We Support The Free Share of the Medical Information

Enlaces PDF por Temas

Nota Importante

Aunque pueda contener afirmaciones, datos o apuntes procedentes de instituciones o profesionales sanitarios, la información contenida en el blog EMS Solutions International está editada y elaborada por profesionales de la salud. Recomendamos al lector que cualquier duda relacionada con la salud sea consultada con un profesional del ámbito sanitario. by Dr. Ramon REYES, MD

Dr. Ramon A. Reyes, MD

Dr. Ramon A. Reyes, MD
Responsable del Blog

martes, 19 de diciembre de 2017

Mechanical Advantage Tourniquet (MATResponder). MAT Training Video

Mechanical Advantage Tourniquet (MATResponder)

Training Presentation

July 18, 2006 Recent geo-political and natural disaster events have shown that one of the primary threats to victim’s survival is blood loss. In particular, the global war on terror has demonstrated specific vulnerabilities in critical blood loss due to damaged limbs. In late 2003, American Special Operations Forces requested the urgent supply of a tourniquet with some special requirements including; operation by one-hand, application and occlusion in less than a minute, applicable to trapped limbs, no external power, quick release and reset, weighing less than 230 grams, and having a 10 year shelf-life. Within seven weeks, Cybertech Medical Product Development delivered the first prototype of the Mechanical Advantage Tourniquet (MAT) to the DoD that solved all of their desired requirements, and to-date is the only device to do so. It’s unique modulated constriction makes the MAT safe to use in preventing tissue damage and loss of limb. 

MAT Tourniquet vs CAT Tourniquet 

Mechanical Advantage Tourniquet (MATResponder)

Three independent military medical tests conducted in 2005 have shown the MAT to be the fastest, easiest-to-use, most efficient and most preferred device in stopping critical blood loss and saving life and limbs. The MAT is the best performing tourniquet tested by the Army, Navy, and Marines.
The MAT has been selected as standard equipment by Homeland Security, and has been deployed to AFT, Border Patrol, military troops throughout the world, and is now used to protect the highest members of the US Government and other dignitaries. The MAT is now part of the Tactical Emergency Medical training courses of many police departments, and is being utilized by EMS services and ER departments.
The MAT won a Gold 2006 Industrial Design Excellence Award (IDEA Award). The Industrial Designers Society of America and BusinessWeek cosponsor the IDEA competition. BusinessWeek selected the MAT in their feature “Design for a Dangerous Planet” in the July 10 “Best Product Design of 2006” issue.
The MAT has been designed, developed and brought into production by Cybertech and Ewing Design Group.

MAT Tourniquet
Instruction and USE

About Bio Cybernetics International
Bio Cybernetics International is the nation's dominant orthotics and trauma products supplier for hospitals and EMS. For more than 7 years, BCI has met the needs and exceeded the expectations of providers throughout the healthcare continuum, including hospitals and emergency medical services (EMS).
About Ewing Design Group
Steve Ewing founded Ewing Design Group in 1994 under the principle that superior products create superior brands. Ewing Design Group does this by designing and engineering products that out-perform the competition, have strong brand identity and emotional appeal.
Their approach to the design problem solving process is holistic. Acting as the hub of the development team, they work with the client's customers, retailers, sales, marketing, engineering, manufacturing and service departments to uncover the needs, wants and desires of all the key players. This results in products that are more than just improvements over their predecessor, they are class leading.

M.A.T. Tourniquet

Dr. Ramon Reyes, MD

Control de Sangrados España. STOPTHEBLEED BCon Basic by TECC España

#StopTheBleed #BleedingControl #Tourniquet #Torniquete #PHTLS #ACLS #TACMED #MEDIVAC #TACEVAC #CASEVAC #CoTECC #CoTCCC #TECC #TCCC #MilitaryMedicine #Spain #HartfordConsensus #ATLS #Trauma #EMS #RemoteMedicine #TECCSpain #Intraosseous #Camilla #malapractica #SEMES #Sistema911 #Emergencias112 #IberoAmerica #CoTCCCLat #TCCCMexico


domingo, 17 de diciembre de 2017

CRoC (Combat Ready Clamp)

