RE: MDs for field amputations

["John L. Meade" <jmeade@statdoc.com>]

Excellent description of the concepts, Wesley. I have nothing to add,
other than the fact that this thread has prompted me to initiate
discussion within my own physician group and EMS people, to establish a
protocol to follow the next time we have this situation. Our last was 5
years ago, so maybe we are overdue. We don't want to have a "goat
roping"! (I love that term!)

JM 
  
John L. Meade, MD, FACEP 
Emergency Medicine Specialist
Emerald Healthcare Group, P.A. 
http://www.statdoc.com/  
 
When you dream in color, it's a pigment of your imagination.




 
 

-----Original Message-----
From: flightmed-admin@flightweb.com
[mailto:flightmed-admin@flightweb.com] On Behalf Of wcemt
Sent: Sunday, June 16, 2002 05:36
To: flightmed@flightweb.com
Subject: Re: MDs for field amputations

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. 
> 
> Improving medical care for the people of developing countries:
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