Use Of Military Antishock Trousers Research Articles

Posterior Thigh Compartment Syndrome as a Result of a Basketball Injury

Acute compartment syndrome of the thigh is a serious although rare occurrence that was sparsely documented in the orthopedic literature until Schwartz et al reported on a series of 21 cases. Although classically associated with high-energy femur fracture, thigh contusion, or the use of military anti-shock trousers, compartment syndrome of the thigh has recently been diagnosed in seemingly low-energy injuries. A complete hamstring avulsion from its ischial origin during routine ambulation and rupture of the quadriceps tendon after a low-energy fall have been shown to result in compartment syndrome. In light of the potential medicolegal ramifications surrounding the diagnosis of compartment syndrome, emergency room consultations to rule out compartment syndrome are on the rise. Specifically, the time to fasciotomy was found to be linearly related to indemnity payment, and a fasciotomy performed within 8 hours was uniformly associated with a successful defense. This article describes a case of a 29-year-old healthy man who developed posterior thigh compartment syndrome as a result of an intrasubstance tear of the biceps femoris muscle sustained while attempting a lay-up during a recreational basketball game. His posterior thigh compartment pressure measured 70 mm Hg and he required emergent posterior thigh compartment fasciotomy.

The Circumferential Antishock Sheet

Hemorrhage control in patients with pelvic ring disruptions remains problematic. To decrease bleeding, efforts have been made to acutely reduce and stabilize the pelvis. The goals of rapid pelvic reduction and stabilization are restoration of normal pelvic volume, protection of the early clot, and improved patient comfort. The use of military antishock trousers, hip spica casts, external fixators, antishock pelvic clamps, early open reduction/internal fixation, and open packing have been reported in the literature. A simple temporary technique of reduction is reported using a circumferential bed sheet. The sheet is placed between the iliac crests and the greater trochanters, encircling the pelvis. The circumferential sheet provides stabilization for transportation and allows transfemoral angiographic embolization or exploratory laparotomy at the receiving hospital. Definitive fixation can then be accomplished.

Prehospital interventions in children

Objectives. Frequently performing procedures assists in skill maintenance. This study was conducted to characterize the frequency and types of basic and advanced prehospital interventions performed on children. Methods. A retrospective study was conducted over a three-month period from emergency medical services (EMS) units working in central Michigan. Data were collected for age, sex, at-scene time, total run time, basic procedures (e.g., spinal immobilization), and advanced procedures (e.g., venous access). Results. A total of 535 EMS runs were reviewed. Runs were excluded for transport refusal (105) and site-to-site transfer (6). Of the remaining 424 children, 287 received an intervention (group 1) and 137 did not (group 2). Group 1 (9.5 ± 5.6 years) was older (p <0.001) than group 2 (6.0 ± 5.8 years). There was no gender predominance between group 1 and group 2 (p = 0.06). In group 1 there were 104 patients who received multiple procedures. Basic procedures (n = 328) included spinal immobilization (149), oxygen administration (123), splinting (27), wound care (24), use of military anti-shock trousers (4), and cardiopulmonary resuscitation (1). Advanced procedures (n = 112) included venous access (65), medications of all routes (26), and cardiacoximetry monitoring (21). No child had an intraosseous line started and no child was successfully intubated. Only 82 of the 424 children (19.3%) had an advanced procedure. Group 1 at-scene times (16.1 ± 8.1 min) were longer (p <0.001) than those of group 2 (11.1 ± 6.6 min). Total run times for group 1 (35.7 ± 15.5 min) were longer (p <0.001) than those for group 2 (26.7 ±11.3 min). Conclusions. Advanced EMS procedures were performed on only 19.3% of children. Opportunities to perform critical interventions (e.g., intubation) were rarely present. Children receiving procedures were older and had longer scene and run times.

The use of military antishock trousers in trauma—a reevaluation

The military antishock trousers (MAST) continue to be used widely. The physiologic mechanisms of action have been further elucidated. There are many potential complications associated with their use, some of which are serious. While most observations in the past were based on dog studies or human volunteers, clinical studies are now providing new information that questions the usefulness of the MAST.

