/ Tranexamic Acid ampoules found in Wye Valley

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Martin Southville 05 Feb 2020

I climbed at Wyndcliff Quarry for the first time today. 

Laying beside the path of Upper Lift (Left) were 2 spent 500mg ampoules of Tranexamic Acid. They looked like they'd been discarded recently. I scooped them up in an old coffee cup and disposed to them properly when I got home. 

With a little research I found out that this is included in some first aid kits, used to slow bleeding. It can also be used immediately after head trauma to reduce the chance of brain injury. 

If they were used for that reason, my thoughts are with the unfortunate person who had to use them and I hope they are recovering well.

No incidents have been reported on www.incidents.thebmc.co.uk but I am still concerned for whoever consumed the medicine. If anyone knows any details that could put my mind at ease, I'd appreciate knowing. Furthermore, is this something I should carry in my first aid kit? 

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Roadrunner6 05 Feb 2020
In reply to Martin Southville:

No, for a start if you need them it's serious and you are giving them to someone else. You have no idea how much to give, why etc. Doesn't it need to be prescribed?

As a first Aider we (I'm not anyway) aren't qualified to make that decision.

Reading a bit it sounds like they could just be taken for heavy bleeding in menstrual cycle. Any prolonged bleed, maybe nose bleeds?

Post edited at 19:52
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Stichtplate 05 Feb 2020
In reply to Martin Southville:

You don’t want to be buggering about with TXA if you’re not medically trained and you definitely don’t need it in your first aid kit.

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wintertree 05 Feb 2020
In reply to Stichtplate:

Would would you recommend for the untrained?  I keep a pack of celox granules and some celox dressings in my kits.  I figure if I ever have to use them it can hardly make things worse...

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Stichtplate 05 Feb 2020
In reply to wintertree:

> Would would you recommend for the untrained?  I keep a pack of celox granules and some celox dressings in my kits.  I figure if I ever have to use them it can hardly make things worse...

Celox is a haemostatic applied at the site of the bleed to promote rapid coagulation. TXA is usually administered intravenously and acts to prevent the break down of clots. It can also drop blood pressure significantly, cause convulsions and is contra indicated for a number of conditions. Celox is relatively benign and non-intrusive, TXA could make things considerably worse if administered inappropriately.

Edit: and I'd maybe bin the celox granules and stick with the gauze. If you use the granules in typical windy mountainside conditions and they get blown into your eyes, you're not going to be a happy bunny.

Post edited at 21:20
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wintertree 05 Feb 2020
In reply to Stichtplate:

Thanks for the comments.  I’d not heart of TXA before.  Having once had a near unstoppable nosebleed far from anywhere I’m suddenly inreagued...

> Edit: and I'd maybe bin the cellox granules and stick with the gauze. If you use the granules in typical windy mountainside conditions and they get blown into your eyes, you're not going to be a happy bunny.

Ouch, yes that could be awful!  The granules live in my household and car packs only - worth putting some goggles in there to and covering any eyes with cloth.

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Stichtplate 05 Feb 2020
In reply to wintertree:

If you're really interested celox regularly run catastrophic haemorrhage courses covering everything from direct pressure and wound packing right through to haemostatics and tourniquets. The courses are attended mainly by emergency services bods but I'd also highly recommend them to anyone who regularly finds themselves dicking about with a chainsaw. Cost 10 or 15 quid to attend and last a couple of hours.

This was the last one they ran, but they do them fairly regularly.

https://www.eventbrite.co.uk/e/catastrophic-haemorrhage-cpd-celox-tickets-78103039293#

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Martin Southville 05 Feb 2020
In reply to Roadrunner6:

> they could just be taken for heavy bleeding in menstrual cycle. Any prolonged bleed, maybe nose bleeds?

There was something about the way they were just tossed aside in an otherwise litter-free area that suggested this was not a climber routinely medicating a reoccurring condition. Whoever left these behind was either motivated by some higher priority or was in a hurry. 

A guy at the crag suggested it might be performance enhancing. At the time that idea fitted the profile of a litterer in the same way people who use nos as a recreational drug seem to enjoy leaving piles of the chargers behind them. But there seems to be no performance enhancing effect and it was a 6a/6b crag so who's doping themselves to say they ascended that?! 

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wintertree 05 Feb 2020
In reply to Stichtplate:

Thanks!  I’ll keep an eye out for a local course.

Oddly enough my purchase of these happened shortly after I got a chainsaw - although I wish I’d had them a decade before when I walked over a collapsed fence and stood on an exposed rusty nail.  Lost about a pint down the bathtub drain before I got the ****** to stop bleeding.