CRoC (Combat Ready Clamp)
 Esperamos en nuestro Grupo en TELEGRAM Soc. IberoAmericana de Emergencias 

CRoC (Combat Ready Clamp)

CRoC (Combat Ready Clamp)

 CRoC (Combat Ready Clamp)
CRoC (Combat Ready Clamp)

CRoC (Combat Ready Clamp)

CRoC (Combat Ready Clamp)
CRoC (Combat Ready Clamp)

Hemorrhage is the leading cause of preventable death on the battlefield. Approximately 25% of potentially survivable deaths are due to uncontrolled junctional hemorrhage, the majority of which are pelvic hemorrhage. The CRoC (Combat Ready Clamp) is a revolutionary device designed to control difficult bleeds in the inguinal region. The CRoC can be used in a tactical environment where traditional methods of hemorrhage control are not possible and standard tourniquets cannot be applied. It provides compression to large vessels and direct pressure to difficult wounds thus controlling hemorrhage and eliminating the need for manual pressure. It is an expandable aluminum clamp that is durable, collapsible, light weight, low cube, easily employed and easily removed. The CRoC is an ideal device for increasing soldier survivability by addressing difficult hemorrhage, one of the leading causes of preventable death on the modern battlefield


1 base plate
1 vertical arm
1 horizontal arm
1 pressure handle
1 pressure disc
1 adjustable strap

Weight & Dimensions:

Unit Weight: 1.5lbs
Unit Dimensions stored: 3.5"H x 11.5"W x 1.5" D
Unit Cube stored: .035

Link details in pdf

TACTICAL MEDICINE TACMED “Medicina Bona Locis Malis” tm. Good Medicine In Bad Places España by EMS Solutions International

sábado, 16 de diciembre de 2017

NAEMT's EMS Vehicle Operator Safety (EVOS) course

NAEMT's EMS Vehicle Operator Safety (EVOS) course addresses the knowledge gap that leads to injuries and deaths, and focuses on the specific behaviors that need to be changed to create a culture of safe driving.
Drawing on the most current research about the behaviors and other hazards that lead to crashes, EVOS features case studies and analyses of both common and catastrophic collisions. EVOS challenges EMS practitioners to reconsider their preconceptions about safe vehicle operations. Instructors can easily incorporate local laws, rules and policies into the curriculum. Topics covered in the course include:
  • Making driving safety a priority
  • Legal aspects of EMS vehicle operation
  • Maneuvering an EMS vehicle
  • Vehicle inspection and maintenance
  • Mental, emotional and physical preparedness
  • Emergency response
  • Crash prevention
  • Driving skills
  • Technological aids
  • Simulation training

EVOS is appropriate for EMS practitioners at all levels.  EVOS is accredited by CAPCE and recognized by NREMT.

Este es el nuevo curso NAEMT a estrenar en Republica Dominicana Enero 2018 Christian Goring, responsable academico y Alexander PAcheco el Coordinador en Rep. Dominicana

El curso de seguridad del operador del vehículo ems (evos) de naemt aborda la brecha del conocimiento que conduce a lesiones y muertes, y se centra en los comportamientos específicos que necesitan ser cambiados para crear una cultura de conducción segura.

Aprovechando la investigación más actual sobre los comportamientos y otros peligros que conducen a accidentes, los evos incluyen estudios de casos y análisis de colisiones tanto comunes como catastróficas. Evos desafía a los profesionales del sme a reconsiderar sus ideas preconcebidas acerca de las operaciones seguras de los vehículos. Los instructores pueden integrar fácilmente las leyes, normas y políticas locales en el plan de estudios. Entre los temas abarcados en el curso figuran:

