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Thread: Etamsylate, Tranexamic acid, and/or Yunnan Baiyao for the SHTF pharmacy?

  1. #1
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    Default Etamsylate, Tranexamic acid, and/or Yunnan Baiyao for the SHTF pharmacy?

    As I understand it - Etamsylate promotes blood clotting through coagulation, Tranexamic Acid inhibits the process your body uses to break up blood clots (an antifibrinolytic), and Yunnan Baiyao is an herb which may have some use in stopping internal bleeding (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3992384/) although the mechanism doesn't seem to be understood yet.

    Tranexamic Acid at least has had a lot of recent studies done, and seems to be recommended for combat injuries where a lot of blood has been lost. Also saw a study recommending it for rural injuries where transport time to a hospital is longer. IV is the preferred route but it's sold in oral tablet form too. The studies make it sound like a wonder-drug of sorts, reducing mortality in nearly every case of severe bleeding if given within 3 hours. That assumes surgery though, not just the drug. The other two I've never seen recommended for EMT/combat medic use.

    Guess I'm thinking of its use more in trauma that caused internal bleeding or maybe postpartum bleeding after the SHTF. Any thoughts from the pros on this? Are there (m)any realistic scenarios where these alone might be curative/life-saving (without surgery)?
    Everything marked, everything 'membered. You wait, you'll see.

  2. #2
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    I can see the need at times, but hemotoxin from snakebite coagulates blood and can kill you. Sounds like something that requires close monitoring and a reversal handy.
    If I had a dollar for every time I thought about you, I'd think about you more often.


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  3. #3
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    I'm done with snakebite discussions. lol

    This question came up after researching someone's suggestion for a combat pill pack - Moxifloxacin, Tramadol, and Etamsylate. One thing led to another while looking into the Etamsylate and found the studies on Tranexamic Acid (on the WHO Essential Meds list btw). Figured Tranexamic Acid wouldn't be available in oral form, but it was. Then figured it wouldn't be a drug that could be readily absorbed under the tongue to avoid the GI route (and get it onboard quicker), but it was. Then figured it probably wouldn't be available from my usual Indian pharmacy, but it was (and cheap). Then started wondering if this (or the others) were really something worth having if the SHTF. Blunt trauma to the abdomen, crush injury to a leg, something like that that breaks a lot of blood vessels internally.
    Everything marked, everything 'membered. You wait, you'll see.

  4. #4
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    Interesting discussion. Here's my input (former 68W, current Paramedic / TEMS Medic / Critical Care)

    So, TXA.

    TXA is not a fix all. As you stated already, it doesn't "promote clotting" at all. Its an antifibrinolytic. Basically, it prevents existing clots from being broken down by the body. Its a great drug, I carry it on the ambulance. I've seen it work, but it only works when you have access to definitive care. Without a surgeon, and a sterile area to operate, and anesthesia (and therefore airway management equipment, ventilator, etc), and tons of blood and IV Antibiotics to treat after surgery, and people trained to nursing level wound care, and ICU level monitoring? Good luck.

    As preppers, we need to be realistic about our medical preparedness capabilities. I could extract a tooth, perform an incision and drainage on an abscess, provide excellent wound care if I really had to and maybe a few other things... but anything requiring surgical intervention inside the box (abdomen/torso)? These injuries routinely kill tons of people today in the best of conditions, let alone in an ad hoc operating theater (aka your work shed). My group has myself, my wife (USAF 4N, EMT), three more EMTs and an RN and a Pharmacist. So, pretty well rounded on the medical prep side... but again, keep it realistic.

    Our focus in the PAW will be on injury and illness prevention, and rapid intervention if that fails. Safety procedures, proper oral and hand hygiene, isolating the sick, proper nutrition. Not much more you can do. Stock up on soap, tooth paste, dental floss, be sure everyone in your group is up to date on dental care and vaccinations, and focus now on healthy living. Control high blood pressure, weight, etc. Be sure people see your group Medic ASAP, even for a small cough or minor injury, fast care prevents serious illness.
    We've become sheep, and I don't trust the Shepherds.

  5. #5
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    Wish we had your groups medical expertise SteelWolf. Prevention of injury and illness is the goal of course, but the risk of both goes up when the SHTF while the accessibility to medical care often goes down. A double-whammy.

