question about MAST/PASG

[jim]

Hi all - i do research for a tv show and we're debating the best way to depict a paramedic treating a young man with a GSW to his leg.

Thought this would be a good place to get input. Imagine the kid's bleeding pretty badly and they are arriving at a hospital...

Would the paramedic have applied PASG? A tourniquet? Splinting of some kind? Someone even said in extreme cases they would use hemos to hold the femoral artery?

Any help would be appreciated.

[Just Plain Ruff]

I think the most appropriate place to get answers other than this group is front line EMS workers in your area.

The mast has fallen out of favor over the years and I don't recall the last time I've put one on except for a hip fracture and it did a wonderful job.

I'm not sure if using hemostats is a good idea but I'll leave that to the trauma junkies who have had more experience with using them than I.

I've only had one experience where we could not stop the bleeding from an artery and that person exsanguinated (bled out) with us prior to leaving the scene.

I hope I've helped but maybe a more seasoned trauma junkie would have some better answers.

Good luck in your investigation/research.

[Ace844]

IThe mast has fallen out of favor over the years and I don't recall the last time I've put one on except for a hip fracture and it did a wonderful job.

I'm not sure if using hemostats is a good idea but I'll leave that to the trauma junkies who have had more experience with using them than I.

Ummmm...that's not even an indication, why did you put the Mast on a Hip FX? What rationale did you use to explain it, and more importantly, what did your Med con.@ QA/QI say???

out here,

Ace844

[Ace844]

Hi all - i do research for a tv show and we're debating the best way to depict a paramedic treating a young man with a GSW to his leg.

Thought this would be a good place to get input. Imagine the kid's bleeding pretty badly and they are arriving at a hospital...

Would the paramedic have applied PASG? A tourniquet? Splinting of some kind? Someone even said in extreme cases they would use hemos to hold the femoral artery?

Any help would be appreciated.

"jim",

A patient suffering an injury like the one you describe is unlikely to be placed in MAST pant's for treatment. But, I do agree with the advice of speaking with someone in your area about local protocols as they vary across the nation.

Also, I think it'd be unlikely that some one would use hemostats to "clamp" an artery in the leg (outside of the hospital, and get away with it, as they'd most likely have to "go fishing in the wound" to do so). I think more than likely you'll find someone watched "Black Hawk Down" a few to many time and is trying to be a "cowboy" in their pre-hospital practice. More than likely if this person did this they would no longer be practicing for very long afterwards...hopefully !!!

The treatment is expose, look for the exit wound, dress and bandage, use direct pressure, and elevate to the extent possible, estyavlish 2 large bore IV's and fluid resus. as needed, monitor, O2, and depending on the path of the missile spinal immobilization, followed by rapid transport to an ER and shortly there after an OR.

Hope this helps,

Ace844

[MedicRN]

Ummmm...that's not even an indication, why did you put the Mast on a Hip FX? What rationale did you use to explain it, and more importantly, what did your Med con.@ QA/QI say???

out here,

Ace844

In several areas, MAST/PASG have been used (and some still use) to stabilize a hip fx. They are not pumped up to the requisite 'velco tearing and/or pop-off valves release,' but rather just enough to stabilize/splint the pelvis (for those of us who are old school, it was being suggested/taught while you were still in pre-school). Yes, there are other more up-to-date stabilization devices out there, but not all services may be that rich. It all depends on your area, service and protocols.

Personally, on this scenerio, I would hold direct pressure to the effected vessel(s), titrate NS or LR to BP and apply large qualities of diesel or aviation fuel. Hemostats would only serve to damage the vessel making surgical repair difficult or maybe even impossible (read leg amputation).

[jim]

Thanks for your help Ace!I spoke on the phone to someone at a EMT training school and they were the ones who mentioned MAST and using hemos to clamp the artery, it seemed a little extreme to me. Our writer had originally written in a tourniquet, but that didn't seem right either. I appreciate the response.