Hacer de la seguridad de conducción una prioridad
Aspectos jurídicos de la operación del vehículo ems
Maniobrar un vehículo de ems
Inspección y mantenimiento del vehículo
Preparación mental, emocional y física
Respuesta de emergencia
Prevención de accidentes
Habilidades de conducción
Ayudas tecnológicas
Entrenamiento de simulación
Los evos son apropiados para los profesionales del ems a todos los niveles. Evos está acreditado por capce y reconocido por nremt.

sábado, 9 de diciembre de 2017


No puedes perdértela. #SEMES#EnfermeriaSEMES #TES #EmergSEMES
TELEGRAM Iberoamerican society of emergency group

No puedes perdértela. #SEMES#EnfermeriaSEMES #TES #EmergSEMES

viernes, 8 de diciembre de 2017

Identificación de Materiales Peligrosos by CIQUIME PDF Gratis

Identificación de Materiales Peligrosos by CIQUIME PDF Gratis

TELEGRAM Iberoamerican society of emergency group

Enlace para bajar documento en formato PDF Gratis 

Enlace descarga 1 

Enlace descarga 2 

Topical TXA in Epistaxis

Topical TXA in Epistaxis
TELEGRAM Iberoamerican society of emergency group

Topical TXA in Epistaxis


Background: Epistaxis is a common Emergency Department (ED) complaint with over 450,000 visits per year and a lifetime incidence of 60% (Gifford 2008Pallin 2005). Standard anterior epistaxis treatment consists of holding pressure, use of local vasoconstrictors, topical application of silver nitrate and placement of an anterior nasal pack. ED patients with epistaxis often fail conservative management and end up with anterior nasal packs which are uncomfortable. This is even more common in the group of patients who are taking antiplatelet agents like aspirin or clopidogrel. Recently, the use of topical tranexamic acid (TXA) has been described in patients with anterior epistaxis with shorter time to epistaxis control and shorter ED length of stay (Zahed 2013). However, prior studies have not focused specifically on patients taking antiplatelet agents.


Zahed R et al. Topical Tranexamic Acid Compared With Anterior Nasal Packing for Treatment of Epistaxis in Patients Taking Antiplatelet Drugs: Randomized Controlled Trial. Acad Emerg Med 2017. PMID: 29125679
Clinical Question: Does application of topical TXA result in a higher proportion of patients with anterior epistaxis control at 10 minutes in comparison to anterior nasal packing.
Population: Patients (did not specify adults, pediatrics or both but assumed adults based on text) presenting to the ED of a single academic teaching hospital in Tehran, Iran with acute, new or recurrent ongoing anterior epistaxis who were currently taking antiplatelet drugs (aspirin, clopidogrel or both). Patients were included if they had continued epistaxis after 20 minutes of continued pressure.
Intervention: Tranexamic acid (TXA) soaked cotton pledget (500 mg TXA in 5 ml)
Control: Anterior nasal packing with cotton pledget soaked in epinephrine (1: 100,000) and lidocaine (2%)


  • (Primary): Proportion of patients in each group with stopped bleeding at 10 minutes
  • (Secondary): Re-bleeding rate at 24 hours and one-week, ED length of stay (LOS), patient satisfaction
Design: Prospective, randomized, non-blinded, parallel group trial
Excluded: Patients with traumatic epistaxis, current anticoagulant drug use, inherited bleeding disorders, inherited platelet disorders, INR > 1.5, shock, a visible bleeding vessel, a history of renal disease and lack of consent.

Primary Results:

  • Patients enrolled
    • n = 384 patients assessed for eligibility
    • n = 124 patients who were included and randomized
  • No patients lost to follow up for the primary or secondary outcomes

Critical Findings:


  • Study asks a clinically relevant question regarding cessation of bleeding in epistaxis
  • Data analysts were blinded to allocation
  • Surpassed target sample size (57 patients needed in each arm to achieve 80% power to detect 25% difference in primary outcome)
  • Follow up was complete (no patients lost)


