Avoid rough handling of the victim, andtransport to a medical treatment facility.If transportation to a definitive care facility willbe lengthy or delayed, seek the radio or phoneadvice of a medical officer on whether to givefluids by mouth or to start an intravenous line. Ifthis consultation is impossible, use your ownjudgment. In the case of cardiogenic shock, DONOT start intravenous fluids since blood volumeis sufficient and only function is impaired.Constantly monitor the patient and record vitalsigns every 15 minutes so that you are able tokeep track of the patient’s progress.PNEUMATIC COUNTER-PRESSUREDEVICES (MAST)Commonly known as Medical Anti-ShockTrousers or Military Anti-Shock Trousers (MAST),pneumatic counter-pressure devices are designed tocorrect or counteract certain internal bleedingconditions and hypovolemia. The garment does this bydeveloping an encircling pressure up to 120 mm Hgaround both lower extremities, the pelvis, and theabdomen. The pressure createdslows or stops venous and arterial bleeding inareas of the body enclosed by the pressurizedgarment;forces available blood from the lower body to theheart, brain, and other vital organs;prevents pooling of blood in the lowerextremities; andstabilizes fractures of the pelvis and lowerextremities.Some indications for use of the pneumaticcounter-pressure devices are whensystolic blood pressure is less than 80 mm Hg,systolic blood pressure is less than 100 mm Hgand the patient exhibits the classic signs ofshock, orfracture of the pelvis or lower extremities ispresent.Although the only absolute contraindication in theuse of these devices is in the case of pulmonary edema,other conditional contraindications include congestiveheart failure, heart attack, stroke, pregnancy,abdominal evisceration, massive bleeding into thethoracic cavity, and penetrating wounds where theobject is still impaled in the victim.Application of the anti-shock garment is a simpleprocedure, but it requires some important preliminarysteps. When the garment is laid out flat, ensure thatthere are no wrinkles. If the patient is to remainclothed, remove all sharp and bulky objects from thepatient’s pockets. Take vital signs before applying theMAST garment. When applying the garment, inflatesufficiently so the patient’s systolic blood pressure isbrought to and maintained at 100 mm Hg. Once thegarment is inflated, take the patient’s vital signs every5 minutes. The garment should be removed only underthe direct supervision of a physician.BREATHING AIDSLEARNING OBJECTIVE:Recognizebreathing aids and their uses.As a Hospital Corpsman, you should becomefamiliar with the breathing aids that may be availableto help you maintain an open airway and to restorebreathing in emergency situations. Breathing aidsinclude oxygen, artificial airways, bag-valve maskventilator, pocket face mask, and suction devices.USE OF OXYGEN (O2)In an emergency situation, you will probably havea size E, 650-liter cylinder of oxygen available. Theoxygen cylinder is usually fitted with a yoke-stylepressure-reducing regulator, with gauges to show tankpressure and flow rate (adjustable from 0 to 15 litersper minute). A humidifier can be attached to theflowmeter nipple to help prevent tissue drying causedby the water-vapor-free oxygen. An oxygen line canbe connected from the flowmeter nipple or humidifierto a number of oxygen delivery devices that will bediscussed later.When available, oxygen should be administered,as described below, to cardiac arrest patients and toself-ventilating patients who are unable to inhaleenough oxygen to prevent hypoxia (oxygendeficiency). Hypoxia is characterized by tachycardia,nervousness, irritability, and finally cyanosis. Itdevelops in a wide range of situations, includingp o i s o n i n g , s h o c k , c r u s h i n g c h e s t i n j u r i e s ,cerebrospinal accidents, and heart attacks.4-25
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