Okay, now we 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 it'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 an ice water slurry, is I wanna stick it in an airtight 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 bathtub 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 an attempt to reattach it. Not
that reattachments 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
meantime 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.