written by reader Will This Unknown Boston Biotech Make Present Surgical Techniques Obsolete?

Dr. KSS Looks at clotting for the Irregulars

By DrKSSMDPhD, October 5, 2014

[Ed. Note: Dr. KSS writes for the Irregulars about medicine and biotech stocks. His topics, words and opinions are his own. Enjoy!]

It’s the second reel of conspiracy film Shooter, and Mark Wahlberg, whom government schemers are trying to frame for assassination, has just been shot twice. In the back of a stolen FBI car, he finds a pouch of QuikClot,┬árips it open and crams a handful of slate-grey powder into his shoulder wound to stop bleeding, even as pressing on it causes him to cry out.

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A gunshot wound has Marky Mark in dire straits. Thank goodness for QuikClot.

QuikClot is zeolite. It provides a foundation that favors platelet clumping and fibrin clotting. The idea of packing powdery or fibrous substances—chitosan; plant fibers in BloodSTOP— into wounds to stanch bleeding is a respected one. Some battlefield cases of injury, where tissues are diffusely bleeding, can be controlled with their use. They fail, however, when arteries, carrying pulsatile blood at elevated pressures, are breached. I’ve been in major trauma situations where despite all the efforts of a surrounding team of health workers to control arterial bleeding and replace blood and fluid, people slip away: they stop moving, begin staring with a dead-mackerel eye into space, stop breathing and go pulseless. A disquieting recent Wall Street Journal story documents how, in 2014, battlefield soldiers still commonly expire because they bleed to death from wound trauma. Trauma that has not claimed a major organ should not kill, and so most such deaths are preventable. The present agents, however, have serious limitations, and any method that could control such bleeding without a need for tools or arterial ligation (which require surgical expertise) would be among the most significant developments in the history of medicine and surgery.

That’s the unpredictable situation. How about the predictable, the controlled, situation? In a routine operation, how much of the period of time from when the surgeon makes an incision to when (s)he closes it is spent stopping bleeding? Blotting, sponging, cauterizing, tying off “bleeders”?

(a) 15 percent

(b) 30 percent

(c) 50 percent

(d) 85 percent

(An old saw in medicine has it that any time you’re asked a question like this the correct answer is always either 15 percent or 85 percent. And then again….)

I had a patient ...

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