Guest guest Posted April 4, 2004 Report Share Posted April 4, 2004 In my class, we were told that they could be used to splint a pelvis fx but not a femur. But there was also talk that they will be removed from the curriculum in the near future because they are not used anymore because of the number of deaths they were supposedly the cause of...but that's a whole different story. MAST > Here I am again. This time with a question from the Baylor EMT-B > class. Scenario: Fractured femur. Question: Would it be > appropriate to use MAST in this situation? Consider open and closed > fx. Consider using the MAST on the injured leg as a splint. Consider > using the MAST on the other leg or on the other leg and abdomen to > support blood pressure. (I am not having much luck picturing MAST + > a traction splint.) > > Thanks a lot. > > Bob in McGregor > LP > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 4, 2004 Report Share Posted April 4, 2004 > Here I am again. This time with a question from the Baylor EMT-B > class. Scenario: Fractured femur. Question: Would it be > appropriate to use MAST in this situation? Consider open and closed > fx. Consider using the MAST on the injured leg as a splint. Consider > using the MAST on the other leg or on the other leg and abdomen to > support blood pressure. (I am not having much luck picturing MAST + > a traction splint.) > The whole idea behind a traction splint is to relieve the pain associated when pieces of the femur rub against each other. MAST mind restrict the motion and decrease the pain due to that motion somewhat, but would be relieved to a greater degree by having traction applied. As far as MAST trousers are concerned, that is up to local standard of care. I personally wouldn't use MAST for anything since it has been shown to have no effect on pt outcome. Regards, Alfonso R. Ochoa NREMT-Paramedic Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 4, 2004 Report Share Posted April 4, 2004 about the mast Ive Had paramedics use mast pants for a fx hip and ive also seen a Keds Used as well for the same thing Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 4, 2004 Report Share Posted April 4, 2004 MAST as a concept seems to be pretty good, esp for BP control, until the ER just cuts them off and the patient crashes... -- Re: MAST > Here I am again. This time with a question from the Baylor EMT-B > class. Scenario: Fractured femur. Question: Would it be > appropriate to use MAST in this situation? Consider open and closed > fx. Consider using the MAST on the injured leg as a splint. Consider > using the MAST on the other leg or on the other leg and abdomen to > support blood pressure. (I am not having much luck picturing MAST + > a traction splint.) > The whole idea behind a traction splint is to relieve the pain associated when pieces of the femur rub against each other. MAST mind restrict the motion and decrease the pain due to that motion somewhat, but would be relieved to a greater degree by having traction applied. As far as MAST trousers are concerned, that is up to local standard of care. I personally wouldn't use MAST for anything since it has been shown to have no effect on pt outcome. Regards, Alfonso R. Ochoa NREMT-Paramedic Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 4, 2004 Report Share Posted April 4, 2004 > MAST as a concept seems to be pretty good, esp for BP control, until the ER > just cuts them off and the patient crashes... and then the ER DR. attributes the death to the MAST. > > > > -- Re: MAST > > > > > > > Here I am again. This time with a question from the Baylor EMT-B > > > class. Scenario: Fractured femur. Question: Would it be > > > appropriate to use MAST in this situation? Consider open and > > closed > > > fx. Consider using the MAST on the injured leg as a splint. > > Consider > > > using the MAST on the other leg or on the other leg and abdomen to > > > support blood pressure. (I am not having much luck picturing MAST > > + > > > a traction splint.) > > > > > > > The whole idea behind a traction splint is to relieve the pain > > associated when pieces of the femur rub against each other. MAST > > mind restrict the motion and decrease the pain due to that motion > > somewhat, but would be relieved to a greater degree by having > > traction applied. As far as MAST trousers are concerned, that is up > > to local standard of care. I personally wouldn't use MAST for > > anything since it has been shown to have no effect on pt outcome. > > > > Regards, > > > > Alfonso R. Ochoa > > NREMT-Paramedic > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 5, 2004 Report Share Posted April 5, 2004 brian here we have a lot of trauma like for farm trauma I could see the use or for a prolonged extrcation as well if your going to be on scene that long whats the point of running so much fluid in to them it turns into water Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 