Re: MDs for field amputations

["wcemt" <wcemt@kronos.terraworld.net>]

Mike, 

Very good questions. 

In a last ditch type effort where rapid field amputation would be 
beneficial, blood loss is a major concern, but direct pressure, clamping and 
tourniquets can be used.  Due to the extensive soft tissue damage associated 
with this type of injury, clamping bleeders can be done rapidly without the 
precise placement of the clamp that would be used in surgery.
(i.e. clamping some surrounding tissue with the bleeder won't matter) 

Pain control is a must! These people will likely be in considerable pain. 
However, keep in mind the nerves in the area of amputation may be severely 
damaged, that along with a strong fight or flight response can often mask 
the pain for a while. Regardless, high dose morphine along with some versed 
would be my treatment of choice. 

The wound from this type of injury is already grossly contaminated.  While 
attempts to avoid further contamination should be made (using sterile/clean 
instruments etc.) in all reality sterile procedure is of little value in 
this situation.  The chance of future sepsis / infection is already there 
regardless.  The contamination has already occurred and rapid extrication 
and transport to a trauma center where the wound can be surgical cleaned and 
repaired will be of more benefit. 

As for fat and bone emboli, again it seems that the damage is done.  The 
chance for these already exists due to the type of injury. 

I would be interested to hear what the Doctors on this list have to say 
regarding this topic. 

Wesley Copeland Sr. 

 


Mike Shuken writes: 

> All this talk about field amputations makes me wonder what concerns you have
> to think about to do the procedure... 
> 
> I would think: 
> 
> -Controlling bleeding.  (Clamping or cauterizing as you go?) 
> 
> -Preventing fat or bone emboli. 
> 
> -Pain control (with a heavy dose of an amnesiac as well...). 
> 
> -Sterile procedure as far as it is practical to prevent future
> sepses/infection. 
> 
> Anyone know what is specifically involved - is it actually a pretty simple
> procedure or is it fairly difficult? 
> 
> Mike 
> 
> Mike Shuken
> Paramedic
> AMR
> Oakland, Calif. 
> 
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