) - http://www.surgery.uthscsa.edu/faculty/pubs/cohn-hemostat.pd...

QuickClot - http://www.quikclot.com/home.aspx

WoundSeal, BioSeal, QR Powder - http://www.biolife.com/ourproducts.html

Also an oldie but goodie, a basic styptic pencil: http://www.amazon.com/Clubman-Styptic-Pencil-0-33-oz/dp/B001...

As a man who enjoys a good shave, I can tell you that clotting agents sting like a bitch

I haven't cut myself shaving in years. I hope you're not using disposables!

Straight razors my friend... such a good shave.

Just every so often you slip a little.

I am a former critical care medic, and lack the scientific training to judge the merits of their claims about mechanism of action, but if history is any guide regarding ‘miracle’ products it will not live up to the manufacturers claims.

The use cases I can think of and commentary:

-Hemostasis after non-emergent ear/nose/throat procedures. -Packing of the wound + local epinephrine administration is currently used. It costs nothing, is well understood, and doesn’t have the potential for embolization or immune system interaction weirdness.

-Hemostasis of an extremity wound AFTER a tourniquet has been applied. -After a tourniquet is properly placed, the arterial flow is halted. Trauma teams have learned from military and orthopedic surgeons that tourniquets are much safer than traditionally understood. Even an amputated limb has a warm ischemia team of 6 hours. The addition of a clotting agent would stop venous oozing, but wouldn’t affect hemodynamics of the patient. It might assist in the case of an inappropriately applied tourniquet.

-Hemostasis of an abdominal wound. - I guess they envisage pouring this material into the abdomen? That seems like the place most fraught with danger of embolization distally to the mesentery and the generation of immune system interaction weirdness beyond my knowledge base.

A kaolin-based product (Quickclot) was similarly marketed as a wonder drug for treating massive hemorrhage on the battlefield, and it has been less than wonderful in practice. There are youtube videos attesting to its efficacy on the femoral arteries of swine, however these videos ignore the effect wind has upon the powder in a combat setting, and the exothermic reaction that takes place to create the plug. The only way to stop a large hemorrhage is to use copious amounts of the material, resulting in severe burns in some case reports. Concern over embolization of the clotted material led them to create a gauze-bag version.

The company’s claims that holding pressure over the wound is not required runs counter to basic trauma care recommendations. The single best way to halt life-threatening hemorrhage in an extremity is a tourniquet, and the only thing that halts thorax hemorrhage is a surgeon’s finger. The inclusion of this gel in the treatment algorithm would need to be as a last resort, and must never distract from the basics of direct pressure and rapid transport to a surgeon.

I don't know if this qualifies as an ad hominem on my part, but the article comes across as written by the journalist in close coordination with the companies PR firm. The 'hook' inherent in the choice of headline combined with the lack of any discussion of the limitations of the product or previous failures with regards to ‘miracle’ hemorrhage agents cements this in my opinion.

OP (edit: submitter) has zero comment history and appears to have only submitted his own articles [1]. Not damning, but a red flag.

[1] https://news.ycombinator.com/submitted?id=leojkent

We all had a story or something that motivated us to register and comment.

I've heard everything he's said before from other people in trauma medicine. (but there are also people who will stick up for the Quickclot type stuff!) It's not my field and I'm not in a position to judge. I will say that I share his view that the article reads like something written by a PR flack.

I believe he was referring to the submitter.

Thank you. My mistake.

So what? There's no rule that says you have to comment. There's no rule that I know of against submitting your own stuff.

If you're writing quality articles (which this is) and submitting OC, then that's a good thing.

Well it seems that this gel might have very little application on it's own and would be best used in conjunction with traditional tried and tested methods.

The major flaw with this gel is the risk of Hematoma. Basically lets say you have a vessel that has been ruptured by trauma and you use this gel to pack up the external wound.

But the vessel is still leaky !! This will lead to collection of blood inside the body and can be harmful in the long run.

It seems this gel is most suited for (their first clients) the military. And would be effective on the field along with using tourniquet.

Also there is already a variety of Surgical Glue that is in use. But it's used along with traditional sutures as the glue is not strong enough and will rupture. So on the fragile inner layers we use the glue and then towards the skin which is much more stronger the usual catgut sutures are used.

Since you clearly know a lot on this subject, what are your thoughts on this related Darpa funded project: http://www.healthline.com/health-news/darpa-wound-stasis-foa...

I'd like to again qualify my status as a non-expert with regards to the surgical aspects of trauma treatment and biochemistry. I have seen similar articles about the foam, and I must admit I am similarly skeptical. The ‘Golden Hour’ is one of those concepts in medicine that everyone praises (it originated @ Marylan’s Shock Trauma center if I recall), but it actually does not have an evidentiary basis.

