alternate essay topic

TKO

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I have been posting on a essay topic that doesnt seem to be working out to well for me. If you can offer any help for this alternate essay topic just in case i have to change i would appreciate it soooo much.

Possible alternate topic:

Assuming that the material I am looking for, just cannot be found in depth and in time, I am prepared to do a second choice of topic. So this may be easier to find for those of you who seem to dig through news articles with ease.

There is a growing controversy in the use of large volumes of crystalloid fluid replacement for patients who have externally hemorrhaged (from crushing injuries or car accidents, etc). Fewer paramedics believe that larger volumes of fluid replacement to maintain the blood pressure and continue perfusion of the tissues (staving off shock) is effective in patient survival management. There are studies (where? I don't know, just what I've read) that indicate that minimal amounts of fluid replacement has better outcomes.

Ok, so why? Well, when you bleed out you don't have enough blood to pump around your body. This means you can't get O2 around to the cells and CO2 out. This leads to acidosis which in turn leads to cell death.
Massive amounts of cells die -> tissues die -> organs die -> you die. That's Shock.

So traditionally we stick someone who is stuck under a tractor (for example) with 2 large bore IV's of Ringer's Lactate (just think water) so that there is enough fluid to keep circulating the remaining blood cells around (mostly it is water from blood that is lost in shock). We then remove the tractor and book it to the big H. If we didn't, lifting the tractor would send all the blood to the whole body decreasing pressure and killing the patient from shock.

Problems from this are that as the blood clots to seal leaks, say in the pancreas, large volume flow bursts the clots open creating real problems again with internal bleeding. It also makes it difficult to keep enough red blood cells in the system if we add fluid that flushes it out. Or else we get to the hospital and the patient is pumped full of fluid and needs blood transfused in....well, they gotta drain the patient (sorta).

So giving blood products in addition to minimal crystalloid solutions would be the best solution in some cases, but not necessarily in others. Also, local protocols don't always allow us to give blood products. And there can be good reasons for that.

Now this brings me to my alternate essay topic. I need to investigate the controversy and examine alternate methods (ie: PASG = pneumatic anti-shock garment) and proposed solutions from previous studies and current statistics. I need stats, protocols, news reports, and most of all, studies performed.
 

rescuecpt

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Interestingly enough, the use of the MAST or PASG around here is being phased out. In 4 years in EMS I've never seen it used. A lot of new EMTs aren't even being taught what it is, we do in-house training on it.
 

ffemt8978

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I once attended a CME lecture by Dr. Robert O'Connor entitled "PASG in Trauma Patients". In it, he talks about how the PASG and large bore IV's may not be appropriate for trauma victims due to the changes in hemodynamic parameters.

Here's a link to some of his work:
PASG in Trauma Patients

You can also try a search for "PASG in Trauma" and get several more articles. While not directly on topic, they do talk about the infusion of large amounts of IV fluid.

Another intersting thing about this is that a lot of agencies are going away from all IV solutions except NS. It keeps their costs down, using other fluids doesn't have much of an effect on the patient in the field, and is easier to remember which drugs go in which fluids.
 

rescuecpt

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Originally posted by ffemt8978@Oct 19 2004, 01:10 PM
Another intersting thing about this is that a lot of agencies are going away from all IV solutions except NS. It keeps their costs down, using other fluids doesn't have much of an effect on the patient in the field, and is easier to remember which drugs go in which fluids.
Suffolk County, NY (and all of it's little minions) only uses NS.
 

PArescueEMT

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Originally posted by ffemt8978@Oct 19 2004, 02:10 PM
Another intersting thing about this is that a lot of agencies are going away from all IV solutions except NS. It keeps their costs down, using other fluids doesn't have much of an effect on the patient in the field, and is easier to remember which drugs go in which fluids.
Philadelphia Fire Department only uses 500 bags of NSS now. I am guessing that it's due to the short transport times that we have here. The last company that I worked for only had NSS and D5W in the trucks. I have only seen LR (or RL) in hospitals out here. I guess that's gone by the wayside any more.


Anyway about the MAST pants... I have never used them in 5 years. I was taught how, then the D.O.H. pulled them from companies without BLS command. Since then, I have had 2 pelvic fractures that I would have liked to stabilize with them. :angry:

oh well :rolleyes:
 

rescuecpt

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Originally posted by PArescueEMT@Oct 19 2004, 03:35 PM
Since then, I have had 2 pelvic fractures that I would have liked to stabilize with them. :angry:
Have you tried turning the KED upside down?
 

Luno

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not to go too old school on you, but did you try the sheet "trick?" It can work very well.
 

ffemt8978

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Originally posted by Luno@Oct 19 2004, 05:07 PM
not to go too old school on you, but did you try the sheet "trick?" It can work very well.
Okay, I'll bite...

What's the "sheet" trick?
 

Tigar

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Here is the problem....fluid overload. It's not just affecting the lungs, but the kidneys (hey for all that extra dumped in it HAS to go out), too. Don't forget PERFUSION of the brain and other cells. Yes you have filled the container, but your not leaving room for the new blood cells (future oxygen carriers). Here in OK, they want us to not overload pts w/ massive volume"s" of fluid. The pt still needs blood and other blood products to replace some of what was lost due to the trauma. Besides, fluid overload sets up high probiblities for DIC (massive, uncontroled bleeding for every body opening - 99% fatal, if they get to a DIC stage). btw - this is not a pretty site to see. Remeber it this way.... you have a critically burned pt. That pt has lost massive amount of fluid. You start your 2 lines yes. But you not overload the pt w/ fluids. It's shock, yes, but cellular not blood fluid. You know that your burn pt has lost fliud, eletrolytes, and some amount of blood (possilbly) too. You wanting to move what blood cells he/she has left, and avoid turning their blood to the color and consistancy of pink coolaid.

As for the sheet trick, I think that is where you fold the sheet longwise to about 2 foot across and place around the pts pelvis and tie. It creates a stable environment for the pelvis. I saw an advertisement the other day for a ?pelvic gridle? I think it is made by SAM Splint. btw - my service removed the MAST pants 4 years ago. But it's still listed on the chechout sheet.
 

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