5, 2004 Report Share Posted April 5, 2004 I do not know who is telling you that MAST is being removed from the curriculum " due to the number of deaths " associated with their use. PASG have fallen out of favor in many areas based on one or two small research projects which did not prove or disprove their efficacy in the rural setting with long transport times nor did they disprove their efficacy for use to splint pelvic fractures. They have NOT been proven to INCREASE the number of trauma deaths. As for whether or not they will be in the next PHTLS book after its revision (which is entirely based on the physician's ATLS revisions) remains to be seen. Jane Hill Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 5, 2004 Report Share Posted April 5, 2004 I do not know who is telling you that MAST is being removed from the curriculum " due to the number of deaths " associated with their use. PASG have fallen out of favor in many areas based on one or two small research projects which did not prove or disprove their efficacy in the rural setting with long transport times nor did they disprove their efficacy for use to splint pelvic fractures. They have NOT been proven to INCREASE the number of trauma deaths. As for whether or not they will be in the next PHTLS book after its revision (which is entirely based on the physician's ATLS revisions) remains to be seen. Jane Hill Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 5, 2004 Report Share Posted April 5, 2004 Obviously you are up-to-date with the scientific literature on MAST. Note also they are effective for warts, rattlesnake bites, hemorrhoids, teenage pregnancy, cancer and strokes. BEB Don't miss EMStock 2004! http://www.emstock.com Re: MAST > > > > > > > Here I am again. This time with a question from the Baylor EMT-B > > > class. Scenario: Fractured femur. Question: Would it be > > > appropriate to use MAST in this situation? Consider open and > > closed > > > fx. Consider using the MAST on the injured leg as a splint. > > Consider > > > using the MAST on the other leg or on the other leg and abdomen to > > > support blood pressure. (I am not having much luck picturing MAST > > + > > > a traction splint.) > > > > > > > The whole idea behind a traction splint is to relieve the pain > > associated when pieces of the femur rub against each other. MAST > > mind restrict the motion and decrease the pain due to that motion > > somewhat, but would be relieved to a greater degree by having > > traction applied. As far as MAST trousers are concerned, that is up > > to local standard of care. I personally wouldn't use MAST for > > anything since it has been shown to have no effect on pt outcome. > > > > Regards, > > > > Alfonso R. Ochoa > > NREMT-Paramedic > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 5, 2004 Report Share Posted April 5, 2004 Wow, Really????? >>From: Bledsoe >>Obviously you are up-to-date with the scientific literature on MAST. Note >>also they are effective for warts, rattlesnake bites, hemorrhoids, teenage >>pregnancy, cancer and strokes. >>BEB 'Tater Salad' Hatfield EMT-P " I had the right to remain silent......but I did not have the abliity. " Mark your calendars now!!! EMStock 2004!!! Booming Midlothian, Texas!!! May 21-23, 2004!!! www.EMStock.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 5, 2004 Report Share Posted April 5, 2004 Wow, Really????? >>From: Bledsoe >>Obviously you are up-to-date with the scientific literature on MAST. Note >>also they are effective for warts, rattlesnake bites, hemorrhoids, teenage >>pregnancy, cancer and strokes. >>BEB 'Tater Salad' Hatfield EMT-P " I had the right to remain silent......but I did not have the abliity. " Mark your calendars now!!! EMStock 2004!!! Booming Midlothian, Texas!!! May 21-23, 2004!!! www.EMStock.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 5, 2004 Report Share Posted April 5, 2004 I'm assuming you are discussing the use of inflated MAST as a prevention strategy for the rattlesnake bites, hemorrhoids and teen pregnancy (for which both parties should be wearing them for increased effectiveness). After all, deflated MAST are rather useless in these instances other than as a fashion statement. , please correct me if I'm wrong, but I thought there was still some discussion about the warts implications for if it's prevention or treatment and for cancer and strokes it's purely relapse prevention, correct? Barry S. Re: MAST > > > > > > > Here I am again. This time with a question from the Baylor EMT-B > > > class. Scenario: Fractured femur. Question: Would it be > > > appropriate to use MAST in this situation? Consider open and > > closed > > > fx. Consider using the MAST on the injured leg as a splint. > > Consider > > > using the MAST on the other leg or on the other leg and abdomen to > > > support blood pressure. (I am not having much luck picturing