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Stichtplate 05 Feb 2020
In reply to Martin Southville:

> There was something about the way they were just tossed aside in an otherwise litter-free area that suggested this was not a climber routinely medicating a reoccurring condition. Whoever left these behind was either motivated by some higher priority or was in a hurry. 

I would imagine they'd been misplaced on scene by either ambulance or helimed personnel. The threshold for administering TXA is pretty high; either catastrophic haemorrhage (meaning in immediate danger of bleeding out) or suffered a major traumatic injury (lost a hand, broke both femurs etc.). On top of that, to administer the presentation you describe you'd first have to correctly insert a cannula into a vein, flush it with saline, steadily administer the TXA over 10 minutes and then flush again with saline, all that after first checking you've got a systolic blood pressure over 90 and no contra indications.

I can only repeat, this is not something your typical punter should have been messing about with.

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SAF 05 Feb 2020
In reply to wintertree:

If it was your foot then pressure from a  standard absorbant dressing and elevation (lie down stick your foot in the air) would have been your best course of action. Gravity is an amazing thing.

Learning how to apply proper pressure dressings would be far more useful at a first aid level, rather than messing about with fancy stuff that barely even gets used in the ambulance service (most goes out of date and in the bin).

We used to carry a brilliant dressing called a "blood stopper" on the ambulance (until the trust decided they were too expensive), a basic absorbant dressing/bandage with an extra 'sausage' of dressing that you lie perpendicular to the wound on top of the absorbant dressing and then tightly bandage down on top of it. Great for getting some really good pressure. You can just use a spare rolled up bandage to do the same job.

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Martin Southville 05 Feb 2020
In reply to Stichtplate:

> I would imagine they'd been misplaced on scene by either ambulance or helimed personnel. The threshold for administering TXA is pretty high; either catastrophic haemorrhage (meaning in immediate danger of bleeding out) or suffered a major traumatic injury (lost a hand, broke both femurs etc.).

Shit. So you're pretty certain that some serious injury did recently occur on the route that I climbed this afternoon. I repeat what I said earlier, I hope they're OK now. 

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wintertree 05 Feb 2020
In reply to SAF:

A very sensible post.  A serious first aid course has been on my todo list for far too long.

The main problem was being torn between wanting to stop the bleeding and wanting to encourage it to make sure no rusty nail or agricultural gunk was left in the hole...

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SAF 05 Feb 2020
In reply to Stichtplate:

>  all that after first checking you've got a systolic blood pressure over 90 and no contra indications.

It can be given with a bp less than 90 systolic.

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geordiepie 05 Feb 2020
In reply to Martin Southville:

Did you see blood anywhere? 

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Stichtplate 05 Feb 2020
In reply to Martin Southville:

> Shit. So you're pretty certain that some serious injury did recently occur on the route that I climbed this afternoon.

Not at all. Don't know the area but mountain bikers are extremely proficient at tw*tting themselves good style and even members of the general public out for a stroll, are remarkably adept at throwing themselves down any available incline for maximum effect.

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Queenie 05 Feb 2020
In reply to Martin Southville:

Pretty commonly taken for heavy periods, 500mg. No prescription needed in Italy and maybe other parts of Europe.

Post edited at 22:35
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Stichtplate 05 Feb 2020
In reply to SAF:

> It can be given with a bp less than 90 systolic.

You're absolutely correct. That should be systolic of <90 as an indicator of major trauma. 

(I blame a couple of beers and the lowly status of NQP1 )

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All999 05 Feb 2020
In reply to Stichtplate:

> I would imagine they'd been misplaced on scene by either ambulance or helimed personnel. The threshold for administering TXA is pretty high; either catastrophic haemorrhage (meaning in immediate danger of bleeding out) or suffered a major traumatic injury (lost a hand, broke both femurs etc.). On top of that, to administer the presentation you describe you'd first have to correctly insert a cannula into a vein, flush it with saline, steadily administer the TXA over 10 minutes and then flush again with saline, all that after first checking you've got a systolic blood pressure over 90 and no contra indications.

> I can only repeat, this is not something your typical punter should have been messing about with.

A blood pressure less than 90 systolic is one of the main indications for TXA.... patients with catastrophic bleeds won’t be maintaining a good blood pressure for long! 

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Stichtplate 05 Feb 2020
In reply to All999:

> A blood pressure less than 90 systolic is one of the main indications for TXA.... patients with catastrophic bleeds won’t be maintaining a good blood pressure for long! 

Yep, see above. 

