"Ow, look at that! What am I gonna do about this?"
In this situation, we're gonna cover what to do in case there's an amputation.
Now the first thing we want to do is treat the patient.
There's about three different dynamics that are going on here.
Patient injury.
Bleeding control.
Looking for signs of shock.
Making sure we're checking for the whole scenario.
Is the scene still safe?
The thing that cut his finger off, is it going to cut our toe off, or another one of our extremities?
So the scene is safe, our gloves are on, our CPR shield is available.
And first things first, we're going to treat the patient.
Second phase of that is, we've gotta try to find the amputated part, and try to salvage it if we can.
Package it properly.
Bring it with the patient to the hospital to see if we can get a reattachment.
So in this situation he's maintaining some pretty good control.
But now we're going to come in with a dressing of some sort.
"Okay, I've got it, sir. I'm just going to put some direct pressure here."
Holding direct pressure is key.
Now the whole time that I'm holding direct pressure, we can also have elevation to keep the part above the heart,
so as to have gravity work with us.
Now in addition to holding direct pressure, as the rescuer, we're never going to stop thinking about the other
condition of the patient.
Right now he's thinking "I'll never play piano again."
Maybe he never played piano in the first place.
But he's also thinking about his bowling score.
He may be thinking about other things that are more important.
"Is this going to effect my livelihood? I use my hands to work on an everyday basis."
There can be psychogenic shock. There can be physiologic shock depending on how much blood-loss has occurred.
And we want to keep checking the patient, making sure they're stable.
Maybe get a chair for them to sit down in.
But we're holding that direct pressure.
I'll be checking to see if it's leaking through.
If it does start to leak through, I'm going to grab additional bandage and apply that to it.
But we never take the bandage away.
That's gonna pull blood clots off from it and start that whole bleeding process again,
when actually we've already begun the clotting process and controlling of that bleeding.
Holding direct pressure, elevation above the heart, keeping the patient stable.
Those are the three primary care stances we're gonna take to make sure we're treating this patient
appropriately before we get them into the hospital for further treatment.
The second phase of this bleeding control is the pressure bandage, now.
We want to bandage this to package the patient so that we don't have to continue to hold this,
en route to the hospital, med center, or whatever our next step is.
So I'm gonna enlist the patient's help here.
"Mike, if you could hold the bandage in place, just hold direct pressure there."
I'm gonna undo my roller gauze.
And now we're gonna begin this bandaging process.
"Okay you can go ahead and let go now."
Usually what I like to do is go right over the top of that stump, as I then wrap around the hand
to secure that in place.
We only have one digit involved here at this time.
But other fingers may get involved in the bandaging, depending on if we can move them out of the way.
The goal here is not to make the person a mummy, the goal is to actually apply pressure,
which sometimes I do with a little twist right over the point of the wound.
Now there's gonna be swelling.
We're going to continue to watch this and monitor it to see if there's any breaththough bleeding.
And a little bit's gonna be one thing, but we don't want it to start hemorrhaging again.
Now as we finish this bandaging, you're gonna have a little bit left over.
You can use that either to secure the cold pack once we put it on,
or just tuck it under there in case there's more bleeding, and we need to actually put more compress
and additional wrapping.
You don't have to use up the whole piece, necessarily, if it's not needed.
Once the icy cold pack is on there, never on the bare skin, that can cause frost-bite,
we want to make sure there's always material between the cold pack and the patient's skin.
Again, like I said before, we could use this excess bandage to just be the piece that holds this packet on a little bit better,
so that when we get ready to move this patient either to the ambulance, or to the car to get them to the hospital,
we're ready to go.
Now, someone might say, "When do you move them to the car?"
Well, if their airway, breathing, circulation is fine, and they're stable, they're not going into shock,
and the bleeding is controlled, that when you might be able to take them by car.
If there's any compromise in airway, breathing, circulation, decreased level of consciousness, or bleeding that's hard to control,
that's when you call 911.
Most of the time when you have an amputated part from an accident like this,
as you can see there's dirt and debris in the wound,
the goal is going to be to actually clean up the amputated part as best as you can.
We don't want to make it too soaked, but to get most of the debris off,
before we finish bandaging the amputated part.
We're then going to put this part into a plastic bag, and then into a cold, icy solution.
Once the amputated part is actually now wrapped, we have the baggy.
We're going to place the part in the baggy.
The goal here is to not allow the part to become soaked.
You know, if you've ever been in a pool or in the bath tub too long, you know what happens to your hands,
they get all pruney.
Well that water tends to break down tissue, especially tissue that is exposed from an amputation,
and we don't want that to happen, or it can really effect the attachment process of that part.
From here, we're going to place it then, into an icy slurry.
We don't want it directly in the water, touching the part.
But if you put it in a bag first, and then put it either touching the bag, or between two cold packs,
that's gonna keep the part fairly cold,
slow down the decaying necrotic process.
Necrosis means tissue death.
We don't want that to die.
We want to keep it so that we can hopefully reattach it, and this patient can get some function back from this amputation.
Last part of amputated finger here, is that we want to keep it with the patient,
and have it arrive at the hospital as soon as the patient arrives at the hospital.
If this is a situation where the part is stuck in a piece of machinery, or you've had to search for it,
get it to the hospital as soon as possible after taking those steps that we just showed you,
in decontaminating it as best you can,
putting it into something cold to keep the tissue from dying any faster than it already is.
But if we want to maximize the opportunity for this part to function again, we want to get it to the hospital with the patient,
ideally at the same time.