The victim of a motor vehicle accident who was in shock

Discussion in 'MRCS Forum' started by Lona., Dec 22, 2007.

  1. Lona.

    Lona. Guest

    The victim of a motor vehicle accident who was in shock is delivered to your trauma center by a rural ambulance service with the pneumatic anti-shock garment (PASG) in place and inflated. BP is 110/86. X-rays reveal a pelvic fracture. The use of this garment -
    a- Elevates blood pressure by an auto-transfusion effect, with augmentation of venous return and cardiac output
    b- Is not recommended for control of persistent bleeding in the setting of severe pelvic fracture
    c- Increases peripheral vascular resistance
    d- Expedites assessment of lower body injuries in the trauma patient
    e- Should be terminated by means of prompt deflation as soon as the trauma patient reaches the emergency department
  2. Lona.

    Lona. Guest

    Answer: c. (Flint, Ann Surg 211:703-707, 1990) The pneumatic anti-shock garment (PASG) is composed of inflatable overalls with three compartments, two for the legs and one for the abdomen. It has now been convincingly demonstrated that the PASG elevates blood pressure by increasing peripheral vascular resistance rather than by an auto-transfusion effect on venous return and increased cardiac output. The PSAG is beneficial for controlling bleeding from pelvic fractures by reduction of pelvic volume and immobilization to restrict fracture movement. The suit pressure must be released very slowly because rapid deflation can lead to sudden, irreversible hypotension. This is probably due to a sudden decrease in peripheral vascular resistance and to the effects of vasodilation and washout of accumulated metabolites of capillary beds under the suit. On reperfusion of the lower body, a systemic metabolic academia with hyperkalemia may result and must be closely monitored. For these reasons, satisfactory intravenous volume must be attained prior to decompression of the PASG, a delay that may prevent adequate early evaluation of concealed injuries to the lower body.

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