Effect of antishock trousers on the trauma score: A prospective analysis

Bickell, WH; Pepe, PE; Applebaum, DJ; Wyatt, CH; Dedo, W.; Matto, KL

doi:10.1016/s0196-0644(84)80207-3

Cited by 2 publications

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“…Despite an initial pilot study demonstrating no differences in the presenting emergency center Trauma Score (TS) of injured patients treated with and without the PASG, these studies have even been criticized as the "withholding" of live-saving therapy." 20 ' 21 To substantiate the need for further investigations, the survival results of this short term pilot study are reported.…”

Section: Introductionmentioning

confidence: 97%

The Effect of Anti-Shock Garments on Prehospital Survival: The Need for Controlled Clinical Trials

Pepe

Bickell

Mattox

1987

J. World Assoc. Emerg. Disaster Med.

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There exists strong sentiment, among emergency medical personnel and physicians alike, that the pneumatic anti-shock garment (PASG) “saves lives.” As a result, controlled studies have been criticized as the “withholding of important therapy.” The purpose of this presentation is to confirm the need for controlled clinical trials of the PASG. Despite an early report that the PASG offered no advantage in terms of the presenting emergency center Trauma Score (TS), similar disparagements have continued, particularly because survival data were not discussed. The present report is a pilot analysis of the effect of the PASG on the prehospital survival of patients arriving at an urban trauma center in the United States. In the study, sixty-eight patients were assigned randomly to control and PASG groups in a prospective investigation involving injured patients with systemic hypotension. The 32 control patients, whose mean initial systolic blood pressure (BP) was 59 ± 32 mm Hg, and the 36 PASG-treated patients, whose mean initial BP was 55 ± 31 mm Hg, were found to be well matched for age, sex, type and location of injuries, initial field TS; response, field management, and transport times; and the total amount of intravenous crystalloid infused. The results demonstrated no significant difference between the control and PASG-treated groups in terms of those pronounced dead on arrival at the trauma center (9/32 vs. 10/36). Further studies are therefore justified to determine how the PASG affects the long-term morbidity and mortality of injury victims, particularly those within certain sub-groups such as penetrating abdominal versus those with penetrating thoracic injuries. This report reaffirms the need for early responsible, scientific scrutiny of prehospital interventions.

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Section: Introductionmentioning

confidence: 97%

The Effect of Anti-Shock Garments on Prehospital Survival: The Need for Controlled Clinical Trials

Pepe

Bickell

Mattox

1987

J. World Assoc. Emerg. Disaster Med.

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Systemic Air Embolism after Lung Trauma

Ling²

1999

Anesthesiology

154

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Systemic air or gas embolism has been increasingly recognized as a complication of serious chest trauma and often presents with catastrophic circulatory and cerebral events. The classic findings are hemoptysis, sudden cardiac or cerebral dysfunction after initiation of PPV, air in retinal vessels, and air in arterial aspirations. The clinician must be wary of more subtle presentations. Several diagnostic tools (TEE, Doppler, CT) can detect intracardiac and cerebral air, but they may not be necessary to confirm the diagnosis of SAE. Cessation of SAE is essential for successful resuscitation. In those with unilateral lung injury, this can theoretically be achieved by isolating and ventilating the noninjured lung. Sole reliance on immediate thoracotomy for hilar clamping to stem the flow of gas emboli is a concept that needs to be challenged. Whether airway and ventilation interventions will eliminate, delay, or decrease the need for thoracotomy and improve the prognosis of SAE remains to be seen. There is little reported in the literature regarding such interventions. Airway management of a patient at risk for SAE should include a technique that can selectively ventilate each lung. Patients with bilateral sources of SAE may benefit from the avoidance of high airway pressures. Regional anesthesia should be considered when appropriate. HBOT is useful in managing cerebral air embolism and should be incorporated as soon as possible. Clinicians involved in trauma care must be familiar with SAE. By adopting a problem-based solution through innovative airway and ventilation management, anesthesiologists may significantly alter and improve the morbidity and mortality rate of SAE resulting from chest trauma.

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Effect of antishock trousers on the trauma score: A prospective analysis

Cited by 2 publications

References 0 publications

The Effect of Anti-Shock Garments on Prehospital Survival: The Need for Controlled Clinical Trials

The Effect of Anti-Shock Garments on Prehospital Survival: The Need for Controlled Clinical Trials

Systemic Air Embolism after Lung Trauma

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