Special Operations Forces Medical Handbook

8-14

guidelines).

2. Inflate garment, legs first, then abdominal compartment, until either the patient’s blood pressure becomes
   adequate (around 80 mm systolic), the Velcro on the suit begins to crackle (indicating that separation is
   imminent), and/or bleeding is controlled and/or fracture(s) is/are adequately stabilized.


3. If applying a PASG that has a pressure gauge that measures the pressure inside the PASG it is
   ESSENTIAL that this pressure NOT be used as an end-point for inflation. This pressure gauge should
   ONLY be used to allow the care provider to maintain a constant PASG inflation pressure despite changes
   in altitude and/or temperature.


4. PASG should ONLY be applied as a temporizing measure and NOT as a substitute for other interventions,
   particularly surgery.


5. If the patient has on going bleeding rapid evacuation for surgical stabilization is indicated.

What Not To Do:
Absolute Contraindication to application of PASG/MAST
Pulmonary edema/congestive heart failure /cardiogenic shock - The increased peripheral vascular resistance
which PASG/MAST produces increases the work of the heart and will worsen these conditions

Relative Contraindications to application of PASG/MAST
Head injury/cerebrovascular accident - use of PASG/MAST will increase intracranial pressure.
Severe and uncontrollable bleeding above the diaphragm - the possibility exists of increasing intrathoracic
bleeding as the blood pressure increases.
Ruptured diaphragm - inflation of the abdominal compartment of the PASG/MAST will force abdominal contents
into the chest cavity
Third trimester pregnancy – do not inflate abdominal compartment.
Impaled object in the abdomen - do not inflate abdominal compartment.

DO NOT remove PASG/MAST until patient is in a location where his/her underlying problem can be fully
addressed (i.e., surgery). Premature removal of the PASG/MAST can lead to severe hypotension. When
the decision is made to deflate the PASG/MAST, slowly deflate the garment, abdominal compartment first,
then legs, until the systolic blood pressure drops by 5 mm Hg. Then, discontinue deflation, and provide fluid
replacement until the pressure is restored. Repeat these steps until deflation is complete. Circumstances
may require a more rapid deflation but this should ONLY be done in the OR when the surgeon and the
anesthetist/ anesthesiologist are fully prepared to deal with the consequences.

NOTE: Treatment of hypovolemic/hemorrhagic shock by applying PASG has fallen into such disfavor that
it is rarely recommended for this application any more. There are good reasons, however for continuing to
recommend their use in combat situations – specifically for use in stabilizing pelvic fractures and tamponading
bleeding in the pelvis, buttocks, and/or groin/upper thigh where a tourniquet cannot be applied to control
hemorrhage.

Procedure: Blood Transfusion

18D Skills and Training Manual, reviewed by COL Warren Whitlock, MC, USA

When: You have a trauma patient who may require a transfusion in a medical facility with blood replace-
ment capability. You must correctly assess the trauma patient to determine whether or not he requires blood
replacement and if he does, what those requirements are.

What You Need:

1. A thermometer, blood pressure cuff, stethoscope, IV stand, tourniquet, large bore IV catheters, tape,
   alcohol and Betadine prep pads, vacutainers, needle and syringe, gloves, crystalloids, and the patient’s
   clinical record.


2. 2 large bore IVs already established and the following materials, blood transfusion recipient set (“Y” type),
   500ml or 1000ml bag of 0.9% normal saline, blood, IV stand, needle and syringe.