MAST > > + > > > a traction splint.) > > > > > > > The whole idea behind a traction splint is to relieve the pain > > associated when pieces of the femur rub against each other. MAST > > mind restrict the motion and decrease the pain due to that motion > > somewhat, but would be relieved to a greater degree by having > > traction applied. As far as MAST trousers are concerned, that is up > > to local standard of care. I personally wouldn't use MAST for > > anything since it has been shown to have no effect on pt outcome. > > > > Regards, > > > > Alfonso R. Ochoa > > NREMT-Paramedic > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 5, 2004 Report Share Posted April 5, 2004 Jane: Your argument is illogical. While there have been two high-quality (randomized controlled trials) of MAST that showed them ineffective in penetrating and blunt trauma (including an increased ICU stay of 1.7 days for patients who received the MAST), there have been NO STUDIES to show they are effective for anything (including rural trauma). So, you are saying, since there is no evidence that they don't work in rural trauma, they must work. That is nonsense. MAST were invented by non-physicans at NASA and sold to EMS as a derivative of the space program. Instead of using them until we prove they don't work, shouldn't we not use them until we prove they do work? Which would be the easiest to prove in court? Are you going to buy one of those $12,000 Revivant AutoPulse CPR devices despite they fact there is no scientific evidence they work or will you wait until there is evidence they work before purchasing them? You are letting emotion and dogma cloud your thinking. BEB Bledsoe, DO, FACEP Midlothian, TX Be good and you will be lonesome. -Mark Twain (from " Following the Equator " ) Don't miss EMStock 2004! http://www.emstock.com Re: MAST I do not know who is telling you that MAST is being removed from the curriculum " due to the number of deaths " associated with their use. PASG have fallen out of favor in many areas based on one or two small research projects which did not prove or disprove their efficacy in the rural setting with long transport times nor did they disprove their efficacy for use to splint pelvic fractures. They have NOT been proven to INCREASE the number of trauma deaths. As for whether or not they will be in the next PHTLS book after its revision (which is entirely based on the physician's ATLS revisions) remains to be seen. Jane Hill Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 5, 2004 Report Share Posted April 5, 2004 Barry: You are, of course, correct. Remember though that for premature ejaculation prevention, the MAST should be inflated until the Velcro cracks. BEB Bledsoe, DO, FACEP Midlothian, TX Be good and you will be lonesome. -Mark Twain (from " Following the Equator " ) Don't miss EMStock 2004! http://www.emstock.com Re: MAST > > > > > > > Here I am again. This time with a question from the Baylor EMT-B > > > class. Scenario: Fractured femur. Question: Would it be > > > appropriate to use MAST in this situation? Consider open and > > closed > > > fx. Consider using the MAST on the injured leg as a splint. > > Consider > > > using the MAST on the other leg or on the other leg and abdomen to > > > support blood pressure. (I am not having much luck picturing MAST > > + > > > a traction splint.) > > > > > > > The whole idea behind a traction splint is to relieve the pain > > associated when pieces of the femur rub against each other. MAST > > mind restrict the motion and decrease the pain due to that motion > > somewhat, but would be relieved to a greater degree by having > > traction applied. As far as MAST trousers are concerned, that is up > > to local standard of care. I personally wouldn't use MAST for > > anything since it has been shown to have no effect on pt outcome. > > > > Regards, > > > > Alfonso R. Ochoa > > NREMT-Paramedic > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 5, 2004 Report Share Posted April 5, 2004 I didn't SAY that, Dr. B. My quote was >>which did not prove or disprove their efficacy in the rural setting<< - note the words " prove or disprove " . I was only disputing the man's claim that they have been showed to be the cause of death in some cases, which, to my knowledge, has not occurred. Jane Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 5, 2004 Report Share Posted April 5, 2004 Sorry. Misread then. Mea culpa, mea culpa mea maxima culpa. Bledsoe, DO, FACEP Midlothian, TX Be good and you will be lonesome. -Mark Twain (from " Following the Equator " ) Don't miss EMStock 2004! http://www.emstock.com RE: MAST I didn't SAY that, Dr. B. My quote was >>which did not prove or disprove their efficacy in the rural setting<< - note the words " prove or disprove " . I was only disputing the man's claim that they have been showed to be the cause of death in some cases, which, to my