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Martin Southville 05 Feb 2020
In reply to geordiepie:

> Did you see blood anywhere? 

I wasn't looking for blood because at the time as my hypothesis was that some shirtless macho gym-bros had necked a performance enhancing serum and tossed it aside. It was only when I got home I learned it was emergency medicine and then got concerned. If there are blood traces they are small, I certainly didn't step in a puddle of it. 

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All999 05 Feb 2020
In reply to Stichtplate:

You might want to edit your post then!😉

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Martin Southville 05 Feb 2020
In reply to Queenie:

> Pretty commonly taken for heavy periods, 500mg. No prescription needed in Italy and maybe other parts of Europe.

OK. There is of course the possibility that a woman placed them to one side with the intention of collecting as she left but then forgot. In which case I've painted this elaborate fictional drama and may have caused some embarrassment. If so I apologise. At least a few more people have learned about Tranexamic Acid. 

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Stichtplate 06 Feb 2020
In reply to Martin Southville:

> OK. There is of course the possibility that a woman placed them to one side with the intention of collecting as she left but then forgot. 

I wouldn't have thought so. The presentation you describe (1g/10ml) is for injecting rapidly into the bloodstream to reduce life threatening bleeding. Typical mode of delivery for reducing heavy menstruation is 500mg tablets for slow release through the stomach lining.

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Kean 06 Feb 2020
In reply to Stichtplate:

The clot thickens!

(chortle chortle...sorrrryyyy!)

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deacondeacon 06 Feb 2020
In reply to Martin Southville:

>  my hypothesis was that some shirtless macho gym-bros had necked a performance enhancing serum and tossed it aside. 

At Wyndcliff? That seems a little unlikely lol

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Stichtplate 06 Feb 2020
In reply to Stichtplate:

> I wouldn't have thought so. The presentation you describe (1g/10ml) is for injecting rapidly into the bloodstream to reduce life threatening bleeding. Typical mode of delivery for reducing heavy menstruation is 500mg tablets for slow release through the stomach lining.

For 'stomach lining' read 'small intestine' (note to self; access to keyboard and beer is an either/or thing).

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Queenie 06 Feb 2020
In reply to Martin Southville:

No, sorry but I was wrong. I was thinking of caplets/tablets rather than ampoules. You weren't being overly dramatic. 

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Tricky Dicky 06 Feb 2020
In reply to SAF:

>  elevation (lie down stick your foot in the air) would have been your best course of action. Gravity is an amazing thing.

On the last St John first aid course that I did we were told that elevation was no longer recomended as it didn't have any appreciable effect.............

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Stichtplate 06 Feb 2020
In reply to Tricky Dicky:

> On the last St John first aid course that I did we were told that elevation was no longer recomended as it didn't have any appreciable effect.............

Apart from SAF clearly knowing their stuff, it's still best practice according to the joint royal college ambulance liaison committee and since they produce the clinical guidelines for all UK ambulance services I'd be inclined to take their word on it.

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CathS 06 Feb 2020
In reply to Martin Southville:

TXA is quite commonly prescribed by GPs (and available from pharmacists without prescription) for heavy periods, so as likely as anything else it was just for that.

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Roadrunner6 06 Feb 2020
In reply to CathS:

It was ampoules, not capsules/tablets. I misread too. So unlikely to be for a less serious event I'd have thought.

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Dave B 06 Feb 2020
In reply to Tricky Dicky:

I think the guidance changed from SEEP to SEPD as people were over emphasising the Elevate over Pressure and Dress. It meant even for small cuts on lower limbs people were being asked to raise their legs where it really wasn't necessary - and could have been an issue, say, for someone in a skirt or dress exposing their underwear, or making them immobile.. Elevation has its place, but the acronym should be applicable in ALL cases, not just some.

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OliverR17 07 Feb 2020
In reply to Martin Southville:

I'm afraid I cannot put your mind fully at ease. 

I'm not in a position to discuss this in depth, however there was a serious incident in the location you describe at the beginning of this year where such things were used. Whilst we made efforts to tidy up the medical waste and so on, our priority was the injured party and by the time the incident was concluded it was well after dark and the air support required had redistributed the litter created. It was my intention to revisit the area to litter pick at the end of last month, however we found ourselves unable to do so. 
 

It was also my intention to write up an incident report, however it was not appropriate at the time and again our priority was the injured party - whilst we vaguely know what happened, the facts are unclear to me and I am in no position to investigate further. If/when said parties recover, and if they are ready to share, I will support them in doing so.

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Bobling 07 Feb 2020
In reply to Martin Southville:

Good to see you getting out again Martin.