  • Unclear whether cessation at 10 minutes clinically more important than cessation at another interval. Additionally, nasal packing may take longer to achieve hemostasis based on mechanism making this particular comparison (primary outcome) unfair
  • Physicians and patients non-blinded to intervention. Researchers indicate that the study wasn’t blinded because pharmacy prepared kits had differing numbers of cotton pledgets and the consistency, color and smell of the medications used for soaking could unblind groups
  • Bleeding at 24 hours and one-week assessed in person or by phone. Authors do not specify how many assessed by each method. May introduce recall bias
  • Majority of patients on aspirin only (> 80%). Though patients on clopidogrel included, results may not apply as well to this group

Authors Conclusions:

“In our study population, epistaxis treatment with topical application of TXA resulted in faster bleeding cessation, less re-bleeding at 1week, shorter ED LOS, and higher patient satisfaction as compared with ANP. “
Our Conclusions: Topical TXA resulted in a significantly higher rate of cessation of bleeding of anterior epistaxis within 10 minutes of application in comparison to anterior nasal packing in patients on antiplatelet agents (primarily aspirin). ED LOS and patient satisfaction were considerably better in the TXA group as well but these were secondary outcomes. Though this study is too small to comment on safety, there have not been any documented serious adverse effects of this approach in the published literature.
Potential to Impact Current Practice: The use of topical TXA is painless, non-invasive and relatively inexpensive. Providers should consider the use of this approach in patients with anterior epistaxis who fail direct pressure prior to placement of an anterior pack.
Bottom Line: The application of topical TXA appears to be a rapid and affective approach to achieving hemostasis in anterior epistaxis. Future studies should look at longer term outcomes and use in patients on anticoagulants or other antiplatelet agents.


  1. Gifford TO, Orlandi RR. Epistaxis. Otolaryngol Clin North Am. 2008;41:525-536. PMID: 18435996
  2. Pallin DJ et al. Epidemiology of epistaxis in US emergency departments, 1992 to 2001. Ann Emerg Med. 2005;46:77-81. PMID: 15988431
  3. Zahed R et al. A new and rapid method for epistaxis treatment using injectable form of tranexamic acid topically: a randomized controlled trial. Am J Emerg Med 2013; 31: 1389-92. PMID: 23911102
Post Peer Reviewed By: Salim R. Rezaie (Twitter: @srrezaie

Original post
Topical TXA in Epistaxis

Epistaxis Management in the Emergency Department: A Helpful Mnemonic
February 15th, 2017 | ENT |4 Comments
By: Moises Gallegos, MD MPH
epistaxisEpistaxis is a common presentation to the emergency department (ED)1 that can be challenging and time consuming. Knowledge of the pearls, pitfalls, and troubleshooting tips around managing nosebleeds often can be the difference between a frustrating versus straightforward ED stay for patients. Use the EPISTAXIS mnemonic to help you remember these points.

Epistaxis Mnemonic

E xamine

Attempt to distinguish between anterior and posterior bleeding
P ressure

Apply pressure over the nose with compression device or fingers
I rrigate

Irrigate with warm water
S ilver nitrate

Apply silver nitrate locally, if anterior vessel identified
T ampons

Insert anterior nasal or posterior balloon tampons
A frin

Oxymetazoline can be sprayed in the nose as part of conservative treatment or applied on tampon
t X A

Apply TXA as gel or solution on tampon
I nterventional radiology

Contact interventional radiology for embolization in conjunction with ENT surgeon
S urgical consultation

Obtain an early ENT consult for severe or high risk bleeding

Anterior bleeding

Contributes to majority of cases
Occurs at the watershed area known as Kiesselbach’s plexus
Posterior bleeding

Contributes to severe cases
Arises from branches of the sphenopalatine artery (rare cases involve the carotid artery)


Causes include direct trauma, nose picking, irritation, dryness
Associated with bleeding dyscrasia, congenital or traumatic arterio-venous malformations, anticoagulation, neoplasm
The majority of bleeding is self-limited and easily controlled.
Epistaxis Solutions in the ED

Recurrent or intractable bleeding has led to the development of management algorithms in the urgent care setting.2,3

Examine/Ensure secure airway

Attempt to visualize site of bleeding. Have patient gently blow nose to clear the clots. Obtain adequate lighting and use a nasal speculum, if available.