knowledge, has not occurred. Jane Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 5, 2004 Report Share Posted April 5, 2004 Ahhh, NUTS! MAST is an instrument of the Devil and I shun it! TD RE: MAST > > I didn't SAY that, Dr. B. My quote was >>which did not prove or disprove > their efficacy in the rural setting<< - note the words " prove or disprove " . > I was only disputing the man's claim that they have been showed to be the > cause of death in some cases, which, to my knowledge, has not occurred. > > Jane > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 5, 2004 Report Share Posted April 5, 2004 , in your original foot into mouth response to Jane you wrote, " Instead of using them until we prove they don't work, shouldn't we not use them until we prove they do work? " While this isn't specifically about MAST, my question is until somebody uses " it " , how can you prove " it " works or doesn't work? ( " It " being whatever the new/old product/procedure is that is under discussion/consideration.) Sort of a chicken and egg question I know, but realizing that with any evolving field there will be some trial and error in order to facilitate the learning and growth of the field. Unfortunately there are some risks (i.e. acts which will produce and protect income for lawyers) involved when dealing with human subjects but outside of small scale research involving primates there's not a lot of acceptable substitutions for humans when it comes to EMS practice research. Your thoughts? Also, and this may sound tacky (for which I apologize), but in your initial response to Jane I had flashback to Jane Curtain and Chevy Chase doing Weekend Update on the original SNL. Thanks for the fun memory. Barry Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 5, 2004 Report Share Posted April 5, 2004 , in your original foot into mouth response to Jane you wrote, " Instead of using them until we prove they don't work, shouldn't we not use them until we prove they do work? " While this isn't specifically about MAST, my question is until somebody uses " it " , how can you prove " it " works or doesn't work? ( " It " being whatever the new/old product/procedure is that is under discussion/consideration.) Sort of a chicken and egg question I know, but realizing that with any evolving field there will be some trial and error in order to facilitate the learning and growth of the field. Unfortunately there are some risks (i.e. acts which will produce and protect income for lawyers) involved when dealing with human subjects but outside of small scale research involving primates there's not a lot of acceptable substitutions for humans when it comes to EMS practice research. Your thoughts? Also, and this may sound tacky (for which I apologize), but in your initial response to Jane I had flashback to Jane Curtain and Chevy Chase doing Weekend Update on the original SNL. Thanks for the fun memory. Barry Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 5, 2004 Report Share Posted April 5, 2004 You are forgiven, Dr. Jane Hill Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 5, 2004 Report Share Posted April 5, 2004 Wow, somebody else who knows who Jane Curtain was. You ARE telling your age now, Barry. This is one of those serious topics that really needs more research, and that research also needs to involve rural response areas where the transport time is greater than say 20 minutes. It is my understanding that the research on this and other topics like this may be coming soon. But, as long as an item like this remains in the PHTLS curriculum which is based on the ATLS curriculum which is updated each 4 years, I will keep them on our trucks and a protocol for their use. When that changes, so will we. I certainly don't want the fact that all our personnel are PHTLS certified and taught this in the curriculum to show up in a courtroom case on one of our trauma patients that met the indications and did not receive the care and died. Of course, they would probably have died anyway in that instance, but I don't want to be the one to try to explain THAT one in front of a very smart lawyer and a jury who sees that it is in the curriculum of at least one of the two major prehospital education providers for trauma care. I personally am not saying that they are right or wrong, but I am very leary of making too many deletions from our protocols when the written word by which we are taught says something has specific indications. That written word will be part of what is evaluated (not just our protocols) when the courtroom case comes up. Jane Hill Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 5, 2004 Report Share Posted April 5, 2004 You know, I may need to ask some of you -- Re: MAST I do not know who is telling you that MAST is being removed from the curriculum " due to the number of deaths " associated with their use. PASG have fallen out