Pressure Dressing Vs. Tourniquet BONUS: True Facts About Gauze

If you've never, not even once in your life thought about Gauze, you aren't alone, but you ARE in luck. Lucky you.
It always surprises me how in depth you can get into a topic as seemingly simple as gauze. But here I go anyway...
Here's what I want you to take away from this video:
Pressure Dressings vs. Tourniquets
1. If you are at all worried the casualty could die from a severely bleeding extremity, use a TQ.
2. If you are concerned, but don't think the casualty is going to die, use a pressure dressing.
3. If the pressure dressing doesn't seem to be working (blood is soaking through the bandage), apply a TQ, while leaving the pressure dressing in place.
4. Standard protocol for QuikClot is to apply direct pressure (with your hand) over the wound for at least 3 minutes to ensure clotting. I think this is a good idea regardless if QuikClot is used.
5. Never remove the gauze after it's been packed into the wound. Let the surgeon do that. You run the risk of pulling out the clot that is keeping the artery sealed off.
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QuikClot Bleeding Control Dressing
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[@cstup5579]

I know I have heard you mention in other videos that the SWAT-T makes a good pressure dressing. You also mention it's important to keep an eye on the dressing to make sure it's not bleeding through. Since the SWAT-T is basically a wide rubber band I assume it would be difficult to know if the wound is still bleeding through the dressing as it would not easily show through the SWAT-T I wouldn't think. Are the smaller Israeli bandages a good alternative? Are there other compact options? I like the multi use aspect of the SWAT-T but since I keep a CAT anyway I wondered if there were other options for the dressing as well that you like.

[@MountainManMedical]

Hmmm, good point. I can see how that could be an issue. I think if it was me I would just peek under the SWAT-T and see if the gauze was saturated.
But to answer your question, yes an Israeli dressing is a great option for a dedicated pressure dressing. I would recommend using a purpose built pressure dressing before breaking out the SWAT-T.
The SWAT is just a back up, or a way to extend your available resources since it can be both a TQ and a Pressure Dressing. If you have the space available, an Israeli Dressing is ideal, but they can be a little bulky and don't pack as efficiently as the SWAT. I built out our medical kits to be as small, but as useful as possible.
We sell Israeli Bandages on the website, but stock our Yellowstone and Sweetwater kits with the Emergency Trauma Dressing (ETD) from NAR because of how compact it is.
Bottom line: If you have the space, carry an Israeli Dressing. If you don't have space, the SWAT is a reasonable alternative.

[@cstup5579]

@@MountainManMedical Makes sense, as it is not being used as a TQ in that situation I suppose it would be easy enough to lift the edge and peek under. I also forgot that you use the ETD in your kits. I got one of the Yellowstone kits through the concealed carry initial offer and have to say that I really like it. I have a couple other older kits that I need to update some things in, hence the question on the dressing. I think the SWAT-T/ETD combo may be the best compromise for compactness and redundancy for a compact to-go kit while the Israeli Bandages are maybe better served for a car or home kit.
Thanks for the reply, I have really enjoyed your videos. The training videos you put together are excellent help for someone like me who is not a trained medic. I am currently saving up for a couple more of your kits and hope to get some real life training this year since I managed to find a place nearby that does some basic combat medical training with some of their shooting schools.
Keep up the good work, the quality and content of your stuff is great, both the video production and the med kits! I really enjoyed the interview with Alien Gear, it sure didn't seem like it was hour long.

[@NicholasLaRosa0496]

Great video. You get straight to the point on when to use what.

[@MstrHunter58]

Thank you for being down to earth and speaking in an easy to understand, easy to follow format! I was not familiar with the ball technique discussed; I always enjoy adding information to my skillset I did not previously have.

[@MountainManMedical]

You're welcome! Glad that I can help. Skills are weight less tools, but they need to be sharpened from time to time.

[@cuteone1702]

Ditto to both comments above

[@ecospider5]

Fantastic information on when to use different techniques on a wound

[@billydoyle6919]

We teach a technique to increase direct pressure over a small area (such as penetrating injury).
If using a standard crepe bandage, twist the bandage and sinch directly over site (thats been packed already).
If you add a plastic bottle top(upside down) or anything solid over the site and continue to twist over site. It has the benefit of decreasing surface area of where force is applied, which increases downwards pressure. You can then apply digital pressue on bottle top as well if needed. I use squash or tennis balls on bigger sites, especially axilla or lateral neck.
It works well and we call it 'mechanical advantage bandaging technique'.
We also teach soaking gauze (for packing) in TXA or if pushed 1:10,000 adrenaline.

