CONTROVERSIES

28. What is the role of the pneumatic antishock garment?

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The military antishock trouser (MAST) has fallen out of favor in most instances. The MAST suit is valuable for patients requiring long-distance transfer who have major bleeding from pelvic fractures. The MAST suit should be avoided in the presence of major thoracoabdominal trauma, especially if a diaphragmatic injury is suspected. The traction splints still are preferred for femur fracture transfer; they decrease bleeding and assist with pain control.

29. In a patient in shock with an obvious head injury, grossly positive peritoneal aspirate, and suggestion of a thoracic aortic injury on chest x-ray, what are the priorities after initial resuscitation?

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An exploratory laparotomy is indicated based on the hemodynamic instability in the face of a grossly positive peritoneal tap (even if the patient has torn his aorta, you should fix active intra-abdominal bleeding first). The patient should have a CT scan of the head and chest immediately thereafter. Intraoperative intracranial pressure monitoring may be diagnostic and therapeutic.

References
WEB SITES

1. http://www.east.org/tpg/chap3.pdf
2. http://www.east.org/tpg/chap3u.pdf
3. http://www.east.org/tpg/bluntabd.pdf
4. http://www.surgery.ucsf.edu/eastbaytrauma/Protocols/ER%20protocol%20pages/c-spine_eval.htm
5. http://www.surgery.ucsf.edu/eastbaytrauma/Protocols/ER%20protocol%20pages/FAST-files/FAST.htm

BIBLIOGRAPHY
1. American College of Surgeons, Committee on Trauma: Advanced Trauma Life Support Course, 6th ed. Chicago, American College of Surgeons, 1997.
2. Bell RM, Krantz BE: Initial assessment. In Mattox KL, Feliciano DV, Moore EE (eds): Trauma, 4th ed. Norwalk, CT, Appleton & Lange, 2000.
3. Biffl WL, Moore EE, Harken AH: Emergency department thoracotomy. In Mattox KL, Feliciano DV, Moore EE (eds): Trauma, 4th ed. Norwalk, CT, Appleton & Lange, 2000.
4. Rozycki GS, Ballard RB: Ultrasound in the initial trauma evaluation. In Trunkey DD, Lewis FR (eds): Current Therapy of Trauma, 4th ed. St. Louis, Mosby, 1999.