As with any bleed, compression is key. Fatigue becomes an issue as patients tire of squeezing their nose. There are commercially available nasal compression clips, but in a pinch (get it?) you can create your own with tongue blades as demonstrated in this trick of the trade.


Irrigation of the nares can improve visibility. Warm-water irrigation has been demonstrated to facilitate hemostasis in posterior bleeds by causing mucosal edema that constricts vessels.4

Silver Nitrate/Cautery

If a bleeding anterior vessel is identified, an attempt at chemical or electrical cautery can be made. Silver nitrate sticks offer an easily accessible and efficacious option.5


Avoid bilateral septal cautery to prevent septal perforation.
Carefully apply silver nitrate very focally on the mucosa being sure not to touch the skin, because it can accidentally burn and stain it (e.g. patient’s nasal ala) black.6

Nasal tampons, often made of Merocel, are used for nasal packing. Patients may be pre-treated with topical lidocaine (2%) and/or oxymetazoline. Nasal tampons can be coated with bacitracin for lubrication before inserting along the nasal floor. Apply saline to expand the tampon. Tampons can also be inserted into the contralateral nostril for further compression.

Balloon catheter tampons provide an alternative option and can target posterior bleeding. They contain an internal balloon that is inflated for extra pressure. Such products have been shown to be easier to use and better tolerated; however, the efficacy is similar to Merocel tampons.7,8

If such balloon catheter tampons are not readily available for difficult cases of posterior bleeding, Foley catheters can be used.9 Insert a 10 or 12 French catheter so that the balloon lies in the nasopharynx. Inflate the balloon with 15 mL of saline, and then apply light forward traction on the catheter to tamponade the bleeding posterior vessels. If bleeding persists anteriorly or into the oropharynx, the balloon can be incrementally inflated up to 30 mL. Avoid inflation with air as the pressure can be lost over time.

Caution should be taken to avoid packing if there is concern for facial fractures.


Oxymetazoline (Afrin), a selective alpha-1 adrenergic receptor agonist and partial alpha-2 receptor agonist, has been shown to be an effective vasoconstrictor even for posterior bleeding.10 Use cautiously in hypertensive patients because elevated blood pressure may contribute to further bleeding. One trick is to apply oxymetazoline directly onto the tampons after insertion. This allows cotton to expand while also providing vasoconstriction.


The use of tranexamic acid (TXA) in epistaxis and mucosal bleeding has been a topic of interest. While research is equivocal, studies are promising regarding TXA application for nasal packing.11–13 The TXA dosing in Zahed et al.’s paper was 500 mg in 5 mL, applied on the nasal tampon.11

Interventional Radiology or Surgery

ENT consultation should be obtained in a timely manner for severe, refractory bleeding that may require intravascular embolization or surgical ligation.


Patients with posterior epistaxis and packing should be admitted to the hospital for observation and ENT consultation.14 These patients may be at higher risk for bradydysrhythmias and recurrent bleeding, requiring surgery. Patients with anterior epistaxis who are hemostatic can be discharged home, assuming stable laboratory testing and vital signs. If they have nasal tampons in place, arrange ENT follow-up at 24-48 hours for re-evaluation and removal of tampons. The routine use of antibiotics to prevent toxic shock syndrome and sinus infections remains debated.

