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At least 433 records · Page 24Linked to original sources
PubMed1988

Pneumatic anti-shock garment: state of the art 1988.

The responses of hypovolemic patients would be expected to be similar to experimental animals that were hypovolemic. Normovolemic patients would be expected to respond as do the normovolemic experimental animals. Hypovolemic patients do not necessarily respond the same as do normovolemic patients or volunteers. The amount of external pressure applied by the device is directly proportional to the amount of tissue pressure increase. Tissue pressure is transmitted to the vessel as reduction transmural pressure, or in change in the size of the vessels and subsequent increase in SVR. Patient response to external pressure varies with the amount of device pressure. The optimal pressure of the PASG is in the range of 60 to 80 torr. Although exceeding this value does not appear to be necessary, it is not harmful in the short term (less than 90 minutes). Using less pressure reduces the SVR and, therefore, the blood pressure response. Keeping the external pressure at approximately 40 torr appears to be ideal for hemorrhage control. Of the more than 300 articles that have appeared in the recent literature addressing the PASG, at least 190 have discussed specific scientific experiments in the animal laboratory, in the human laboratory, or in the clinical environment, in which results gathered addressed how, why, or if the PASG worked. These studies demonstrate that the PASG does, in fact, improve blood pressure, control hemorrhage, improve carotid and upper body blood flow, improve the ability of the prehospital provider to start IV lines, and improve survival (particularly short-term) with few hospital and even fewer prehospital complications. The device produces its blood pressure response by improving preload, increasing SVR, and mobilizing some blood (500 to 1,000 mL) to the upper body compartment above the device. These responses are most probably produced by decreasing the radius of the vessels compressed by the device, decreasing the compartment volume, and differentially affecting the blood flow without and within the device. Hemorrhage is controlled by increasing the external pressure on the vessel by the transmitted increased tissue pressure, reducing the vascular lumen, and reducing the area of the laceration. Short-term survival is improved by decreasing intra-abdominal hemorrhage and improving perfusion (maintaining better oxygenation in the heart-brain-lung circulation.) Long-term survival is improved because the device controls hemorrhage, maintains blood pressure, and allows delivery of the severely injured patient to the trauma center and within the hospital while awaiting an OR, as in the case of a leaking aortic aneurysm.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1988

MAST application in the treatment of paroxysmal supraventricular tachycardia in a child.

A case of paroxysmal supraventricular tachycardia (PSVT) in a child with successful termination of the arrhythmia by military antishock trouser (MAST) application is described. The use of MAST application in terminating PSVT in adults has been previously reported. Ours is the first such case reported using this method in the therapy of PSVT in children. Our report suggests that MAST application may be another maneuver to add to those vagal maneuvers known to be of benefit in the termination of PSVT in children as well as in adults.

Child↗
PubMed1988

More on MAST.

Explore the source record for details and available documents.

Clinical Trials as Topic↗
PubMed1989

Management of hemorrhage from severe scalp lacerations with Raney clips.

A 23-year-old man was assaulted about the head and face with a wrench, sustaining multiple severe scalp lacerations. Massive bleeding from the lacerations ensued, resulting in refractory hypovolemic shock. Emergency department control of this hemorrhage was accomplished by the application of Raney clips to the edges of the scalp lacerations. Following stabilization and radiologic studies, the patient was admitted to the ICU, where his scalp wounds were managed definitively. The remainder of his hospital course was unremarkable, and he was discharged on the third hospital day to be followed in the surgical clinic as an outpatient.

Adult↗
PubMed1989

Treatment of uncontrolled hemorrhagic shock by hypertonic saline and external counterpressure.

