Читать книгу Emergency Medical Services - Группа авторов - Страница 189

The lack of definitive studies on the treatment of shock by EMS clinicians leaves the medical director without clear guidelines for treating these patients. As a result, considerable controversy exists with respect to many areas of the treatment of shock (especially traumatic shock) in the prehospital setting.

The benefit of an EMS procedure must be weighed against potential risks. A major pitfall associated with shock treatment is that resuscitative interventions may delay definitive care. Pantridge and Geddes demonstrated that some aspects of definitive care, such as defibrillation and arrhythmia management, should be delivered in the field [75]. However, for trauma victims with uncontrolled internal hemorrhage, definitive care can only be provided in the hospital. Any field procedure that significantly delays delivery of definitive care must have proven value. For example, pneumatic anti‐shock garments were implemented in clinical EMS practice without supporting evidence, and then a formal assessment revealed that they actually worsened patient outcome in certain circumstances, particularly thoracic injury [76].