An evaluation of the pneumatic anti-shock garment (pasg) in various clinical settings

O’Connor, Robert E.; Domeier, Robert M.

doi:10.1080/10903129708958783

Cited by 20 publications

(9 citation statements)

References 63 publications

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“…22,23 Although the garment is used rarely as a therapeutic intervention for shock, in our case it elicited a marked response and allowed maintenance of an improved blood pressure during the initial 24 hours of treatment. Immediately after inflation of the suit's compressive trousers, a 10 mm Hg increase in diastolic pressures was noted.…”

Section: Discussionmentioning

confidence: 96%

Conventional and Unconventional Lifesaving Therapies in an Adolescent With Amlodipine Ingestion

Reuter‐Rice

Peterson

2016

Critical Care Nurse

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Amlodipine, a dihydropyridine calcium channel blocker, is commonly prescribed for the treatment of hypertension. Ingestion of an overdose leads to severe hypotension; if the hypotension is not treated, death may be imminent. Conventional and unconventional interventions were used to treat an adolescent who ingested a life-threatening dose of amlodipine. Severe hypotension resistant to conventional treatment with intralipids and hyperinsulinemia-euglycemia therapy led to the use of plasmapheresis and a pneumatic antishock garment as lifesaving measures. Plasmapheresis has been described in only one other case of severe amlodipine overdose, and the use of a pneumatic antishock garment has never been described in the management of a calcium channel blocker overdose. Because short-term use of a pneumatic antishock garment has associated risks, the critical care nurse's anticipation of side effects and promotion of safe use of the garment were instrumental in the patient's care and outcome. A standard daily dose is 2.5 to 10 mg, and the mean half-life is 30 to 55 hours.1 When inappropriate amounts are accidentally or intentionally ingested, severe hypotension and slow metabolic clearance often lead to fatality.2 The mechanism of action of amlodipine lowers the systemic vascular resistance and reduces the influx of extracellular calcium, resulting in inotropic and chronotropic effects on the myocardium. Amlodipine overdoses have been associated with near-fatal and fatal instances of hypotension and reflex tachycardia, hyperglycemia, metabolic acidosis, and pulmonary edema.3-12 Conventional therapies include calcium replacement, vaso pressors, intralipids, high-dose insulin-euglycemia therapy, and plasmapheresis to maintain end-organ perfusion. [5][6][7]10,11,[13][14][15] Critical care nurses are expected to understand conventional multimodal therapies for patients with amlodipine overdose while providing life-sustaining bedside care. At times, unconventional therapies may be used to maintain life support.

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Section: Discussionmentioning

confidence: 96%

Conventional and Unconventional Lifesaving Therapies in an Adolescent With Amlodipine Ingestion

Reuter‐Rice

Peterson

2016

Critical Care Nurse

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“…[1425–29] It also stated that MAST was helpful and probably not harmful (Class II b evidence) in elderly with a history of congestive hart failure, who have penetrating abdominal injuries, uncontrolled gynecologic and lower limb haemorrhage, septic and spinal shock. [2329–31] MAST application is contraindicated (Class III evidence) in patients with diaphragmatic injury, thoracic injury, abdominal evisceration and gravid uterus among others. MAST is not used as an adjunct to Cardiopulmonary resuscitation (CPR).…”

Section: Mast and The Emsmentioning

confidence: 99%

“…In a 1983 study, it was found that in 136 cardiac arrest patients who were older than 20 years old, the survival to hospital was 9% as compared to 4% in the usual care group. [29]…”

Section: Mast and The Emsmentioning

confidence: 99%

Military anti-shock garment: Historical relic or a device with unrealized potential?

Lateef

Kelvin

2008

J Emerg Trauma Shock

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Military anti-shock trousers represents a medical device which has engendered very divergent views, even up to today. From the time the concept was formulated in 1903 by surgeon George W Crile, there have been significant swings in opinion and evidence. The guidelines, where available, are often kept relatively general and cautious. As a spin-off to the mechanism and technology, several alternative devices have been proposed or developed over the years. This include the auto-transfusion torniquet, the non pneumatic anti-shock garment (Life Wrap) and the non inflatable antishock garment, which are discussed in this paper.

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“…In addition, no clear evidence exists for their use in blunt injury cases at this time. However, some EMS systems still recommend use of the PASG as a pneumatic splint for suspected pelvic fractures, which could pose a risk of life‐threatening haemorrhage 52–54 . Again, no clear evidence exists for this proposed use.…”

Section: Post‐traumatic Haemorrhagementioning

confidence: 99%

Controversies in the prehospital management of major trauma

Pepe

2000

Emergency Medicine

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Many traditional therapies in the prehospital management of major trauma may be of little value or may be even harmful. Little scientific evidence exists to support the use of the pneumatic antishock garment, and some studies have shown it to worsen outcome. The traditional role of intravenous fluid resuscitation also has been questioned and, in situations such as penetrating truncal trauma, it may be associated with comparatively worse outcomes. Although some infusion may be appropriate in severe haemorrhage, the clear priority in such patients is evacuation to definitive surgical intervention. Airway control and establishment of intravenous access are recommended en route. Endotracheal intubation may be capable of prolonging the ability to tolerate circulatory arrest, but overzealous ventilation may further compromise cardiac output where there is severe haemodynamic instability. If these procedures delay patient transport, any benefit they may offer could be outweighed by delaying definitive care. Many of the paradigms of prehospital trauma care should be reconsidered and carefully evaluated in future randomized controlled trials.

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An evaluation of the pneumatic anti-shock garment (pasg) in various clinical settings

Cited by 20 publications

References 63 publications

Conventional and Unconventional Lifesaving Therapies in an Adolescent With Amlodipine Ingestion

Conventional and Unconventional Lifesaving Therapies in an Adolescent With Amlodipine Ingestion

Military anti-shock garment: Historical relic or a device with unrealized potential?

Controversies in the prehospital management of major trauma

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