An amputation from trauma involves the loss of an extremity like a finger or toe but could also include an arm or a leg. It's important to not get too distracted looking for the amputated part and focus on the wellbeing of the victim.
As amputation injuries often occur in machine accidents, the amputated part can get thrown quite a distance from the scene of the accident. It may also be covered in saw dust or shavings of some kind, which could make finding it more problematic. If there are other people on the scene, you may want to consider asking for help to locate the missing part.
Amputation injuries are quite serious. It’s important to assess the patient beyond the amputation, including:
- Did the victim lose consciousness?
- If so, did they hit their head and are now suffering from a concussion?
- Is the victim showing signs of being in shock?
How to Provide Care
Clean-cut amputations bleed less than you might expect and often less than crushed extremities or partial amputations. The reason for this is that the arteries contract up into the stump and clamp down, which helps to control the bleeding for at least the first few minutes following the amputation.
After you make sure the scene is safe, proceed with the following steps.
- Put on latex-free gloves if available or wash your hands thoroughly using soap and water or a sanitizer of some kind, preferably with alcohol.
- If the victim is conscious and not in shock or showing signs of other life-threatening injuries, ask him or her to help apply pressure to the wound.
- If there is already a cloth or dressing pad covering the stump, don’t remove it, as this will pull off some of the clotting blood.
- Apply a second piece of gauze padding and, if necessary, subsequent pieces until bleeding is controlled and apply pressure.
- If the victim can't help apply pressure, you'll need to manage it yourself or ask someone to assist you.
Pro Tip 1: With amputation injuries, there will sometimes be a protruding bone fragment. These can be very sharp and may cut you while you attend to the victim. Therefore, it's important to be careful when dressing the wound. If you're not, you could easily:
- Damage the bone further
- Cause more pain to the victim
- Introduce bacteria into the wound
Once you've controlled the bleeding, meaning it is no longer leaking through the dressing pads, it's time to wrap the wound with a roller gauze bandage.
Pro Tip 2: Your goal in wrapping the wound is to apply enough pressure to hold the dressing pads in place and control the bleeding. Be careful not to wrap so tight that you cut off circulation. Remember to use the pinch test on finger and toe nails if appropriate and you are able to.
If blood begins to leak through while you're wrapping the wound, simply insert another dressing pad and continue wrapping. If you need extra pressure at that point, twist the bandage over the wound area. This will apply a bit more torque and should help control the bleeding. When you're done wrapping, tuck or tape the end of the bandage.
By this point, the bleeding should be controlled, and the patient should be stable. Continue assessing the victim for signs of shock or other health concerns.
How to Handle the Amputated Extremity
If you or someone at the scene were able to find the amputated part, it’s important that you handle it properly using the following steps.
- Make sure it's clean.
- Wrap it in a sterile gauze pad, preferably an abdominal dressing pad if you have one. This will offer much more insulation than regular pads and help protect the part from cold damage.
- Place the part into a sealable plastic bag.
- Put the bag with the part between two cold packs or into a bag filled with ice water and seal that bag.
Warning: The amputated part has no blood flowing through it, which makes it much more susceptible to frost bite and tissue damage. You want to keep it cold, not frozen. It's also important to keep it dry.
When skin becomes water logged and gets pruney, this is actually the onset of that tissue breaking down and will make reattachment more difficult.
Pro Tip 3: It's important to keep the amputated part with the victim and, if possible, out of sight from the victim. You don't want to encourage psychosomatic shock, but you want the surgeons at the hospital to have access to both victim and part immediately.
As amputations are serious injuries, you should be continually assessing the victim for signs of shock or other life-threatening conditions.
A Word About Early Signs of Shock
We will be discussing shock in great detail in the next lesson, but it's important to know that it's a progressive condition. Symptoms may seem minor at first, but the situation can quickly get worse. Your rapid response is vital.
Early symptoms of shock include:
- The victim expresses anxious or apprehensive feelings
- The victim's body temperature is lower than normal
- The victim's breathing is quicker than normal
- The victim's pulse has increased
- The victim's blood pressure has decreased
- The victim's skin appears pale or clammy
If you suspect that the victim is in shock, it's important to call 911 immediately. It's impossible to know when an individual will go into shock, but with amputation injuries you may want to consider the threat more elevated. And knowing the warning signs and being able to spot them early on could make a big difference.