(mast/pasg) bad???

[alkalinefood]

medical anti-shock trousers (MAST)/pneumatic anti-shock garments (PASG) BAD?

I hear there not so good, but why? Whats the problem or problems with them, anyone know?

btw...

Does anyone knowany good sites for EMS Medical Journal Articles?Well... short journal articles relating to EMS and Medicne? :roll:

[Just Plain Ruff]

One more time for everyone

Google Scholar is the place I go to get the info I need on studies

http://scholar.google.com

type in the search field

Hit enter

Enjoy

But for the links you are wanting

http://scholar.google.com/scholar?hl=en&lr=&q=PASG

[ERDoc]

Also try pubmed.com but you must know how to read true research papers.

[Ridryder 911]

Yes, as said .. google and

Also try pubmed.com but you must know how to read true research papers.

So basically, if you do not know understand the above it is basically

PASG

Proven not to increase survivor rates or morbidity either.. thus no clinical indications to use them. As well, can potential cause further harm with delay of deflation procedures and increasing. Anecdotal reports have shown them to be successful in some situations, such as use in rural areas, with long transport times.

Studies: Many of the studies have been demonstrated to be flawed in that procedures of application, and use. As well, the level of trauma that was evaluated outcomes would had been poor to dismal, no matter what the treatment would be.

I highly recommend, for everyone to study recent studies and shock theories such as..... "permissive hypotension" and " no fluid resuscitation".. this is the current methodology that is being researched and studies as well as hypertonic saline, and initial synthetic blood or oxygen carrying fluids.

Again, the Google button is your friend.

R/r 911

[allison20]

In the EMT-B class, we were shown the mast pants, but are no longer trained on them. What they told us was that doctors didn't like them and took them out of most protacals. The 2 paramedics in class said that they DID work, and we are a rural ems, with level 1 tramas in the next state.

[UMSTUDENT]

Yes, as said .. google and

So basically, if you do not know understand the above it is basically

PASG

Proven not to increase survivor rates or morbidity either.. thus no clinical indications to use them. As well, can potential cause further harm with delay of deflation procedures and increasing. Anecdotal reports have shown them to be successful in some situations, such as use in rural areas, with long transport times.

Studies: Many of the studies have been demonstrated to be flawed in that procedures of application, and use. As well, the level of trauma that was evaluated outcomes would had been poor to dismal, no matter what the treatment would be.

I highly recommend, for everyone to study recent studies and shock theories such as..... "permissive hypotension" and " no fluid resuscitation".. this is the current methodology that is being researched and studies as well as hypertonic saline, and initial synthetic blood or oxygen carrying fluids.

Again, the Google button is your friend.

R/r 911

I've heard significant information to counter the studies that supposedly "disproved" the use of PASG; mostly regarding the studies that were conducted in Houston. Some people say that the studies were "out to get" the PASG. I know a lot of paramedics who still use them and swear by them from experience. Granted, many of these people work in rural environments.

[Ridryder 911]

Three of those physician's are professional acquaintances of mine. They used to hate to see me attend their lecture debunking the PASG. Mainly due to the poor study that was performed such as "inflating the PASG until the "pop off valves are initiated" .. I have yet not been able to perform this, as well as the TRISS level of patent's severity score, bad so severe that if you had trauma surgeon standing beside the patient, there would be no change in outcome... A .357 GSW to the chest over the pericardial area, will cause death.. no matter what instruments is used.

Again a bias report was made... it demonstrated that PASG did not change outcomes..... but, what it did not emphasize was that it did not boast, was it did not increase morbidity as well... so basically a neutral study. But so many knee jerked after the first study, it was too late. Propaganda and false implications occurred.

I agree, PASG was never designed or can be used in the "total treatment of shock" and definitely needed to be studied. As well, inappropriate use was being used at that time. Increasing BP can actually be bad for trauma patients... duh!..

And here I debate them as well.... they (some of the researchers) are concerned of coronary circulation, where as I am concerned about coronary and cerebral... if you do not perfuse the brain, what use is it?...

I highly respect these physicians, and if you do some research you will still find them successful in EMS and Emergency Medicine research.....i.e Pep`e, Bickell, Meningus, etc.. In fact, Dr. Bickell, (many from Tulsa will recognize these names) performed a very in-depth research on fluid resuscitation myth. Very interesting as per discussing, "permissive hypotension".

Again as I and so many others have pointed out, research is essential to move forward, but we need to able to interpret those findings, by knowing how to properly read these studies.

R/r 911

.

[UMSTUDENT]

Three of those physician's are professional acquaintances of mine. They used to hate to see me attend their lecture debunking the PASG. Mainly due to the poor study that was performed such as "inflating the PASG until the "pop off valves are initiated" .. I have yet not been able to perform this, as well as the TRISS level of patent's severity score, bad so severe that if you had trauma surgeon standing beside the patient, there would be no change in outcome... A .357 GSW to the chest over the pericardial area, will cause death.. no matter what instruments is used.

Again a bias report was made... it demonstrated that PASG did not change outcomes..... but, what it did not emphasize was that it did not boast, was it did not increase morbidity as well... so basically a neutral study. But so many knee jerked after the first study, it was too late. Propaganda and false implications occurred.

I agree, PASG was never designed or can be used in the "total treatment of shock" and definitely needed to be studied. As well, inappropriate use was being used at that time. Increasing BP can actually be bad for trauma patients... duh!..

And here I debate them as well.... they (some of the researchers) are concerned of coronary circulation, where as I am concerned about coronary and cerebral... if you do not perfuse the brain, what use is it?...

I highly respect these physicians, and if you do some research you will still find them successful in EMS and Emergency Medicine research.....i.e Pep`e, Bickell, Meningus, etc.. In fact, Dr. Bickell, (many from Tulsa will recognize these names) performed a very in-depth research on fluid resuscitation myth. Very interesting as per discussing, "permissive hypotension".

Again as I and so many others have pointed out, research is essential to move forward, but we need to able to interpret those findings, by knowing how to properly read these studies.

R/r 911

.

Sounds like class. Specifically the studies on the fluid resuscitation myth have been integrated into our study of shock. Seemingly new, they're teaching us to carefully consider the pros and cons of both the application of a fluid bolus and the PASG. In the case of fluid resuscitation, we're being told to consider them vs. natural "compensatory stabilization" to be specific. More directly, we're being told to consider the effects of wash-out and blood dilution in the development of clots during natural shock compensation, especially in the presence of DIC in stage III decompensatory shock. While I'm not familiar with the specifics of the study, I would imagine that the major dilemma for EMS providers is in weighing the benefits of increased intravascular volume and those of natural clotting factors.

[Dustdevil]

Before we throw out the baby with the bathwater, do any of these studies or opinions address uses other than the "autotransfusion" shock treatment? I see a lot of lower extremity trauma out here. Legs with a dozen or more shrapnel holes in them. Although I have not utilised the MAST for this (tourniquet is quicker), I still see potential benefit to the MAST is these and other situations.

[AZCEP]

That situation sounds like it would fall into the "penetrating trauma, below the level of the suit." I'd be tempted to try it, if not for the extra time that it would take to apply to the patient in a "HOT" situation.

Tourniquet, and rapid removal from the situation might be a more prudent strategy until better stabilization could be performed.