Welcome to the murky dark side of the sport.  I guess the down votes are for 'rubber-necking'...but I think that's a bit harsh myself.  It's human curiosity and it's obvious that you are struggling to reconcile your enjoyment of a route with what seems to have been a life changing experience, in a not good way, for someone else.  I'm afraid it's just a fact that people get hurt and worse climbing.  If you pick up the old Avon guide you'll find comments about fatalities on routes like the Arete and Giant's Cave Buttress.  

There's one route I have coveted for years but that I won't get on for the forseeable future as I know someone died on it a few years back.  Spooked.  The Russian (HVS 5a) at Symond's Yat is another well known 'chop' route.

On my last proper day out way back in August we spent the first hour of our day helping stretcher someone off the crag.  Climbing afterwards an instructor beside us trotted out the old line to his shaken group of novices that "You are more likely to get injured on the drive to the crag than at the crag".  Seems like bullsh*t to me, but I didn't take issue with him then.  Fact it it's a dangerous sport and bad stuff happens.  

What's my point? Make sure you are as safe as you can be, keep your eyes open and don't let your guard down.  It's a wonderful sport, and the risk is part of the allure, but when it bites it's not pretty. 

Sorry for the slightly morbid post.

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The Lemming 07 Feb 2020
In reply to Stichtplate:

> I would imagine they'd been misplaced on scene by either ambulance or helimed personnel.

I doubt if it was either ambulance or helimed. No matter what the situation, we put all our sharps away in the correct container. Well, almost always. You can't say always.

I can't think of a single person that I have worked with, that has left their sharps out, even if the proverbial has hit the fan. There is always time to put your toys away, back in the box.

Edit

Just seen OliverR17's reply

I think fading light and a giant fan blowing shit everywhere is a good enough excuse.

Post edited at 23:49
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The Lemming 07 Feb 2020
In reply to Tricky Dicky:

> >  elevation (lie down stick your foot in the air) would have been your best course of action. Gravity is an amazing thing.

> On the last St John first aid course that I did we were told that elevation was no longer recomended as it didn't have any appreciable effect.............


Got to agree with SAF, elevation is a great aid to stemming blood flow.

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Martin Southville 08 Feb 2020
In reply to OliverR17:

Thank you for the information Oliver. I do hope your friend makes a full recovery.

Your intention to revisit and litter pick doesn't appear to be required now. The ampules were the only items I could see and they are gone now.

Given the probability of the subject matter I was in 2 minds about whether to write the original post. I considered the recent trending of the article about discussing incidents to avoid complacency and decided that it might be important to ask. I have learned a lot from the responses.

As you are closest I will let you make the call on if you think this thread is appropriate. If you think it should be removed out of respect just say so and I will oblige. 

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Martin Southville 08 Feb 2020
In reply to Bobling:

> it's obvious that you are struggling to reconcile your enjoyment of a route with what seems to have been a life changing experience, in a not good way, for someone else.   

Thanks Bobling, you're spot on. We had the most pleasant day on Wednesday but later in the evening as I thought about those ampules and what they'd been used for it seemed almost unbelievable that such an incident had occurred in that same idyllic spot. The group next to us didn't even feel the need to wear helmets despite having the same guidebook as us which strongly advises them.

Climbing is not the first dangerous sport I have taken to although it is my most recent. I ride a motorbike and have done scuba diving, the training for both of which carry that ever-present sobering truth that mistakes hurt. Conditioning the head and muscle memory in the techniques of maintaining safety is part of the enjoyment for me. 

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LastBoyScout 09 Feb 2020
In reply to CathS:

We have some of the 500mg tablets mentioned - my wife was prescribed it after child birth.

1-2 tablets, 3 times a day.

Hope the other recipient is making some sort of recovery.

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Frank R. 09 Feb 2020
In reply to SAF:

Thanks to all the first responders here, it's a difficult job! And I hope the injured recovers.

> We used to carry a brilliant dressing called a "blood stopper" on the ambulance (until the trust decided they were too expensive), a basic absorbant dressing/bandage with an extra 'sausage' of dressing that you lie perpendicular to the wound on top of the absorbant dressing and then tightly bandage down on top of it. Great for getting some really good pressure. You can just use a spare rolled up bandage to do the same job.

That's a good tip! While I might carry the very latest and most expensive pressure dressing in my personal kit, getting the job done with what is in your average car FA kit (usually the worst and the cheapest) is all that matters for most people. Not that I support cutting of the more expensive and useful stuff for the ambulances, of course!

Post edited at 12:49
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