title: Thermal injury resulting from application of a granular mineral hemostatic agent.
abstract: BACKGROUND
  Uncontrolled hemorrhage accounts for the majority of deaths in combat. Effective topical hemostatic agents suitable for use on the battlefield may be valuable in controlling hemorrhage until definitive surgical intervention is possible. In an effort to identify a hemostatic agent suitable for battlefield use, we evaluated several potential hemostatic agents in a swine injury model and noted thermal injury to tissues with a granular mineral hemostatic agent (QuikClot).
  
  
  METHODS
  Anesthetized swine were maintained with a mean arterial pressure in excess of 60 mm Hg. Cutaneous, muscular, hepatic, splenic, venous, and arterial wounds were created in a standardized fashion. Topical hemostatic agents were immediately applied to the wounds and the amount of bleeding and time to hemostasis were noted.
  
  
  RESULTS
  The results reported here are part of a larger study in which a variety of hemostatic agents were evaluated. Only the findings related to the granular mineral hemostatic agent are discussed here. Application of the agent resulted in elevated tissue surface temperatures in excess of 95 degrees C and internal tissue temperatures exceeding 50 degrees C, 3 mm deep to the bleeding surface. Necrosis of fat and muscle were noted as well as full and partial thickness cutaneous burns.
  
  
  CONCLUSIONS
  Topical administration of a granular mineral hemostatic agent to a variety of wounds in an experimental swine model resulted in thermal tissue injury and necrosis. Suggestions for reducing the extent of injury with this product are offered.
authors.affiliation: 311 Health Sciences Wing, Air Force Material Command, Brooks City-Base, Texas, USA. James.Wright@hurlburt.af.mil
authors.forename: James K
authors.initials: JK
authors.lastname: Wright
authors.forename: John
authors.initials: J
authors.lastname: Kalns
authors.forename: Edward A
authors.initials: EA
authors.lastname: Wolf
authors.forename: Frederick
authors.initials: F
authors.lastname: Traweek
authors.forename: Stacy
authors.initials: S
authors.lastname: Schwarz
authors.forename: CleAnn K
authors.initials: CK
authors.lastname: Loeffler
authors.forename: William
authors.initials: W
authors.lastname: Snyder
authors.forename: Loudon D
authors.initials: LD
authors.lastname: Yantis
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Eggers
mesh_terms: D000279:Administration, Cutaneous; D000818:Animals; D001158:Arteries / Q000293:injuries; D002057:Burns, Chemical / Q000175:diagnosis / Q000209:etiology*; D004195:Disease Models, Animal; D004353:Drug Evaluation, Preclinical; D005781:Gelatin Sponge, Absorbable / Q000627:therapeutic use; D006470:Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D006488:Hemostasis, Surgical / Q000009:adverse effects / Q000379:methods; D006490:Hemostatics / Q000008:administration & dosage / Q000009:adverse effects* / Q000737:chemistry; D006801:Humans; D008099:Liver / Q000293:injuries; D008887:Military Medicine; D008889:Military Personnel; D018482:Muscle, Skeletal / Q000293:injuries; D009336:Necrosis; D012867:Skin / Q000293:injuries; D013154:Spleen / Q000293:injuries; D013552:Swine; D013817:Thermography; D013997:Time Factors; D014680:Veins / Q000293:injuries; D014857:Warfare; D014945:Wound Healing / Q000187:drug effects; D014947:Wounds and Injuries / Q000150:complications*; D017641:Zeolites / Q000008:administration & dosage / Q000009:adverse effects* / Q000737:chemistry
chemical_list: C411004:FloSeal Matrix; D006490:Hemostatics; D017641:Zeolites