The effect of an external counterpressure device (ECPD) on hypertonic saline treatment of uncontrolled hemorrhagic shock (UCHS) was studied in rats. The rats were divided into five groups. In group 1 (n = 11) UCHS induced by incision of three radicals of the ileocolic artery was treated by 5 mL/kg NaCl 0.9% (normal saline). In group 2 (n = 20), UCHS was treated by 5 mL/kg NaCl 7.5% (hypertonic saline). In group 3 (n = 6), UCHS was treated by inflation of ECPD to 50 torr. In group 4 (n = 7), UCHS was treated by ECPD and normal saline; in group 5 (n = 9), UCHS was treated by ECPD and hypertonic saline. Incision of the ileocolic artery in group 1 rats led to a fall in mean arterial pressure to 33 torr (P less than .001) followed by a spontaneous rise to 48 torr (P less than .01) with a mortality rate of 27% and a mean survival time of 161 +/- 9 minutes. Infusion of hypertonic saline during UCHS was followed by a further fall in mean arterial pressure to 18.5 torr (P less than .001); mortality was 80% within 80 minutes with a mean survival time of 35.5 minutes, which was significantly lower than in group 1 (P less than .01). Inflation of ECPD during UCHS in group 3 or treatment with ECPD and normal saline in group 4 did not alter the hemodynamic response and mortality, which were similar to those of group 1.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2000

Abdominal haemorrhage--a preventable cause of death after field stabilization?

The causes of preventable death vary in different operational settings, and the topic has not previously been explored in a fully developed central European rescue system. The factors associated with potentially preventable death were studied in a retrospective study of 430 fatal traffic accident victims (1980-96) in Lörrach County, Germany. Mission protocols could be retrieved for detailed analysis in 239 of the cases. These were studied in order to identify factors associated with preventable death. At the scene of the accident, 38% of the patients died without cardiopulmonary resuscitation (CPR) and 18% after CPR. Four patients died after a certain delay without CPR before reaching hospital. A total of 43% of the victims were admitted to hospital, 5% had received prehospital CPR and the remaining 38% had not. In a subgroup representing the experience of a single emergency physician 60 fatalities were studied. Of these, 27 (45%) patients died within the hospital; almost half of these cases (13/27) had been conscious at some time after the accident and of these, seven (7/13) died from intra-abdominal bleeding within 4 h after admission. The same cause of death was found in 3 of the 14 comatose patients. Pleural drainage was carried out in four patients and unrecognized pneumothoraces or spinal injuries did not occur. Tracheal intubation was employed in 24/27. Medical antishock trousers (MAST) were not available. The data indicate that intra-abdominal haemorrhage is an underestimated cause of death in a comprehensive rescue system, possibly as a consequence of field stabilization. The use of MAST may be a relevant therapeutic option to prevent these fatalities. The method offers the possibility of intra-abdominal compression and haemostasis after tracheal intubation has been performed. Previous controlled studies on MAST may have been biased by faulty methodology (e.g. absence of tracheal intubation) and inappropriate indications (e.g. other causes of shock). The value of MAST in comprehensive rescue systems should therefore be reassessed. The difficulties in identifying factors leading to preventable death in a retrospective analysis, are discussed and it is recommended that a permanent prospective quality control be performed in all cases of fatal accidents in order to ensure the continued improvement of prehospital emergency medical systems.

Abdominal Injuries↗
PubMed2000

Alternative methods of mechanical cardiopulmonary resuscitation.

Due to the relative ineffectiveness of standard resuscitation techniques, alternative methods have been explored for many years. The aim of new methods is to improve haemodynamics and increase survival rates. In spite of some encouraging haemodynamic results, all but one study failed to show an increase in long-term survival rates with an alternative method in a convincingly large group of patients (hospital discharge without neurological damage, and 1-year survival). In this study active compression-decompression resuscitation (ACD-CPR) increased long-term survival compared to standard-CPR. The results from certain individual studies, which showed a significant increase in short-term survival rate, could not be reproduced in other trials. This may be attributed in part to the fact that the alternative methods are not significantly superior, but also due to logistical and statistical problems in the conduct of the studies and differences in application within and between the study sites. ACD-CPR has been the most studied method amongst the alternatives and can be recommended for patients with asystole in centres with special training and where outcome quality is regularly verified and evaluated.

