NORTH COAST EMERGENCY MEDICAL SERVICES Policy # 5317

POLICIES AND PROCEDURES

Subject: Medical Direction

Anti-shock Trousers - MAST/PASG

Associated Polices: 6502, 6523, 6536, 6541 01/16/98

  1. Indications:
  1. Significant clinical hypotension/shock
  2. Fractures of pelvis and lower extremities.
  3. Uncontrollable bleeding of lower extremities.
  1. Therapeutic Effects:
  1. Provides an increase in blood pressure.
  2. Increases blood flow to the heart, brain and lungs.
  3. Provides control of bleeding via direct pressure.
  4. Provides stabilization of fractures of the lower limbs and pelvis.
  1. Contraindications
  1. Absolute:
  1. The presence of pulmonary edema secondary to heart failure.
  1. Relative:
  1. Transport time £ 30 minutes
  2. Hemorrhaging thoracic wounds or a mechanism of injury leading to a high index of suspicion for thoracic injury.
  3. Abdominal wounds with evisceration.
  4. Wounds with foreign body protrusion or compound fractures.
  5. Pregnancy (leg compartments may be used).
  6. Gastrostomy (leg compartments may be used).
  1. Adverse Effects:
  1. Compartment syndrome.
  2. Metabolic acidosis after prolonged use.
  3. Decreased Renal function.
  4. Decreased respiratory vital capacity.
  5. Compression of the stomach can cause vomiting.
  6. Removal of the trousers in a hypotensive patient can cause profound shock.
  1. Equipment:
  1. Antishock trousers, preferably 3-chamber style with pneumatic trouser pump.
  2. Adult and pediatric sizes or the ability to "down size" adult trousers for pediatric use.

 

 

 

  1. Procedure:
  1. Application of MAST Trousers:
  1. Apply a tight pressure dressing to bleeding lower extremities and dressings to abdominal wounds before application of trousers.
  2. Remove clothes as time allows.
  3. Document distal CSM.
  4. Prepare trousers on a patient carrying device and place patient on it,
  5. Contact base hospital for an order to inflate the trousers.
  6. Radio failure protocol: trousers may be inflated if no contraindications exist.
  7. Base order is not required if device is used for splinting of lower extremities.
  8. Apply manual traction and straighten fractures to legs until splinting is assured through inflation. If used, apply traction splint to femoral fractures under the trousers.
  9. Wrapping: 1) wrap legs first; 2) wrap abdomen just below lower edge of the rib cage, make sure the suit is fitted close to the crotch.
  10. If Adult trousers are used on pediatric patient, fold abdominal compartment to locate top edge at rib cage, and fold leg compartments to the inside to expose feet.
  11. If trousers are used to stabilize multiple fractures of lower extremities, the child can be placed in one leg of adult trousers with padding between legs. Do not use abdominal section and inflate only high enough to stabilize legs.
  12. Connect the foot pump to the appropriate compartmental access valves.
  13. Inflate leg compartments first, then abdomen. Inflate to lowest pressure necessary to obtain clinical response of systolic BP between 80-100 mm Hg or until Velcro begins to "crackle". An automatic pop off valve will release excessive pressure. Leg compartments can be used alone, never inflate abdominal section alone.
  14. Carefully monitor the patient’s blood pressure throughout inflation and transport.
  15. Monitor for fluid overload (rales, neck vein distention, etc.).
  1. Field deflation of Anti-shock Trousers:
  1. Two (2) large bore IVs should be in place.
  2. Check patient’s vital signs - note baseline vital signs and overall patient’s status.
  3. Gradually deflate the suit, carefully monitoring blood pressure throughout.
  4. Deflate abdominal compartment first (in 3 chambered trousers). If patient’s condition does not improve, then deflate leg compartments individually.
  5. Continue deflation when blood pressure has stabilized. In cases of severe pulmonary edema, diuretic therapy may be ordered.
  6. Twenty to sixty minutes may be required for this deflation. If hemorrhage is suspected, removal of the anti-shock suit may precipitate rapid decompensation and should be accomplished in the operating room.
  1. Special Information:
  1. Application and inflation should not increase scene time.
  2. Check inflation often. During the application procedure, trousers may be damaged.
  3. Changes in temperature or altitude may cause fluctuation in the pressure within the device. Especially in helicopter evacuation.
  4. Removal of the trousers in the field should be avoided. If patient develops evidence of fluid overload or systemic hypertension, removal may be necessary. Contact Base Hospital if possible prior to removal.