When is a PASG contraindicated? Cardiogenic shock is the key reason.

In which condition is a PASG contraindicated?

• A. Severe hypotension
• B. Cardiogenic shock
• C. Hypovolemic shock
• D. Anaphylactic shock

Answer: (B)

The use of a Passive Anti-Shock Garment (PASG) is specifically contraindicated in cardiogenic shock due to the dynamics of how this condition affects the cardiovascular system. Cardiogenic shock occurs when the heart is unable to pump sufficient blood to meet the body’s demands, often leading to inadequate perfusion of vital organs. Applying a PASG can increase intrathoracic pressure, which may further impair cardiac output and worsen perfusion issues. The pressure from the PASG can also interfere with venous return to the heart, complicating an already compromised system. In cases where the heart's ability to pump is impaired, any additional pressure can exacerbate the situation and lead to further complications, making it dangerous to use a PASG in cardiogenic shock. This contrasts with the other conditions listed. In hypovolemic shock, for example, the PASG can help maintain blood flow by supporting circulation when there is a significant decrease in blood volume. Similarly, in severe hypotension, it may be beneficial to use a PASG to promote venous return and improve circulation. Anaphylactic shock can cause vasodilation and increased capillary permeability, where the PASG may also be used as part of the management strategy to help stabilize the

When you’re on a scene with a patient who’s struggling to keep blood moving where it needs to go, every tool in the kit gets a moment under the spotlight. One tool that often sparks curiosity—and a few heated debates—is the Passive Anti-Shock Garment, or PASG. It’s the kind of device that sounds simple in theory: wrap the body, pressurize the limbs and abdomen, and maybe push blood back toward the heart to improve perfusion. In real life, though, things aren’t always so neat. The science is subtle, and the situation you’re facing can tip the balance from helpful to harmful in a heartbeat.

What is a PASG, anyway?

Let’s set the stage. A PASG is a garment that fits around the legs and abdomen. When inflated, it exerts external pressure on the body's core and lower extremities. The intended effect is twofold: it helps squeeze blood back toward the torso and heart, and it can raise overall blood pressure by shoring up venous return. Think of it as a temporary nudge for a system that’s trying hard but isn’t quite keeping up.

The idea dates back decades, and you’ll still hear echoes of it in some EMS systems and older protocols. It’s a classic example of a life-saving concept that’s complicated by changing science and evolving guidelines. So when you hear a clinician talk about PASG, the first thing to remember is: it’s not a one-size-fits-all fix. Its value depends entirely on the patient’s underlying problem.

Cardiogenic shock: the one situation to avoid

Here’s the key teaching point you’ll encounter repeatedly: a PASG is contraindicated in cardiogenic shock. Why? Because in cardiogenic shock the heart isn’t pumping effectively. The problem isn’t that blood is missing—it’s that the pump isn’t delivering it where it’s needed. When you add external pressure to the chest and abdomen in that context, you can actually make the heart’s job harder.

Two core mechanisms explain the risk. First, increasing intrathoracic pressure can reduce venous return to the heart. If the heart is already struggling to push blood forward, squeezing more blood into it from the vena cava can backfire, leading to worsening perfusion of vital organs. Second, the added pressure effectively increases afterload—the resistance the heart has to work against to eject blood. In a failing heart, that extra resistance can further drop cardiac output instead of boosting it.

That combination is why, in cardiogenic shock, PASG becomes more of a liability than a help. The goal in cardiogenic shock is to support the heart’s pumping action and optimize oxygen delivery to tissues. A device that can potentially impede those very processes doesn’t line up with the plan.

What about the other shock states?

The story isn’t as stark as a single contraindication, because the context matters a lot. In the broader world of trauma and shock, PASG has been described as helpful in some scenarios, though with important caveats and evolving guidelines.

• Hypovolemic shock: Historically, PASG was used to help maintain perfusion when blood volume was low due to bleeding. The idea was that external pressure around the legs and abdomen would augment venous return to the heart and help push blood toward the core while bleeding was controlled. In the field, this can buy time for rapid transport and definitive care. That said, modern practices emphasize rapid hemorrhage control, judicious fluid resuscitation, and careful monitoring. PASG isn’t a universal fix, but in some settings it’s considered as a bridge to definitive care.

• Severe hypotension without a clearly defined pump problem: In cases where a patient’s blood pressure is dangerously low but the heart’s pumping capacity isn’t failing per se, the garment can help momentarily improve venous return and circulating volume. It’s not a cure, and it doesn’t replace the need to identify and treat the underlying cause.

• Anaphylactic shock: Anaphylaxis creates a different cascade—massive vasodilation and capillary leakage. Some clinicians have explored PASG as part of a broader resuscitation plan, especially when transport times are long and blood flow to organs is critically compromised. The standard treatment remains airway management, epinephrine, fluids, and ongoing monitoring, with PASG considered only in very specific circumstances and under protocol guidance.