Animals↗
PubMed1998

Comparison of the characteristics and features of pressure garments used in the management of burn scars.

Two companies provide custom-made pressure garments to clients with burn scars at Westmead Hospital. This prospective study was completed in order to make objective decisions about which garments were most appropriate and cost effective to provide to clients. Issues such as cost, durability, fit and client preferences were investigated. Data were collected from 43 clients; at the time of initial fitting, at a follow-up appointment 4-6 weeks later, and at the time one of the garments required replacement. One Second Skin and one Jobst garment were provided to each client and the garments were compared using therapists' evaluation and clients' perspectives on a number of variables. Second Skin garments had significantly more favourable results on the variables of time for delivery, fit at follow-up, garment design, quality of fabric and seams, overall satisfaction and garment preference for ongoing wear. On all other variables there was no significant difference between the garments. Second Skin provided the most optimal and appropriate option for pressure garments in the management of burn scars for our clients.

Adolescent↗
PubMed1976

Prehospital use of the military anti-shock trouser (MAST).

Complications of prehospital use of the military anti-shock trouser (MAST) in treating hypotensive and hypovolemic patients have been few and minor. Undesirable consequences--compromised respiratory excursion or autonomic disturbances such as emesis, urination or defecation--were rare. Forty-seven (88.7%) of 53 patients with conditions classed as potentially lethal or severe survived. Close communications between prehospital and emergency department personnel can assure accurate transmission of circumstances of MAST application and result in optimal responses and improved inhospital patient care. Both "false positives" (supposed initial hypotension or hypovolemia) and "false negatives" (seeming stability in the face of major anatomic derangements) require a carefully structured operational sequence. Further evaluation of the device, particularly in cardiovascular/cardiopulmonary cases, is in progress.

Allied Health Personnel↗
PubMed1979

Metabolic acidosis with pneumatic trousers in hypovolemic dogs.

To evaluate the possibility of anaerobic metabolism occurring beneath pneumatic trousers because of the decreased circulation, 20 mongrel dogs were evaluated for central and femoral vein levels of lactic acid, potassium and central pH changes when the trouser pressure was both above and below systolic arterial pressure. The results indicate that if the systolic pressure is less than trouser pressure, there is a significant increase in both potassium and lactic acid levels. There was a drop in the central pH accompanying these metabolic changes. When the pneumatic trouser pressure was less than systolic arterial pressure, changes in anaerobic metabolism were present but not nearly as great. This change was much closer to that in the central circulation and may result from other factors. Based on these results, trouser inflation pressure should not exceed that required to achieve adequate arterial pressure. Deflation should be started as soon as possible and be gradual.

Acidosis↗
PubMed2002

Mechanical devices for cardiopulmonary resuscitation: an update.

Despite the promise and universal use of the Kouwenhoven technique for closed chest cardiac massage, this method has been shown repeatedly to suffer from lack of clinical efficacy. Although the Kouwenhoven technique can clearly save lives, the inherent inefficiency of this approach and the challenges related to teaching and retaining the skills needed to perform the technique correctly have limited its overall effectiveness. This has prompted the development of newer lifesaving CPR techniques and devices. Some of the advances, such as the vest approach, active compression-decompression, and the impedance threshold valve, offer a benefit when compared with the Kouwenhoven technique. It is clear, however, that challenges related to implementation of these newer approaches will determine their ultimate utility. It is not sufficient to have a better technique or device available. Challenges to implementation of the newer approaches include overcoming the inertia of a universal mindset on the already-familiar Kouwenhoven technique and creating a cost-effective justification for change. Each year, approximately 10 million people in the United States are trained in the Kouwenhoven technique. Americans spend nearly $500,000,000 annually on this form of CPR training and retraining. Given the less than 5% survival rate for the 300,000 patients who experience out-of-hospital cardiac arrest each year in the United States, the prudence of this societal investment when compared with other ways health care dollars are spent should be questioned. It is hoped that this mismatch between costs and benefits will be recognized and will lead to the adoption of more effective means to resuscitate patients.