There are 3 categories of trauma patient, people who will die no matter what you do (hole in the aorta), people who will live no matter what you do (fractured extremities), and people where the outcome may be influenced by treatment in the field. My non-evidence based opinion is that the people in this 3rd population who have the types of injuries that would benefit from this foam will be rather limited. The aorta, inferior vena cava, kidneys and parts of the duodenum, pancreas and rectum are all retroperitoneal. Thus, filling the peritoneal cavity with foam could put pressure on bleeding structures located in the retroperitoneal space, but I would be skeptical. So this foam is for people who have don’t have large hemorrhage of anything in retroperitoneal space and don’t have a fatal mesenteric, liver, or spleen injury, but do have an injury to one of these structures that is sufficiently bad to warrant the foam. The risk of exposing patients with liver and spleen lacerations that could have been managed non-operatively (again, not a surgeon by any stretch but I believe this is a growing trend) to an unnecessary laparotomy isn’t mentioned.

The target audience for this item is going to be armed forces medics with (in my opinion) highly variable clinical skills. Expecting these medics to accurately diagnosis these injuries under heavy stress and not sacrifice time that should be spent on proven therapies like blood administration, tourniquet placement, warm blankets, etc. seems unwise to me.

Thanks so much for responding. My worry when reading articles like these is that I know I don't have the background to evaluate the technology, but I don't often know where to go to find people who do.

This was a really useful perspective to hear.

So where does the blood go?

The demo video shows an extreme bleed. Like a artery has been cut or something. Sure, you seal the blood in but wouldn't you still bleed out internally?

Like if you cut your femoral and gel up your leg. Would you survive for any length of time?

Your arteries and veins form a pressurized system. If you seal a hole well enough (stronger than the systolic pressure of the heart), it will prevent any blood from leaking out. When you close your bathroom faucet it doesn't cause water to start leaking out somewhere else in your house.

But if I cut the pipe leading to the faucet then merely shut the cupboard door, my cupboard is not going to be very happy.

I think he's comment was that the gel isn't necessarily sealing the arteries/veins, only the 'hole in your leg' - the assumption being this could still result in fatal internal bleeding - that more traditional methods such as pressure on the wound or a tourniquet could have had better success with.

I wonder how this differs from the existing products celox[1] and quikclot[2], which AFAIK are coagulants?

[1] http://www.celoxmedical.com/tech_howitworks.htm

[2] http://www.z-medica.com/healthcare/How-QuikClot-Works/How-Qu...

edit: from a quick look over all three (I'm no expert), it seems like this new one might be faster acting.

Sounds cool, but I wonder what would happen with bacteria that are trapped underneath the rapidly solidifying gel.

Usually, the flow of blood tends to wash pathogens out of the wound, reducing the chance of nasty infections. Positive blood pressure can therefore be considered a natural defense mechanism. But if you stopped the bleeding too quickly, wouldn't it trap pathogens inside the body before the blood has had a chance to wash them out? Or does the extra-rapid clotting actually trap pathogens within the solid matrix, preventing them from spreading further into the body?

It's a temporary stop-gap. I'm assuming the strategy would be that when the injured gets brought in for treatment, then you re-open the wound, cleanse the area, and give the body appropriate anti-biotics to fight off any infections.

You've gotta pick the lesser of two evils - somebody that bleeds out, or somebody that is alive and able to fight off an infection.

I would imagine its a trade off, infections can be more readily treated, however bleeding out only takes a few moments.

Seems like you could mix in a triple antibiotic?

The article mentions that you can freely mix antibiotics into the gel, so hopefully such a thing would prevent (or at least resist) infection in the wound.

No doctor talking: I think it all depends on the situation. If you are bleeding heavily and the only way to stopp it quickly enough would be to use the gel then use it and treat the bacteria later with antibiotics or something...

I am not a doctor, but from what I've read, treating an infection is usually considered much less of a priority by emergency responders than stopping severe bleeding.

You can bleed to death in a few minutes. Few if any infections are going to be that fast-acting. So stopping severe bleeding will hopefully buy you some time to get to the ER, where they'll pump you full of antibiotics if they have to.

Yep. Emergency responders use the mnenomic "ABC" to guide their actions in a life-threatening situation: Airway, Breathing, Circulation.

Infection is not on the list.

Military sometimes uses "CABC" - Catastrophic Hemorrhage, Airway, Breathing, Circulation. This gel would address the "C"'s in an emergency situation.

Unfortunately antibiotics are becoming less and less useful. In 50 years we could be back to where a cut on your toe is life-threatening. :(

I don't know if it'll ever get so bad that a small cut could be life-threatening but it certainly is a large issue. People need to learn that they need to take the antibiotics for as long the doctor told them to, deciding to stop taking them cause you don't feel so bad anymore is the main reason for drug-resistant bacterial strains.