of favor in many areas based on one or two small research projects which did not prove or disprove their efficacy in the rural setting with long transport times nor did they disprove their efficacy for use to splint pelvic fractures. They have NOT been proven to INCREASE the number of trauma deaths. As for whether or not they will be in the next PHTLS book after its revision (which is entirely based on the physician's ATLS revisions) remains to be seen. Jane Hill Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 5, 2004 Report Share Posted April 5, 2004 You know, I may need to ask some of you -- Re: MAST I do not know who is telling you that MAST is being removed from the curriculum " due to the number of deaths " associated with their use. PASG have fallen out of favor in many areas based on one or two small research projects which did not prove or disprove their efficacy in the rural setting with long transport times nor did they disprove their efficacy for use to splint pelvic fractures. They have NOT been proven to INCREASE the number of trauma deaths. As for whether or not they will be in the next PHTLS book after its revision (which is entirely based on the physician's ATLS revisions) remains to be seen. Jane Hill Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 5, 2004 Report Share Posted April 5, 2004 You know, I may need to ask some of you grey foxes to unpack this whole thing for me. I am a lowly EMTB, and very recent at that. Furthermore, I'm not even a professional, but a volunteer First Responder. I was trained on MAST, I was trained on the HARE traction splint, I was trained on backboards and C-collars, rescue breathing with CPR, and of course, o2. I have seen each of these things taken to task and left in the ether as " no scientific proof " of being interventions that actually help the patient. Now, I understand that it is a wise thing to question accepted wisdom, as you may find out your accepted wisdom is actually superstition. At the same time, I'm one of those simple fellers who likes to know why I'm doing what I m doing past the obvious, trite, " because the protocol says so " thing. I also understand that of the things I've mentioned, it's the MAST issue that has the most potential for eliciting emotional responses. Help me wrap my mind around this " PRACTICE of emergency medicine " thing, please! Mack FFEMT -- Re: MAST I do not know who is telling you that MAST is being removed from the curriculum " due to the number of deaths " associated with their use. PASG have fallen out of favor in many areas based on one or two small research projects which did not prove or disprove their efficacy in the rural setting with long transport times nor did they disprove their efficacy for use to splint pelvic fractures. They have NOT been proven to INCREASE the number of trauma deaths. As for whether or not they will be in the next PHTLS book after its revision (which is entirely based on the physician's ATLS revisions) remains to be seen. Jane Hill Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 5, 2004 Report Share Posted April 5, 2004 You know, I may need to ask some of you grey foxes to unpack this whole thing for me. I am a lowly EMTB, and very recent at that. Furthermore, I'm not even a professional, but a volunteer First Responder. I was trained on MAST, I was trained on the HARE traction splint, I was trained on backboards and C-collars, rescue breathing with CPR, and of course, o2. I have seen each of these things taken to task and left in the ether as " no scientific proof " of being interventions that actually help the patient. Now, I understand that it is a wise thing to question accepted wisdom, as you may find out your accepted wisdom is actually superstition. At the same time, I'm one of those simple fellers who likes to know why I'm doing what I m doing past the obvious, trite, " because the protocol says so " thing. I also understand that of the things I've mentioned, it's the MAST issue that has the most potential for eliciting emotional responses. Help me wrap my mind around this " PRACTICE of emergency medicine " thing, please! Mack FFEMT -- Re: MAST I do not know who is telling you that MAST is being removed from the curriculum " due to the number of deaths " associated with their use. PASG have fallen out of favor in many areas based on one or two small research projects which did not prove or disprove their efficacy in the rural setting with long transport times nor did they disprove their efficacy for use to splint pelvic fractures. They have NOT been proven to INCREASE the number of trauma deaths. As for whether or not they will be in the next PHTLS book after its revision (which is entirely based on the physician's ATLS revisions) remains to be seen. Jane Hill Quote Link to comment Share on other sites More sharing options...
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