Amputation


Okay, now we’ve got a situation where this worker
was working in a sheet metal shop, they were using something to cut the sheet metal, and
got their thumb in the way, and it was amputated. Now, there’s a point to make here. It’s
easy to get distracted as a rescuer in trying to retrieve the amputated part, but we have
to remember that patient is the primary focus first. It isn’t that we’re not concerned
about the part, in fact we may send volunteers with gloves to go and locate the part. If
it’s in close proximity, great, but remember spinning and cutting devices could actually
throw the part or the partial amputation quite some distance from the accident site. So could
be a little difficult. It may also be covered in sawdust or in shavings and a little hard
to find. So, have other people do that, if at all possible or if they’re capable of
doing that while you attend to the patient. It’s easy to get really focused on the primary
injury, but what we might not realize is that they also passed out and hit their head on
a heavy piece of equipment, meaning they may have been knocked unconscious, and they’ve
got a serious concussion. So don’t forget to access the patient for life threatening
emergencies as well as the bleeding issue. The next point I wanna make about amputations
is that in all my experience as a paramedic, not to say that an amputated part, or especially
a partially amputated part or a crushing injury can bleed a lot. But most of my clean cut
amputations have not bled all that much. Some of it is because of this phenomenon where
the arteries actually contract up into a stump and the veins and sort of clamp themselves
down for at least the first few minutes that gives us a little bit of time so that we can
control that injury and the bleeding that’s associated with it. So, you may not see a
ton of blood, but let’s still address it all the same. The person is awake, they respond
to me normally, they are helping me hold pressure over the remaining stump, and they seem to
have no other life threatening injuries. So let’s control this bleeding. I can see that
it’s beginning to leak through. I’m not gonna remove the gauze bandage to look at
it, because that will pull the first beginning clots off. Now I’m going to simply replace
his fingers with the gauge bandage, and ask him to continue to press while I do other
things. If he can’t do that or if he’s starting to suffer from like some emotional
shock, that’s understandable, so I may have to control it or get another bystander to
give me a hand and make sure they have protection on their hands with gloves. But a special
note here. When there’s been an amputation, though it could be a clean cut, sometimes
you’ll have bone fragments actually sticking, out and I think you need to be really careful
if you apply that direct pressure that you don’t become victim number two by poking
that bone end into your skin. Not only do we not wanna damage that bone fragment any
more or cause unnecessary pain and bacteria to get in there. But tt’s like a needle.
I mean some of those bone fragments are really sharp. So just be very careful as you are
covering that bone end that you actually poke yourself with that bone end. But now he’s
holding it just fine, he’s doing a great job, and I don’t see it leaking through
the second bandage. Now I’m gonna take my roller gauze and I’m gonna hold that dressing
in place. Let me just go and take your hand here a moment, and now I’m wrapping it as
a pressure bandage, but I’m certainly not trying to cause a tourniquet effect. I’m
really just tried to hold that pressure bandage in place. And as long as it’s controlling
the bleeding, it’s certainly tight enough. If it begins to leak through again, I’ll
put more bandage on there and continue to wrap. A little special trick of the trade,
sometimes if I need a little extra pressure when I come on top over the wound, I’ll
twist the bandage and then just bring it around, it just adds a slight bit more torque over
the actual wound site and can help control that with a little extra pressure. Now if
the person can hold the bandage, or I can cut it, tape it or I can actually tuck it
underneath the other bandage. That bleeding is controlled, the patient is stable. Now
let me address the next piece which is the amputated part. Hopefully, the bystanders
were able to locate it and bring it to me. Once we actually have the amputated part with
us, there’s a few things we need to do. The first thing that I want to do is keep
it just as clean as possible. I’m also going to wrap it in a sterile gauze or bandage if
I can. Now, I’m using an abdominal dressing here and I’ll tell you why. I like the insulation
that that offers. If I’m going to put it between ice or cold packs. Cold packs aren’t
such a big concern, because they’re not really up to that freezing level, but I do
want them, the tissue to be protected from getting damaged through frostbite. Think about
frostbite with an attached limb that has warm blood flowing through it. This little piece
does not have blood flowing through it and so its ability to freeze is actually much
faster than if it was still attached to the patient. So I’m insulating it from cold
damage and if I don’t keep it cool between cold packs, I have another method. The first
thing I wanna do before I use the submerging into a ice water slurry, is I wanna stick
it in an air tight bag. So this is a sealable bag. I’m going to go ahead and seal it.
Fold it over, and now using some ice and some water, it does not have to be sterile water
because it’s not touching the water. I’m gonna now submerge the sealed part into this
ice water slurry. And I’m gonna seal the outside of this bag. This helps keep the part
cold but not frozen. Now. you might say, what’s the big deal about keeping that part dry?
Well, have you ever been in a hot tub swimming pool or bath tub too long, what happens to
your skin? It tends to get pruney, doesn’t it? That is because it kind of breaks down
the tissues. It will do that to this part as well and can make it a nightmare when it
comes time for attempt to reattach it. Not that we attachments are guarantees anyways,
but it does certainly help if the part, skin is not damaged because of water contact. Now,
last but not least, we wanna make sure this amputated part stays with its owner. We need
it to ride along with the patient. This is probably not a good idea to have it in front
of the patient. They know they just had a serious injury, they know that’s their thumb
and that alone could start to develop some psychosomatic or psychogenic shock. I like
to hide it kind of behind the patient, keep it out of their view, but if you’re not
gonna have it on the stretcher or with the patient directly, it’s important that you
vitally keep an eye on where it’s at and remain diligent, really about keeping the
part with the patient so that when they arrive to the hospital, the surgeons can get it as
fast as possible and reattach it or at least attempt to reattach it as fast as possible.
Some tips, and how to do that, and in the mean time always be watching with your secondary
survey for those signs of life threatening emergencies and be sure to treat them if you
see them arise.

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