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EMS Equipment Highlight . . . PASG
PASG stands for Pneumatic Anti-Shock Garment and is sometimes referred to as MAST (Medical Anti-Shock Trouser).
This is designed to provide uniform pressure on the lower extremities and abdomen. This is used in some EMS systems on shock and hemorrhage patients.
The PASG device is intended to compress the vascular space and accomplish 4 objectives:
1) Increase peripheral vascular resistance by pressurizing the arteries of the lower abdomen and extremities.
2) Reduce the vascular volume by compressing venous vessels.
3) Increase the central circulating blood volume with blood returned from areas under the garment.
4) Immobilize the lower extremities and the pelvic region.
The proper use and application of the PASG can return about 250 mL of blood back to the central circulation.
There are some concerns with the use of the PASG, among them are
* The abdominal part of the PASG pressurizes the abdominal cavity and increases the work associated with breathing.
* This can reduce chest excursion.
* Studies have shown that application of PASG in cases of penetrating chest trauma has increased mortality.
* PASG may be detrimental to patients with uncontrolled internal hemorrhage.
Indications for using the PASG include:
> shock patients w/ controlled hemorrhage
> patients w/ pelvic fracture and instability w/ hypotension
> patients w/ possible neurogenic shock
> any shock patients w/ uncontrolled hemorrhage below the mid-abdomen.
Contraindications are:
< Poulmonary edema
< Cardiogenic shock
Make sure that vitals are taken before application of the PASG and then again after it is applied and inflated. Then continue to monitor vitals frequently. The purpose of using the PASG is not to return the blood pressure and circulation to normal levels, but instead to stabilize the patient's condition. Once inflated, the PASG shoudl not be deflated in the prehospital setting. Releasing the pressure reduces the peripheral vascular resistance and expands the size of the vascular space and removes about 250 mL of blood from the active circulation. This could seriously harm the patient as they are trying to compensate for shoc
Replies to This Discussion
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Permalink Reply by Mike Schlags (Captain Busy) Retd on
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I used these years ago and on the times I used them, they did save lives. One call in particular was an ectopic pregnancy where the patient was bleeding out... We used the mast trousers and she regained consciousness... What made this really cool was that the brand new mast trousers were sitting in the office at the fire station. we had just received the order... A patrol car drove the new unit Code 3 to the incident, we put the trousers on the young lady who by the time we arrived at the ER was fully conscious. What was sad was the ER almost killing the girl... When we arrived in the ER, one of the nurses asked what's this? and removed it! The girls blood pressure dropped and they almost did not get her back... Moral of the story is make sure everyone knows about how to use these... For my part of the world, they removed these from use. I don't recall why now but maybe folks like Ralph or Paul might have the answer?
TCSS,
CBz
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Permalink Reply by Loyd Dittfurth on
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In the texas panhandle they removed them from protocols because the ER would take them off without starting IVs to replenish the fluid or they would take them off to quickly and send all the dirty blood back to the heart. At least thats what I was told.
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Permalink Reply by Oldman on
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Or an over-zealous physician wants them off yesterday, and cuts them off.
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These, (so I thought) went the way of things like; the Thomas half ring, EGTA's, and Calcium Chloride. As a matter of fact, the device's use is not taught in the EMT classes, at least not around here.
I have read many studies over the years both for and against their use. I used them years ago with mixed results. I can't say that their use contributed to the death of trauma patients, but over all, I can't say they helped anything either. Personally, I won't advocate their use. I have experienced pretty much the same results with transporting a patient trendelenberg and an IV.
But I guess there are still parts of the country where the transport time are long, and or helicopters can't be utilized, so it could be another tool at your disposal under dire circumstances.
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Permalink Reply by Station10Capt106 on
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They are still on our trucks and we do use them occassionally, but as mentioned by others their use has declined. I remember 10 years ago we used them on alot of trauma but now we use them in only certain situations.
These are still taught in our EMT classes but the focus is not placed on them like they were in years past.
Who knows, in a few more years the use may turn around and we will be using them more and more or they will go the way of the dinosaur and be taken off the trucks completely.
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