Cardiopulmonary Resuscitation↗
PubMed1996

Prehospital interventions.

This article examines a number of areas in emergency prehospital care that the authors view as important and controversial. It offers a Canadian perspective on international research done in the field of prehospital care, and it is not intended to suggest recommendations for the American prehospital care environment. The discussion is not encyclopedic. The authors believe that the areas discussed merit further research and analysis.

Air Ambulances↗
PubMed1984

The incidence of myoglobinuria in patients with pneumatic trousers.

The possible association between the use of pneumatic trousers and myoglobinuria was investigated. One hundred and four victims of multiple trauma were entered into a study over a three-month period. Patients who suffered serious injuries to two or more organ systems qualified for entrance into the study. Patients who arrived at the emergency department with inflated pneumatic trousers served as the test population (n = 50), and patients who did not have pneumatic trousers served as the controls (n = 54). Urine specimens were obtained from all patients just before the completion of their treatment in the emergency department. No patients in the control group had myoglobinuria 0%), and only one patient in the test group had myoglobinuria 2%). The results were not statistically significant. Myoglobinuria is not an acute complication of the use of pneumatic trousers. The presence of pneumatic trousers on a multiple-trauma patient is not an indication for routine screening for myoglobinuria in the emergency department.

Adult↗
PubMed1990

[Antishock trousers in the prevention of air embolism].

This study aimed to assess the efficiency and safety of military anti-shock trousers (MAST) in preventing venous air embolism in children undergoing neurosurgical procedures in the sitting position. It included 26 children, 7.7 +/- 4-year-old and weighing 25.4 +/- 10.5 kg. All had the same anaesthetic protocol including premedication with oral lorazepam, induction with thiopentone or propofol with fentanyl and vecuronium, and maintenance with isoflurane and a continuous infusion of fentanyl. In 10 patients, a retrograde central venous catheter was inserted for measurement of pressure in the superior bulb of the internal jugular vein. Haemodynamic measurements were carried out with the patient supine; with the patient sitting, the MAST not being inflated; 10 min after inflation of the MAST (40 mmHg in the limbs, 30 mmHg in the abdominal part); after starting 10 cmH2 O positive end expiratory pressure; and after fluid administration with 5 ml.kg-1 macromolecules (Plasmion). The criterion for air embolism was a decrease in PetCO2 of more than 5 mmHg over more than 30 s, not preceded by respiratory or cardiovascular impairment. Inflation of the MAST resulted in a dramatic rise in venous pressure, still reinforced by minor PEEP. Transmission of pressure from the right atrium to the dural sinus was linear, and seemed to be sufficient to prevent occurrence of detectable venous air emboli. No deleterious side-effects were noted. This method would therefore seem to be very efficient, preserving the advantages of the sitting position, and restricting its disadvantages. Unfortunately, the limited availability of different paediatric sizes of MAST reduces the possible uses of this method.

Adolescent↗
PubMed1988

[Crush injury of the lower limbs. Use of anti-shock trousers].

A case of lower limb crush injury is reported. A 16 year old female sustained severe soft tissue, muscle, skeletal and vascular lesions during a road traffic accident. She rapidly presented with severe haemorrhagic shock due to a popliteal arterial injury. At the scene, massive vascular loading by emergency physicians using both colloids and group O negative packed red cells was not enough to improve the haemodynamic state, even though there was adequate control of the bleeding artery. The pneumatic antishock trousers were therefore used despite the severe injuries to the legs, with rapid improvement of the haemodynamic parameters. By using bilateral femoral nerve blocks, the limb fractures were reduced rapidly; this decreased ischaemic time and allowed correct placement of the garment. Although the left leg was amputated above the knee, the postoperative course was uneventful. The authors insist on the important part such early management at the scene plays in preventing acute post-traumatic renal failure.

Acute Kidney Injury↗