[Ace844]

In several areas, MAST/PASG have been used (and some still use) to stabilize a hip fx. They are not pumped up to the requisite 'velco tearing and/or pop-off valves release,' but rather just enough to stabilize/splint the pelvis (for those of us who are old school, it was being suggested/taught while you were still in pre-school). Yes, there are other more up-to-date stabilization devices out there, but not all services may be that rich. It all depends on your area, service and protocols.

Personally, on this scenerio, I would hold direct pressure to the effected vessel(s), titrate NS or LR to BP and apply large qualities of diesel or aviation fuel. Hemostats would only serve to damage the vessel making surgical repair difficult or maybe even impossible (read leg amputation).

"Medic RN,"

I've been doing this for awhile myself...I'm not new either....I was taught all about MAST in both my basic and medic programs. I have applied them myself in pre-hospital practice, so i hardly think that you're assertion that I am clueless because

"those of us who are old school, it was being suggested/taught while you were still in pre-school)....."

Well guess what, you're not the only one with experience who posts here....

Usually MAST is most often used "at splinting pressures" for A) an unstable pelvis B.) severe Bilat lower extermity trauma C.) any combination of A and B D.)Traumatic arrest . I Find it hard to justify under the circustances of a hip Fx (UNLESS IT WERE SO BAD AS TO BECOME OPEN, which would contrindicate their use anyway...) the use of MAST/PASG, and frankly I think if you ask the docs that are your Medical contol they'll agree with me. Most Hip Fx's aren't severe and or with enough hemodynamic compromise to require their use. Even at your asserted "splinting pressures"..As a nurse you have to see hip Fx's ALOT in the ER, so you of all people should know better. Furthermore I think that there would be an evengreater possibility that the ER you would be transporting to would both ? your decision to use MAST in this case, and probably try to pursue soem kind of corrective training/reprimand. Also, if you truely doubt me, go ahead and ask an Orthopeadic surgeon, if he thinks MAST is a good idea. I'm sure they will look at you "Funny", make an offhanded albeit polite remark and walkaway to later tell the story about that "medicRN" who wants to use MAST on hip Fx's because he's "old school" and "Protocol" says.......

In short MAST/PASG outside of a narrow range of therepeutic/treatment uses are THE WORK OF THE DEVIL, They cause harm, and even in some cases in crease injury related morbidity. this stuff is Right up there with that telephone hot line, ASK A NURSE!!!! :) ahhahaaha, LOL!!!

out here,

Ace844

[MedicRN]

Most Hip Fx's aren't severe and or with enough hemodynamic compromise to require their use. Even at your asserted "splinting pressures"..As a nurse you have to see hip Fx's ALOT in the ER, so you of all people should know better.

Hemodynamic compromise is not the purpose behind their usage. The most comfortable hip fx patients I've seen have been the ones splinted with MAST (obviously, this has been many, many years ago). The pressure exerted is comparative of that of an air splint, compression stockings or sequential compressive devices, ie. not enough to effect blood pressures.

[Ace844]

Hemodynamic compromise is not the purpose behind their usage. The most comfortable hip fx patients I've seen have been the ones splinted with MAST (obviously, this has been many, many years ago). The pressure exerted is comparative of that of an air splint, compression stockings or sequential compressive devices, ie. not enough to effect blood pressures.

I understand both the phys, and what you meant, you obviously misunderstood the context....They provide no benefit to the patient, and have a larger amount of risk, also few instituions/providers are comfortable and or familiar enough to feel comfortable using them. If one were to take your advise in todays current practice environment...Well I say to you...GOOD LUCK B/C YOUR GONNA NEED IT... Please reread my previous post and or the literature, any ?'s feel free to ask. I'm always willing to help...Conversely feel fre to post any literature and evidence that i am wrong with my information and I will gladly stand corrected. We all learn everyday in this business and when we think we don't it's time to stop, IMHLO, just my .001.

Out here,

Ace844

[Ace844]

"Jim,:

I see your in LA, you could always try to get ahold of some of the county/city paramedics there, especially the south central kind, as I am sure they are quite fimiliar and have lots of practical experience dealing with the injuries your looking for info on as well as knowing the local prcatice parameters/protocols. There are even 1 or 2 here, but they don't seem to post that much...

Hope this helps,

Ace844