Use of military antishock trouser in a child

Circumferential pelvic antishock sheeting: a temporary resuscitation aid

Acute traumatic pelvic ring instability causes severe pain and associated hemorrhage. Circumferential pelvic sheeting provides patient comfort and noninvasive, rapid, and temporary pelvic ring stability. A bed sheet is readily available, inexpensive, easily applied around the pelvis, and disposable.

Circumferential pelvic antishock sheeting: a temporary resuscitation aid

Acute traumatic pelvic ring instability causes severe pain and associated hemorrhage. Circumferential pelvic sheeting provides patient comfort and noninvasive, rapid, and temporary pelvic ring stability. A bed sheet is readily available, inexpensive, easily applied around the pelvis, and disposable.

[Severe trauma in children]

Trauma are responsible for approximately 50% of the deaths of the pediatric population between 1-15 years of age. This high mortality rate, associated with frequent sequelae, leading sometimes to severe handicaps, is a major problem of public health in the developed countries. Pediatric trauma have some particularities, due to anatomical and physiological differences, and to specific injury mechanisms. Management of a patient with severe trauma is best performed by trained physicians, working in a multidisciplinary team with a two steps approach: 1) emergency rapid clinical assessment and resuscitation. 2) a secondary complete clinical evaluation associated with medical imaging, mainly based on CT scan. Head injuries are frequent and represent the main prognosis factor, mass lesions being less frequent and cerebral oedema more frequent in children, than in adult; brain swelling appears to be less frequent than initially reported. Management of head trauma has evolved in recent years, and is now largely directed towards the prevention of secondary ischemic brain injury: new monitoring devices are proposed to pursue that goal: transcranial doppler and continuous jugular vein oxygen saturation monitoring. Spinal cord injuries are rare but may be severe: cervical and spinal cord injuries without radiological abnormality (SC/WORA) appear to be more frequent than in adult. Most often, abdominal plain viscera injuries are treated with a conservative non operative approach. Among chest injuries, pulmonary contusion is the most frequent, with a favorable outcome in most cases within 3-4 days. Child abuse must be suspected in any case where there is no clear injury mechanism or when there is a discrepancy between the severity of the injury and the alleged mechanism.

Teaching technical skills in pediatrics

Technical skills are an important and difficult part of managing a very sick or injured child. However, technical procedures are more often learned from experience than practice. This article reviews a variety of technical skills and procedures commonly performed in a pediatric emergency department. Each technical procedure can be practiced using live or artificial model for simulation.

Pneumatic anti-shock garment: state of the art 1988

The responses of hypovolemic patients would be expected to be similar to experimental animals that were hypovolemic. Normovolemic patients would be expected to respond as do the normovolemic experimental animals. Hypovolemic patients do not necessarily respond the same as do normovolemic patients or volunteers. The amount of external pressure applied by the device is directly proportional to the amount of tissue pressure increase. Tissue pressure is transmitted to the vessel as reduction transmural pressure, or in change in the size of the vessels and subsequent increase in SVR. Patient response to external pressure varies with the amount of device pressure. The optimal pressure of the PASG is in the range of 60 to 80 torr. Although exceeding this value does not appear to be necessary, it is not harmful in the short term (less than 90 minutes). Using less pressure reduces the SVR and, therefore, the blood pressure response. Keeping the external pressure at approximately 40 torr appears to be ideal for hemorrhage control. Of the more than 300 articles that have appeared in the recent literature addressing the PASG, at least 190 have discussed specific scientific experiments in the animal laboratory, in the human laboratory, or in the clinical environment, in which results gathered addressed how, why, or if the PASG worked. These studies demonstrate that the PASG does, in fact, improve blood pressure, control hemorrhage, improve carotid and upper body blood flow, improve the ability of the prehospital provider to start IV lines, and improve survival (particularly short-term) with few hospital and even fewer prehospital complications. The device produces its blood pressure response by improving preload, increasing SVR, and mobilizing some blood (500 to 1,000 mL) to the upper body compartment above the device. These responses are most probably produced by decreasing the radius of the vessels compressed by the device, decreasing the compartment volume, and differentially affecting the blood flow without and within the device. Hemorrhage is controlled by increasing the external pressure on the vessel by the transmitted increased tissue pressure, reducing the vascular lumen, and reducing the area of the laceration. Short-term survival is improved by decreasing intra-abdominal hemorrhage and improving perfusion (maintaining better oxygenation in the heart-brain-lung circulation.) Long-term survival is improved because the device controls hemorrhage, maintains blood pressure, and allows delivery of the severely injured patient to the trauma center and within the hospital while awaiting an OR, as in the case of a leaking aortic aneurysm.(ABSTRACT TRUNCATED AT 400 WORDS)

Antishock trousers in pediatrics--a case management report

A pediatric trauma patient whose initial management was assisted by antishock trousers is presented along with a discussion of the usage and cautions of this device.