The practical take: how PASG fits into patient care

If you’re ever faced with a patient where a PASG might be considered, a few practical checks can keep you from stepping into trouble:

• Confirm the shock type. If you suspect cardiogenic shock, hold the PASG. If the patient’s problem looks more like hypovolemia from blood loss and there are no chest or abdominal injuries, you might discuss the garment as part of a broader plan with your medical oversight.

• Look for contraindications. Chest trauma, suspected rib fractures, or a significant chest injury—these situations can be worsened by extra intrathoracic pressure. Also be mindful of pregnancy concerns and abdominal injuries where external compression could risk other injuries.

• Fit and monitoring. If a PASG is used, ensure it’s properly fitted and monitored. The goal isn’t to squeeze the patient until they look better; it’s to support circulation while you arrange rapid transport and definitive care. Continuously monitor blood pressure, heart rate, respiration, and mental status.

• Time and transition. The garment isn’t a long-term solution. It’s a bridge to care. As soon as you have definitive treatment under way — hemorrhage control in hypovolemia, airway and epinephrine in anaphylaxis, or advanced cardiac support where appropriate — reassess whether continued use is beneficial.

A few caveats that help make sense of the nuance

No single device or protocol will fit every patient. The way EMS clinicians use PASG has shifted as new evidence emerged and as overall resuscitation principles evolved. In many places, PASG is used less routinely than in the past, precisely because the potential benefits don’t always outweigh the risks in certain patients, especially those with heart pump failure.

That doesn’t mean the concept is dead. It means the judgment call is sharper: you weigh physiology, treat the underlying driver, and rely on rapid transport to definitive care. If a patient presents with signs pointing to cardiogenic impairment—chest pain, signs of heart failure, low ejection fraction symptoms, signs of poor tissue perfusion—you pivot away from PASG and toward interventions that support the heart and improve oxygen delivery.

A useful way to remember it

• Cardiac pump problems? Avoid PASG. The heart can’t tolerate the extra pressure, and venous return can get tangled in a bad way.

• Low volume due to bleeding or dehydration? PASG may be considered as part of a broader resuscitation strategy, while you address the source of loss and replace fluids as appropriate.

• Severe allergic reactions with swelling and vasodilation? The main line is epinephrine and airway management; PASG isn’t a universal fix here, but it might be used in some protocols depending on the system and the patient’s response.

The bigger picture: what this teaches us about EMS care

This topic isn’t just about memorizing a single contraindication. It’s a reminder of why physiology matters so much in patient care. The same principle applies across many tools you’ll encounter in the field: a device can be life-saving in one context and harmful in another. Your job is to read the patient, not just the protocol.

Let me explain with a quick analogy. Imagine you’re trying to water a garden during a drought. A hose clamp might help you push water to the thirsty plants when the supply is uncertain, but if the soil is already waterlogged, squeezing the hose tighter will flood the roots and damage them. Medical devices work in a similar way. The same squeeze that supports perfusion in one situation can drown the heart in another.

A small note on writing and learning this material

If you’re exploring topics like PASG within the broader landscape of EMT knowledge, you’ll notice how the explanations weave together anatomy, physiology, and real-world practice. That blend is what makes this field both challenging and rewarding. Understanding the “why” behind a guideline helps you apply it with confidence on the street, not just memorize it for a test.

Final thoughts: keep the focus on the patient

The question about PASG and cardiogenic shock isn’t just a test item. It’s a window into clinical reasoning. In the field, you’ll encounter questions that demand you read a person’s story—where their symptoms point, what their heart is doing, and what the next step should be to stabilize them. The right answer isn’t always the flashiest tool; sometimes the best move is to opt for care that steadies the system without adding stress to a fragile heart.

If you’re someone who loves thinking through these scenarios, you’ve got the right instinct. Build your knowledge by tying anatomy, physiology, and practical care together. The more you practice that habit, the more confident you’ll feel when a real patient needs you to navigate a tough decision with calm focus.

Key takeaways to remember

• PASG is contraindicated in cardiogenic shock because extra pressure can hinder the heart’s ability to pump and reduce venous return.

• In hypovolemic shock, the PASG has historically been used as a bridge to care, but modern practice emphasizes rapid hemorrhage control and fluid resuscitation.

• For anaphylaxis and other shock states, PASG is not a blanket answer; use depends on protocol and clinical judgment.

• The big goal is to support perfusion while you get definitive care, not to rely on a single device as a universal fix.

• Always assess contraindications, monitor the patient, and prioritize causes and definitive treatments over device use alone.

If this topic sparks more questions, that curiosity is a good sign. It means you’re thinking through how to keep patients moving toward stability, even when the path isn’t obvious. And that thoughtful approach—paired with clear physiology—will carry you a long way on the road to becoming a skilled EMS clinician.