[@SpudKai]

wow, sir are you a medic somewhere? Where are you coming from and you actually carry those mechanical advantage devices, bottle caps or small balls? Very neat, former Medic in the US Army here.

[@ethanhart5237]

The idea of mechanical advantage dressing has never crossed my mind past a wadded up gauze ball over a small bleed. Very clever ideas will remember this thank you

[@jimpiper5297]

I love and have used many times that fluffy gauze (trade name Kerlix?) in the hospital for wound dressing. Yup, takes up a lot of room in a field FAK. Rather than pay extra for a commercial vacuum packed dressing, I've taken all my Kerlix and used a home food vacuum packager for the task. Works great!

[@Pugrug.]

For the wound packing part where you talk about dropping the gauze. North American Rescue sells S-rolled gauze and the packaging acts like a tissue box so you if you accidentally drop it, it stays sterile.

[@glock-hm3ro]

great video on this topic sir. keep it up.

[@roland.j.ruttledge]

Very informative, many thanks UK

[@cuteone1702]

Another great video. Thanks

[@seriouslight6963]

I think it would be cool to see a video about an impromptu tourniquet. I know from past videos you said the CAT tourniquet is a much better option, but maybe if you find yourself without a CAT tourniquet or maybe you messed up and left Mountain Man medical kit behind, what would you use to stop massive hemorrhaging?

[@MountainManMedical]

Agreed! I have a video planned about that, probably discuss a little about belt TQ's as well.

[@magnum15917]

Great video, thanks is there an average size Powerball nickel size -quarter size? Or could it very depending on the wound 🩹

[@MountainManMedical]

I would say it depends on the wound, but I've found just tying a quick knot in the end is sufficient for most wounds. The key take away is: No matter the size of the powerball, make sure it's right on top of the bleeder. This is where you'll get a majority of your bleeding control. The knot puts more pressure over the artery so that it stops bleeding.

[@thestillthrill1166]

If youre not sure, apply a tourniquet. You can always reass the bleeding once you're in a safer area/once your head is cleared.

[@MalaklypsetheElder]

Dude tour channel us fucking awesome. Also, you should join American Contingency, the network Mike Glover started. Everyone should.

[@michaelruppert882]

The video is misnamed. It is a discussion of dressings and has good information as long as he stuck to dressings, But it is not a comparison of the dressing vs TQ since he never showed a TQ. There are two main TQs on the market using a windless system to stop blood flow. The CAT is the only one that can be realistically applied to a man on himself and is the fastest to apply -- therefore the one recommended by the military and medical association for paramedics. My training classes in Ohio and Indiana all recommend using the TQ immediately, not a dressing. There is NO danger of losing a limb because of TQ use. The sandbox wars have had 12 hour TQs on soldiers with no loss of limb or function afterwards. You can use dressings for wounds when you have only one injured party -- AND you can tell that is the sole source of bleeding. With an auto accident or Las Vega shooting or Boston Marathon bombing you -- AND THE VICTIM -- don't have time for dressing the wound -- and hoping that stops the bleeding. I was also told you NEVER worry about dirt causing infection. The quote was "not my problem." If the victim keeps bleeding he will be dead NOW. Infection is a problem down the road. He has to be alive to have an infection.

[@MountainManMedical]

Hi Michael, thanks for the comment. The title of the video was meant to imply when to use a TQ, VS. when to use a pressure dressing.
It's about using the right equipment for the wound that you have. Not every wound you encounter requires the use of a tourniquet. This is where the pressure dressing comes in.
I agree with your educators who say a TQ should be used for every life threatening bleed. But not every wound is going to be life threatening. This is when you would use a pressure dressing.
And yes, the danger for losing a limb is not as great as most people think, especially if they live in an area with a great EMS response time.
However, I've never seen a report of a 12 hour TQ with no complications.
According to the National Center for Biotechnology Information:
"Muscle damage is nearly complete by 6 hours, with likely required amputation. Numerous studies have been performed to determine the maximum duration of tourniquet use before complications. The general conclusion is that a tourniquet can be left in place for 2 h with little risk of permanent ischaemic injury."
www.ncbi.nlm.nih.gov/pmc/articles/PMC2660095/#:~:text=Muscle%20damage%20is%20nearly%20complete,risk%20of%20permanent%20ischaemic%20injury.

[@cuteone1702]

@@MountainManMedical thanks for that time number. I never knew a number until now.

[@MountainManMedical]

@@cuteone1702 You're welcome!