1. Pallin D, Chng Y, McKay M, Emond J, Pelletier A, Camargo C. Epidemiology of epistaxis in US emergency departments, 1992 to 2001. Ann Emerg Med. 2005;46(1):77-81. [PubMed]
2. Traboulsi H, Alam E, Hadi U. Changing Trends in the Management of Epistaxis. Int J Otolaryngol. 2015;2015:263987. [PubMed]
3. Newton E, Lasso A, Petrcich W, Kilty S. An outcomes analysis of anterior epistaxis management in the emergency department. J Otolaryngol Head Neck Surg. 2016;45:24. [PubMed]
4. Novoa E, Schlegel-Wagner C. Hot water irrigation as treatment for intractable posterior epistaxis in an out-patient setting. J Laryngol Otol. 2012;126(1):58-60. [PubMed]
5. Shargorodsky J, Bleier B, Holbrook E, et al. Outcomes analysis in epistaxis management: development of a therapeutic algorithm. Otolaryngol Head Neck Surg. 2013;149(3):390-398. [PubMed]
6. Maitra S, Gupta D. A simple technique to avoid staining of skin around nasal vestibule following cautery. Clin Otolaryngol. 2007;32(1):74. [PubMed]
7. Badran K, Malik T, Belloso A, Timms M. Randomized controlled trial comparing Merocel and RapidRhino packing in the management of anterior epistaxis. Clin Otolaryngol. 2005;30(4):333-337. [PubMed]
8. Singer A, Blanda M, Cronin K, et al. Comparison of nasal tampons for the treatment of epistaxis in the emergency department: a randomized controlled trial. Ann Emerg Med. 2005;45(2):134-139. [PubMed]
9. Ho E, Mansell N. How we do it: a practical approach to Foley catheter posterior nasal packing. Clin Otolaryngol Allied Sci. 2004;29(6):754-757. [PubMed]
10. Doo G, Johnson D. Oxymetazoline in the treatment of posterior epistaxis. Hawaii Med J. 1999;58(8):210-212. [PubMed]
11. Zahed R, Moharamzadeh P, Alizadeharasi S, Ghasemi A, Saeedi M. A new and rapid method for epistaxis treatment using injectable form of tranexamic acid topically: a randomized controlled trial. Am J Emerg Med. 2013;31(9):1389-1392. [PubMed]
12. Kamhieh Y, Fox H. Tranexamic acid in epistaxis: a systematic review. Clin Otolaryngol. 2016;41(6):771-776. [PubMed]
13. Tibbelin A, Aust R, Bende M, et al. Effect of local tranexamic acid gel in the treatment of epistaxis. ORL J Otorhinolaryngol Relat Spec. 1995;57(4):207-209. [PubMed]
14. Supriya M, Shakeel M, Veitch D, Ah-See K. Epistaxis: prospective evaluation of bleeding site and its impact on patient outcome. J Laryngol Otol. 2010;124(7):744-749. [PubMed]

 2013 Sep;31(9):1389-92. doi: 10.1016/j.ajem.2013.06.043. Epub 2013 Jul 30.

A new and rapid method for epistaxis treatment using injectable form of tranexamic acid topically: a randomized controlled trial.



Epistaxis is a common problem in the emergency department (ED). Sixty percent of people experience it at least once in their life. There are different kinds of treatment for epistaxis. This study intended to evaluate the topical use of injectable form of tranexamic acid vs anterior nasal packing with pledgets coated with tetracycline ointment.


Topical application of injectable form of tranexamic acid (500 mg in 5 mL) was compared with anterior nasal packing in 216 patients with anterior epistaxis presented to an ED in a randomized clinical trial. The time needed to arrest initial bleeding, hours needed to stay in hospital, and any rebleeding during 24 hours and 1 week later were recorded, and finally, the patient satisfaction was rated by a 0-10 scale.


Within 10 minutes of treatment, bleedings were arrested in 71% of the patients in the tranexamic acid group, compared with 31.2% in the anterior nasal packing group (odds ratio, 2.28; 95% confidence interval, 1.68-3.09; P < .001). In addition, 95.3% in the tranexamic acid group were discharged in 2 hours or less vs 6.4% in the anterior nasal packing group (P < .001). Rebleeding was reported in 4.7% and 11% of patients during first 24 hours in the tranexamic acid and the anterior nasal packing groups, respectively (P = .128). Satisfaction rate was higher in the tranexamic acid compared with the anterior nasal packing group (8.5 ± 1.7 vs 4.4 ± 1.8, P < .001).


Topical application of injectable form of tranexamic acid was better than anterior nasal packing in the initial treatment of idiopathic anterior epistaxis.