MAST

[chbare]

With all of the research on permissive hypotension, are we actually helping patients by increasing their blood pressure? Especially when we talk about internal hemorrhage. It is known that MAST pants will increase systemic vascular resistance and cause limited autotransfusion. Perhaps increased venous return occurs as well? However, I cannot see how this mechanism will benefit the patient who is acutely hypovolemic.

Take care,

chbare.

[tniuqs]

With all of the research on permissive hypotension, are we actually helping patients by increasing their blood pressure? Especially when we talk about internal hemorrhage. It is known that MAST pants will increase systemic vascular resistance and cause limited autotransfusion. Perhaps increased venous return occurs as well? However, I cannot see how this mechanism will benefit the patient who is acutely hypovolemic.

Take care,

chbare.

Thats kinda curious because we here (in acute hypovolemia and prior to going under the blade) We transfuse uncross matched blood if we have access, When we HAVE crossmatched blood all the better, Packed cells and other factors for clotting, best case is senarios are cell savers which are labour intensive but worth the time and efforts.

Point being is this not simmilar situation, autotransfusion vs transfusion, that said stored blood has citrates and in the past (attempting to normalize PH was perhaps a folly as well?) Newer studies are indicating that acidosis may be a protective mechanism at the cellular level.

Tropes to increase SVR are a later choice and but if transport times are excessive and the typical 3:1 of NS has been attempted/ infused a huge third spacing vcan occure ... seen a few of those, we called then the stay puff marshmallow men.... bit of black humour there sorry.

But: I do see your point as permissive hypotension was found to be of some benifet with those seriously injured in the Fauklands experiance, then again, hypothermia may have been a serious consideration as well under those nasty conditions.

AZCEP: My suggestion is to use the device for lower extremity fractures including pelvic/hip fracture/dislocations. Don't use it to solve a volume/bleeding issue. Use it as a splinting device. You don't have to use anywhere near as much air pressure to accomplish it.

I try to use Traction devices when possible, I only use MAST with Pelvic fractures as (iliac artery leaks are 3 biggest killer in trauma quite insidious .. and very difficult to dx/ treat) Lots of my acute transports are by air and that damn Boyles Law thing.

With long bone extremity fractures "muscle spasm is the major source of the pain" therefore I try to relieve that pain and use less narcotics (if possible) as that does complicate the picture in a polytrauma patient.

Normal blood volume does not equate to normal arterial blood pressure. I'm not sure where you misread that.

3 things in "shock" to put it in the most of elementary terms.

1- The pump.

2- The volume of fluid.

3- The control of container.

perhaps better control of the container then?

Must be heavy into the Labatt's tonight eh?

Well I am now :roll: but not Labatts as we just sell that to the tourists EH :wink:

[Dustdevil]

Okay, here's a simple experiment for all you who still don't get it:

Take a sponge. Saturate it with water. Squeeze it. What happens?

Pressure goes up. Fluid leaves the body. Regardless of whether you remove the pressure or not, you have bled out the sponge. You only notice it sooner if you release the pressure.

End of story.

[tniuqs]

Okay, here's a simple experiment for all you who still don't get it:

Take a sponge. Saturate it with water. Squeeze it. What happens?

Pressure goes up. Fluid leaves the body. Regardless of whether you remove the pressure or not, you have bled out the sponge. You only notice it sooner if you release the pressure.

End of story.

Why am I thinking its time for a bath ?

Dust are you gearing your very over simplified analogy for a volley basic from snowshoe alberta ? Come on dood , you have not included the "container" with my oversimplified explanation. So was that:

SpongeBob physiology ?

So lets blow a few hole's in this anlogy just for giggles shall we, no compesatory mechanisms, and no SPINE. LOL. :roll:

Regardless of whether you remove the pressure or not, you have bled out the sponge. You only notice it sooner if you release the pressure

Could this be the exact explanation for the failure of MAST ?

A sudden loss of pressure when fluids or "control" of the container is "iatrogenically" lost?

I propose the rubber ducky would be a far better model, at least one can stick in a line up that little butt hole to bring the pressure up, or not release the preussure maintaing the pressure .... the sponge senario more akin to septic shock model ..... pumping into space, don't you think ?

END OF STORY ? :shock:

So then just forget about trying to improve the treatment of Trauma ?

Love the words in Predator (Arnie btw) when the native guy says :

"Were all going to die" ! :twisted:

I promise I will leave MAST in the old cabinet in the back of the station where they have been for the last 15 years. But this has been an interesting study of how we EMS people embrace and refuse to give up something as boneheaded as the Medical Anti-Shock Trouser. When I get time, I will detail how I saw a chicken come back to life with only the music from an accordion as intervention. Maybe I need a debriefing…

It is very similar to this lit study debunker, so whats his name again ?

Does this texan ever do any research on his own ... like a positive input ? hmm please shoot me the links if I am missing something .... PLEASE.

Hey perhaps HE does need a more positive attitude enhancement training or maybe even attend a CISM couse as well :twisted: ... just saying, he's only one man and not so NOT the god of EMS. :wink:

cheers

[asy]

One must learn to be a sponge if one wants to be loved by hearts that overflow.

(Friedrich Nietzsche)

(SpongeBob SquarePants)