4. TRAUMA EMERGENCIES
4.10 TRAUMATIC AMPUTATIONS
The partial or complete severance of a digit or limb is most commonly the result of an industrial/machine operation accident. It often results in the complete loss of the digit/limb. The amputated part or the skin of the amputated part may be utilized by the reimplantation surgical team. Major limb amputations may result in death due to uncontrolled hemorrhage. Careful management of the patient and their amputated part(s) will reduce the possibility of infection and increase the likelihood of successful reimplantation.
ASSESSMENT / TREATMENT PRIORITIES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway and assist ventilations as needed. Assume spinal injury when appropriate and treat accordingly.
3. Administer high flow oxygen by non-rebreather mask or bag valve mask as determined by patient's condition.
4. Determine patient's hemodynamic stability and symptoms. Continually assess Level of Consciousness, ABCs and Vital Signs.
5. Treat all life threatening conditions as they become identified.
6. Obtain appropriate history related to event, including Past Medical History, Medications, Drug Allergies, Substance abuse.
7. Patient transport must not be unnecessarily delayed in an effort to find avulsed tissue and/or body parts if they are not readily available. These tissues and/or body parts may be transported to receiving facility by other EMS/law enforcement providers at a later time.
TREATMENT
BASIC PROCEDURES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway and assist ventilations as needed. In cases of suspected head/neck injury, assure cervical spine stabilization/immobilization.
3. Administer oxygen as determined by patient's condition.
4. Control/stop any identified life threatening hemorrhage (direct pressure, pressure points, etc.) Tourniquets should be avoided if at all possible, except when absolutely required to prevent death due to life-threatening hemorrhage.
5. Management of injured tissue:
a. Tissue still attached to body (i.e., avulsion):
- clean wound surface with sterile Normal Saline
- gently return skin to normal position if possible
- control bleeding and bandage wound with bulky pressure dressings
b. Complete amputation:
- clean wound surface with sterile Normal Saline
- control bleeding and bandage wound with bulky pressure dressing
- retrieve amputated tissue/part(s) if possible
- wrap amputated tissue/part(s) in sterile gauze moistened with sterile Normal Saline
- place amputated tissue/part(s) in a plastic bag
- place sealed bag into a cool/cold water immersion. NOTE: ice cubes may be in the water, however, no direct contact between injured tissue/part(s) and ice should occur.
6. Activate ALS intercept, if deemed necessary and if available.
7. Initiate transport as soon as possible with or without ALS.
8. Notify receiving hospital.
INTERMEDIATE PROCEDURES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway and assist ventilations as needed. In cases of suspected head/neck injury, assure cervical spine stabilization/immobilization.
3. Administer oxygen as determined by patient's condition.
4. Control/stop any identified life threatening hemorrhage (direct pressure, pressure points, etc.) Tourniquets should be avoided if at all possible, except when absolutely required to prevent death due to life-threatening hemorrhage.
5. Management of injured tissue:
a. Tissue still attached to body (i.e., avulsion):
- clean wound surface with sterile Normal Saline
- gently return skin to normal position if possible
- control bleeding and bandage wound with bulky pressure dressings
b. Complete amputation:
- clean wound surface with sterile Normal Saline
- control bleeding and bandage wound with bulky pressure dressing
- retrieve amputated tissue/part(s) if possible
- wrap amputated tissue/part(s) in sterile gauze moistened with sterile Normal Saline
- place amputated tissue/part(s) in a plastic bag
- place sealed bag into a cool/cold water immersion. NOTE: ice cubes may be in the water, however, no direct contact between injured tissue/part(s) and ice should occur.
6. ALS STANDING ORDERS:
a. Provide advanced airway management if indicated due to other injuries and/or illness.
b. Administer a 250 cc-500 cc fluid bolus, if indicated by patient’s hemodynamic status.
7. Contact MEDICAL CONTROL. Medical control may order:
a. Additional IV Normal Saline 250 cc - 500 cc bolus or wide open titrated to patient's condition.
8. Activate Paramedic intercept, if deemed necessary and if available.
9. Initiate transport as soon as possible with or without Paramedics.
10. Notify receiving hospital.
PARAMEDIC PROCEDURES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway and assist ventilations as needed. In cases of suspected head/neck injury, assure cervical spine stabilization/immobilization.
3. Administer oxygen as determined by patient's condition.
4. Control/stop any identified life threatening hemorrhage (direct pressure, pressure points, etc.) Tourniquets should be avoided if at all possible, except when absolutely required to prevent death due to life-threatening hemorrhage.
5. Management of injured tissue:
a. Tissue still attached to body (i.e., avulsion):
- clean wound surface with sterile Normal Saline
- gently return skin to normal position if possible
- control bleeding and bandage wound with bulky pressure dressings
b. Complete amputation:
- clean wound surface with sterile Normal Saline
- control bleeding and bandage wound with bulky pressure dressing
- retrieve amputated tissue/part(s) if possible
- wrap amputated tissue/part(s) in sterile gauze moistened with sterile Normal Saline
- place amputated tissue/part(s) in a plastic bag
- place sealed bag into a cool/cold water immersion. NOTE: ice cubes may be in the water, however, no direct contact between injured tissue/part(s) and ice should occur.
6. ALS STANDING ORDERS
a. Provide advanced airway management if indicated due to other injuries and/or illness.
b. Initiate IV Normal Saline.
c. Administer a 250 cc - 500 cc fluid bolus if indicated by patients hemodynamic status
7. Contact MEDICAL CONTROL. Medical control may order:
a. Additional Normal Saline 250 cc - 500 cc bolus or wide open titrated to patient's condition.
b. Morphine Sulfate 2 - 5 mg IV, may repeat up to 10 mg maximum.
8. Initiate transport as soon as possible.
9. Notify receiving hospital.
MoonDragon's EMS Index Page
HELPFUL PRODUCTS & FURTHER EDUCATION
-- by Phyllis A. Balch, James F. Balch - 2nd Edition
-- by Phyllis A. Balch, James F. Balch - 4th Edition
-- by Phyllis A. Balch
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