Teaching wound packing has always been challenging as there are few good wound packing models. The Phokus wound cube has 4 different wound profiles and has a realistic texture. In this short video, see the wound cube packed with Combat Gauze, Kerlix Gauze, the XStat 12, and a Foley Catheter.
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The Phokus wound cube is an excellent table top wound packing trainer with four different wounds.
In this video we pack the Wound Cube with four different materials.
Packing a Laceration Wound
The laceration is packed in a standard fashion: step 1 – find the point of bleeding, step 2 – wrap a small portion of gauze on your finger tip, step 3- place that first piece of gauze at the point of bleeding and then fill the entire wound with gauze, step 4 – “open up” the wound to allow more gauze to fit. This “overfilling” is what generates the pressure on the bleeding source.
In this laceration you’ll be filling horizontally, compared to more “shot glass” like wounds which fill bottom to top.
In the video, Combat Gauze was used, which as a hemostatic requires three minutes of direct pressure after the wound is packed for clotting to occur.
Packing a large, "Flashlight" Wound
This wound was originally designed to have a small flashlight inserted into it to help see how well the other wounds were packed. Newer version of the Wound Cube have turned this into another narrow track wound.
It’s packed the same as the laceration, but here, with the narrow wound track, you can see why we start with a small bit of gauze at our finger tip. A larger lump of gauze or a “speedball” as some call it, just won’t fit in the wound.
Similar to a hemostatic gauze, after packing with cotton or “kerlix” gauze, we would also hold several minutes of direct pressure. How long? Some say ten minutes with plain gauze. I’ve never seen it studied.
XSTAT in a large or narrow track wound
XSTAT pellets expand when they come into contact with liquid. This expansion provides direct pressure to the point of bleeding. Once again, its important to try and identify the point of bleeding, as that is your target area for initial deployment of the compressed pellets.
Insert the XSTAT applicator and deploy pellets while withdrawing the applicator. XSTAT can be ideal for very narrow track wounds with the smaller applicator.
Technically, the pellets provide their own direct pressure so additional direct pressure on the packed would isn’t considered necessary, but still seems like a good idea.
Wound Packing with Foley Catheter Ballon Tamponade
Our final technique is packing this large wound with a Foley catheter. You’ll remember the balloon inflates and can apply direct pressure from within the wound. In this case, it is a 10 milliliter balloon. They also make a 30 milliliter balloon.
Steps, we insert this to the belly of the wound. This technique is best studied in neck wounds. We inflate the balloon. One thing to remember is this catheter is made to drain urine out of your bladder, so blood could be coming out of the end of this tube. You have a couple of choices: you can just clamp it, or you can knot it off. Obviously, you can’t knot it off until after you fill the balloon or you’d never be able to fill the balloon.
The balloon then tamponades bleeding directly into the wound belly.