Acute compartment syndrome of the thigh. A spectrum of injury.

Twenty-one compartment syndromes of the thigh in seventeen patients were identified for retrospective review. Ten of the compartment syndromes were associated with an ipsilateral femoral fracture; five of these femoral fractures were open. In five patients, the syndrome followed femoral intramedullary stabilization. The remaining eleven syndromes followed blunt trauma to the thigh, prolonged compression by body weight, or vascular injury. The patients who were awake and alert at the time of the examination complained of intense pain in the thigh, and they had neuromuscular deficits. For the patients who could not cooperate with a subjective physical examination because they were under general anesthesia or because of associated injuries, the measurement of compartment pressure assumed a more important diagnostic role. All of the patients had tense swelling of the involved thigh. The predisposing risk factors for the development of compartment syndromes of the thigh, which are common in the multiply injured population, include: systemic hypotension, a history of external compression of the thigh, the use of military antishock trousers, coagulopathy, vascular injury, and trauma to the thigh, with or without a fracture of the femur. In approximately one-half of these patients, a crush syndrome developed, with myoglobinuria, renal failure, and collapse of multiple organ systems. Eight patients (47 per cent) died as a result of multiple injuries. Of the nine patients (ten compartment syndromes) who survived, infection developed at the site of the fasciotomy in six. Follow-up examination revealed marked morbidity, including sensory deficit and motor weakness of the lower extremity.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal vascular injuries.

Treatment of major abdominal vascular injuries is a challenge. Since 1973, 93 patients have been treated at our institution for 147 abdominal vascular injuries. The majority of these injuries (67%) resulted from penetrating trauma in young men between 21 and 30 years of age. Upon admission 72% of the patients were in shock. Injured most frequently were the iliac vessels (36%) and the inferior vena cava (20%). Suture repair with preservation of function was possible in 61%; ligation of the damaged vessel was necessary in 24 cases (26%). Overall mortality was 29%. Military anti-shock (MAS) trousers were used in the management of ten patients who had an average admission systolic blood pressure of 52 mm Hg; 50% survived. In six cases of refractory hypotension or cardiac arrest, thoracotomy was done in the emergency room; mortality in this group was 100%. For some abdominal vascular injuries, ER thoracotomy has a very limited application. The key factors for increasing the survival rate in patients with major abdominal vascular injuries include rapid stabilization, reversal of hypotension (especially by the use of MAS trousers), and prevention of coagulopathy, combined with prompt surgical exploration and thoracotomy when indicated.

Limitations of Abdominal Binding during CPR

Sudden cardiac death is the number one killer in the western world. In the USA alone, CPR attempts are justified in 200,000 cases per year. Recovery of brain function requires immediate initiation and uninterrupted maintenance of artificial ventilation and circulation by basic life support (BLS) until restoration of spontaneous circulation (ROSC) is possible with advanced life support (ALS). Presently recommended standard CPR (SCPR) produces only 6–30% of normal common carotid blood flow. For this reason, a more effective method of prolonged CPR-BLS is necessary in the absence of ALS ambulance services, which is common in rural areas.Augmentation of blood flow during CPR can be accomplished by intravenous fluid load and epinephrine, which are unavailable to BLS personnel. Sustained abdominal compression in dogs during CPR increases blood flow but produces a high incidence of hepatic trauma. The use of military anti-shock trousers (MAST) during short-term SCPR has been shown to increase common carotid blood flow (CCABF); this, however, has not been evaluated with a long-term model.

Lower extremity ischemia associated with use of military antishock trousers

A 58-year-old man was admitted to a community hospital following an overdose of nifedipine. Military antishock trousers (MAST) were applied to combat severe hypotension. Blood pressure was restored to 110/50 mm Hg three hours after admission, but the patient remained comatose. Subsequent to MAST garment removal, ischemia of both legs and scrotum was observed; at surgery, both iliofemoral systems were occluded from the aortic bifurcation to the feet. The patient never regained consciousness and died from recurrent ventricular tachycardia. The possible contributing role of the MAST garment in producing lower extremity ischemia is discussed.