    But if you had TXA in your bag and were presented with an injury that in your judgement warranted it's use during normal times, would you administer it in a SHTF/PAW knowing definitive care was not likely going to be available? Why so, or why not? I can understand that when you are trained to treat trauma and see it regularly you're going to be a much better judge on what actions might be helpful or harmful given a particular injury, I'm just hoping to quantify the risk/reward here somewhat for a semi-informed layperson (me). I might say:

    Yes - because TXA been shown to reduce hemorrhaging, and hypovolemia (or exsanguination) seems the immediate primary risk, or

    No - because it has only a 1 in 1,000 chance of being the deciding factor in saving life or limb now, but has a 1 in 50 chance of contributing to the pulmonary embolism that kills them a week from now if they survive.

    Any thoughts appreciated. 2 grams = $2.50, and not like another roll of kerlix / coban is going to make a difference in our supplies.
    Everything marked, everything 'membered. You wait, you'll see.

  6. #6
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    Without definitive care? Its pointless. Absolutely pointless. Maybe you buy someone a few more hours? Especially with Abdominal or Thoracic trauma, only a skilled Surgeon can fix that problem. Even with definitive care? We are still researching its benefit. It appears to improve survival to hospital, and in some cases survival to hospital discharge, but TXA, like any drug, carries with it risk. In a world with functional Level 1 Trauma Centers, staffed with multiple specialist Physicians, its an awesome tool.

    Will you have definitive care in the PAW? Probably not. More importantly, even if you did have definitive care, bleeding patients require adequate resuscitation prior to surgical intervention (in an ideal world, both can be done simultaneously). And by resuscitation, I mean Whole Blood or PRBC:PLASMA:PLATELETS in a 1:1:1 ratio, not salt water that doesn't carry oxygen, and causes acidosis, hypothermia and coagulopathy (which just so happen to be all three elements of the Lethal Trauma Triad).

    We have a "Golden Hour Box" in our transport units. It contains:
    (2) Units PRBC, O-
    (2) Units FFP (Fresh Frozen Plasma)
    (2) Grams TXA

    TXA is Cheap. Blood and Blood Products? not so much. Its hard to justify carrying this stuff when probably 1-5% of our calls would require it. But, several agencies are participating in a study across multiple western states. And there are Medical calls that we could use these on (GI Bleeding as an example).

    Proper resuscitation of the bleeding patient, once hemostasis is achieved (if the bleeding can be controlled) requires knowledge of physiology, and proper monitoring equipment (at a minimum a blood pressure cuff and a thermometer, though I much prefer a proper monitor). How much Blood or fluids are too much? At what point to we risk pulmonary injury or the risk of "clot washout" (a phenomenon where your body has formed clots, but blood pressure rises due to your resuscitative efforts and can actually break these clots off, essentially undoing everything we are trying to do). And Blood/ Blood Products require very specific storage and maintenance requirements too. Field transfusion kits are available, but there are very specific methods used to obtain blood from a donor prior to transfusion. And what about transfusion reactions? Off duty, I wouldn't have access to Epi, IV Diphenhydramine and Dexamethasone. Although rare, these reactions do happen and can have dire consequences. So, proper resuscitation of the bleeding patient will not be an option either.

    I know the drug is cheap, easy to store, etc., but, in my mind, its hard to justify even spending a few bucks when its one small part of a very complex problem. I wouldn't include it in my SHTF preps. Honestly, Kerlix would be a better use f that $2.50. You will never have enough gauze. Heck, i've ran out of gauze on fully stocked ambulances before.

    Plus, as small as the vials are, they still take up space. That vial of TXA that has questionable use? Replace it with a bottle of antibiotics. Here's the other side of penetrating trauma. The number one cause of death in trauma, assuming you survive the injury and stabilizing surgery, is Sepsis. But that's a whole other box of worms worthy of its now thread.

    After stabilization, these patients require extensive round the clock monitoring and care from highly skilled MD's and RNs. Potent pain management, possible sedation (and therefore airway management and the use of a mechanical ventilator), IV Antibiotics (All of the above require electrically powered IV Pumps) , frequent wound and chest tube care (requiring electrically powered suction units)... its a crapshoot.
    We've become sheep, and I don't trust the Shepherds.

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