And the use of antibiotics in food production: http://en.wikipedia.org/wiki/Subtherapeutic_antibiotic_use_i...

From what I've read the antibiotic resistant strains of bacterial are outcompeted by non-antibiotic strains when not in the presence of antibiotics.

So if antibiotics become completely ineffective and people stop using them, the resistant strains will die off eventually, possibly quickly.

Reference?

http://www.ncbi.nlm.nih.gov/pubmed/20208551

You are on a board communicating with members of the species homo sapience, the only species ever to have developed flight, increased its max speed by more than ten times and gone to the moon in less than a century.

You communicate with these people by seending electronic interference that not one of them can see, feel, hear or touch but which they none-the-less can pickup, route, transmit, copy and send around the world -- in less time than it takes you to clap your hands.

And you worry about what will happen in fifty years.

Could you not just use Superglue for a temporary fix before treatment?

Superglue does work. But if you watch the video in the article there is no way you could apply Superglue to a cut that deep and that long.

Couldn't you just use a piece of waterproof [well blood-proof] material lathered with superglue and slap it on; basically a superglue band-aid. That would contain the bleeding and be cheaper and easier to apply, presumably, than this solution. It would have the same problem of internal bleeding as well of course.

With the OP's solution how do you remove it to treat the injury?

It would contain the bleeding but it wouldn't stop it.

I understood that was what the gel in question did, contained the bleeding to prevent bleeding out before medical aid could be given. But, that it was not preventing the bleed from continuing internally.

As you may guess I have basically no medical training so I may well have misunderstood.

Superglue probably wouldn't dry as fast. It might be toxic, depending on the chemicals. It sounds like this forces the blood to clot, I don't know if the blood would clot fast behind a superglue barrier.

The next time you use superglue (cyanoacrylate) and want it to dry and harden instantly, go get some baking soda and gently sprinkle the soda over the superglue. It instantly hardens, albeit with a mottled texture.

I've done that before when I got superglue on my finger, and wasnt sure what was water and what was glue. Some baking soda, and it hardens for me to see and feel it. Also worked well on my RepRap, when I had my X-idler delaminate.

I don't know enough to say why that would or wouldn't work in some absolute sense. But if we're comparing instead of talking absolutes, my first question to narrow it down is: "Doesn't superglue have some gnarly stuff in it? Stuff that you don't want in your body if an alternative like this exists?"

That'll depend on the exact type of superglue, but there's a more basic problem in that the standard stuff uses a cyanoacrylate that often is an irritant. So they use a slightly different variety in medicine, first trade name Dermabond, which was used the last time I got a bad enough cut. It's really good stuff, but as noted elsewhere, not so applicable for catastrophic hemorrhage.

  | Using ordinary Super Glue on wounds
  | can cause side effects, but a safer 
  | alternative exists.

http://www.nytimes.com/2007/12/04/health/04real.html?_r=0

Is that for real ? Does Super glue on wounds is an existing alternative?

If you go to the pharmacy and buy a bottle of liquid bandage, it's just superglue with antiseptics mixed in.

https://www.google.com/search?q=Dermabond

That's amazing

In my experience with superglue-based liquid bandage, it works poorly on an actively bleeding wound, as the blood mixes with and breaks through the glue before it sets.

Having previously worked as a carpenter I have vast experience with moderate size cuts, and always had a bottle of brush-on superglue in my belt. If you rinse the cut and leave it a little damp when you apply the superglue it actually pulls the wound closed as it dries as well as killing any bacteria.

Common in bowling as well, for the cuts you'll inevitably get on your thumb. Most pro shops will sell liquid bandage, which is essentially just superglue as well.

I believe the liquid bandage also has an antiseptic in it as well to make sure you kill any pathogens.

Does this generate intense heat like the older products do?

Of all the things from the Mass Effect universe they could invent they picked medigel? Come on!

Thinking the same thing. But the medigel is that thing too useful to be banned by the Council, so ... yes.

I'm an infantry veteran with three combat tours under my belt. Been there, done that.

The problem with these sort of fast-clot systems (Quick clot or quiclot or however you spell it) is that they inevitably damage the surrounding tissue and make recovery and healing difficult if not impossible without permanent damage. There's a reason they didn't want us to have any of these systems when we got back to the real world (though I kept a couple for myself). If we used them on civilians, we would probably be sued into oblivion for causing severe damage to the bleeder even if we saved their lives using it.

Just like the other medics here will probably tell you, if this isn't on a battlefield saving lives under fire, I don't trust it.

The CAT and the Israeli Bandage, however, are seriously useful, and are in my laptop bag first aid compartment, and in a couple parts of the car, and the range bag.

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