Field Limb Amputations
Welcome back, everyone!
Did everyone have a nice summer break? Away from tense clinical trials, hectic trauma rooms, and cold operating rooms? Well, you guys might not know that the ORs are cold, but they are. The temperature in ORs is kept low for equipment maintenance, the sterility of supplies, and the comfort of the surgical team working under hot lights. Funny enough, even the ORs at "Grey's Anatomy" are cold. Probably for the same reason – the cast and crew work under hot lights, too…
Anyway, back to the medicine! And what awesome medicine did we bring you in these first two hours – injuries from a SINKHOLE COLLAPSE! (If you want to check out a crazy real-life sinkhole picture, go ahead and search on the web for the 2010 sinkhole that happened in Guatemala due to Tropical Storm Agatha – it's nuts). And talk about injuries – poor Danny and Susannah Wilson. Not only did they become trapped in the sinkhole by their car (in the middle of a marital argument no less), Danny had to attempt to amputate Susannah's leg to help the rescue team extricate her.
Yep. We totally started the season off with a field amputation. Like I said, welcome back.
Besides sinkhole collapses, what other kinds of situations might a field amputation be necessary?
Well, first of all, a field amputation is not the norm – the procedure should ONLY be used as a last resort method of rescuing a victim from a difficult entrapment. In other words, field amputation should only be done if the victim's life suddenly becomes at stake – life over limb.
Other entrapment scenarios include motor vehicle crashes, industrial/farming accidents, and structural collapses. But again, the the need for field amputations is actually rare, so many agencies still do not even have a protocol in place. So yay for Seattle for knowing what to do!
Here are four indications for field amputations:
• The victim suffers from an entrapped extremity that will not be extricated rapidly. The patient's vitals are usually unstable, such as low blood pressure readings, and the patient does not seem to be responding well even when given IV fluids (such as blood products and crystalloid).
• The victim suffers from an entrapped extremity that will not be extricated rapidly. If not extricated immediately, the structure could collapse further, inflicting MORE injuries on the patient.
• The victim suffers from an entrapped extremity that will not be extricated rapidly. The patient's vitals are somewhat unstable, but he/she seems to be responding to IV fluids. In this type of situation, the incident commander on the scene would have to make a judgment call based on discussions with other rescue and medical team members.
• The victim suffers from an entrapped extremity and maintains normal vital signs. However, extrication may take several hours, if it can be done at all. Again, the incident commander would have to make a judgment call.
Callie and Owen let down a medical "kit" to Danny for the amputation. What kind of supplies were in there?
Agencies that have an established protocol do maintain "field amputation kits" with the following supplies:
• Anesthetics: Paralytics, analgesics, sedatives
• 2 Tourniquets, 6 inch Ace wraps
• Sterile gloves, gown, mask, goggles
• ABD pads, gauze, laparotomy pads, sterile towels
• Saline
• Plastic bags
• Scalpel, Mayo scissors, Kelly clamps, hemostats (small and large)
• Betadine solution
• Hand-held battery operated sagittal saw (spare blades and backup battery)
• Gigli saw
Without going into ALL the gory details, what's the overall process at the site?
After the decision has been made to proceed with a field amputation, the amputation kit should be located and set up. Then, pain medication and sedatives should be administered to the patient. The trauma surgeon (or at times, the paramedic) would place a tourniquet above the operative field – but not over a joint, apply sterile betadine solution to the area, place sterile towels around the site, and begin with the scalpel to divide the soft tissue. After the saw has been used to cut the bone, sterile dressings, that are also saline-moistened, would be placed over the wound and covered with an ace bandage. If possible, the amputated limb should be retrieved and transported in a clean, plastic bag with the patient.
For more information on limb amputation, please visit:
http://www.nlm.nih.gov/medlineplus/ency/article/007365.htm
