Trapped pt with amputation

[falcon-18]

Hello, every body.

If pt is trapped in a machine with crush injury and incomplete amputation of

one lower leg. in any crush injury heavy fluid resusitation is essential before

extrication to avoid acute renal failure. in this scenario, as the pt is trapped

so life saving limb amputation is necessary at the scene. time is crucial, so if

a surgeon could not available, assuming that the scene is in far remote area.

in this case supposing to be in wilderness, can an EMT iniate amputation,

while ligating bleeders and securing haemorrhage with onlline medical

direction? AS this is a life saving procedure in this scenario, so I suggest that

EMTS, specialy working in far remote areas or wilderness should have short

courses to handle such a situation. I know that this life saving amputation in

a trapped pt should be done by surgeon it is very difficult for EMT to perfom

amputation even then sometimes to save a life, this topic can be considered.

 

[Akulahawk]

One word: Tourniquet...
2nd word: helicopter
3rd word: Surgeon.

Not necessarily in that order...

 

[exodus]

Tourniquet above, that will stop bleeding, and help control alot of the pain.

 

[falcon-18]

One word: Tourniquet...
2nd word: helicopter
3rd word: Surgeon.

Not necessarily in that order...

Tourniquet above, that will stop bleeding, and help control alot of the pain.

wilderness EMT should be aware to face such situation

spiceally if helicopter also not available or it will take long time to arrive, and

pt limb is trapped .

Tourniquet useful to stop bleeding but how to get pt out.

surgeon also will take a lot of time to arrive, and amputation is the only way

to get the pt out. so how to procede.

 

[vquintessence]

wilderness EMT should be aware to face such situation

spiceally if helicopter also not available or it will take long time to arrive, and

pt limb is trapped .

Tourniquet useful to stop bleeding but how to get pt out.

surgeon also will take a lot of time to arrive, and amputation is the only way

to get the pt out. so how to procede.

Really, use the tourniquet. We don't perform field amputations, not even escharotomies. If pt is trapped to extent you want the scenario to be, take as much of the "crushing stuff" off as possible, then transport whatever is necessary. If it's truly a rural environment, then I'd hope the wilderness service would have cutting devices with them.

For the situation you want to create, the person would probably die.

Consider this instead: With the situation you described, of a prolonged and severely trapped lower extremity, you'd potentially be dealing with one hell of a crush injury. Imagine all the lactic acids and other byproducts being created by the anaerobic metabolism of the trapped tissues. Fluid resuscitation is only the beginning of your pts problems.

Forget the field amputation my friend, and do some worrying about the rapid release of those trapped lactic acids and byproducts into main circulation!

 

[VentMedic]

in any crush injury heavy fluid resusitation is essential

As an EMT-B, how much fluid do you intend on running into the patient? How much is too much?

 

[falcon-18]

As an EMT-B, how much fluid do you intend on running into the patient? How much is too much?

UNTIL WHEN YOU WILL GIVE HIM FLUID?

My point is ; if they are not comig early because mountain or weather...or for any reason and you do not have a cut machine. what you will do. only give him fluid . this is my point. for this pt, he needs amputation to save his life.

??????


falcon-18

 

[reaper]

As an EMT, you will never do an amputation. You will kill the pt with fluids, long before you would need to amputate!

EMS is about thinking outside the box. You need to look at the ways to get the pt out or get a surgeon there!

 

[Akulahawk]

You must figure out a way to extricate the patient from the machine, or the machine from the patient. If that involves disassembly of the machine, so be it. EMT's of any level do not perform field amputations, that I'm aware of.

My feeling on this is if you can not disassemble or cut the patient from the machine you should apply a tourniquet and manually turn the machine backwards, while extricating the patient. Do NOT allow the tourniquet to be released.

I would further suspect that such machinery would have been delivered somehow, and has a power source so I would suspect that waiting for several hours for a surgeon to arrive by ground or by air is still appropriate if a field amputation is necessary.

Extrication is, in my opinion, the most appropriate thing to work on... and rushing to perform a field amputation by personnel not trained/authorized to perform such an amputation is inappropriate.

 

[falcon-18]

As an EMT, you will never do an amputation. You will kill the pt with fluids, long before you would need to amputate!

EMS is about thinking outside the box. You need to look at the ways to get the pt out or get a surgeon there!

You must figure out a way to extricate the patient from the machine, or the machine from the patient. If that involves disassembly of the machine, so be it. EMT's of any level do not perform field amputations, that I'm aware of.

My feeling on this is if you can not disassemble or cut the patient from the machine you should apply a tourniquet and manually turn the machine backwards, while extricating the patient. Do NOT allow the tourniquet to be released.

I would further suspect that such machinery would have been delivered somehow, and has a power source so I would suspect that waiting for several hours for a surgeon to arrive by ground or by air is still appropriate if a field amputation is necessary.

Extrication is, in my opinion, the most appropriate thing to work on... and rushing to perform a field amputation by personnel not trained/authorized to perform such an amputation is inappropriate.

I said you can not extiate pt and he is in criticale case and surgeon need more time to come.

yes extrication you will do it but when you can not do it. what you will do?

 

[VentMedic]

I said you can not extiate pt and he is in criticale case and surgeon need more time to come.

yes extrication you will do it but when you can not do it. what you will do?

What makes this patient critical? It seems as if you are so focused on one issue that you may be forgetting a few basic things that you can do for a patient as an EMT-B. Focus on the patient and not a mangled body part. If you let your own emotions get carried away, that will lose the patient faster than the situation they are actually in.

If this patient is still conscious, you may kill the patient when you start sawing or chopping on their extremity. Even a knife can be traumatic depending on the location and alertness of the patient. Believe it or not but unconscious patients will still get some medication for patient and maybe something like Versed as a sedative even though they do appear unconscious. Whatever shock condition they are in will be enhanced at the hands of an inexperienced and minimally educated provider. Yes, there are many stories of individuals sawing their own body parts off but this is not the situation.

You also have NO way to maintain their BP once any pressure is relieved or as they go deeper into a shock state.

Stop watchinig the TV shows and start learning a little more about the body's responses to trauma and what you can do as an EMT-B.

 

[VentMedic]

I think this thread needs some clarification.

Falcon,

I am an EMT-P and I am 23

Are you a Paramedic in the United States and what are your protocols?

Or, are you asking specifically about the U.S. EMT?

In the U.S., the EMT has only 120 hours of basic first-aid.

 

[falcon-18]

Hello, every body.

If pt is trapped in a machine with crush injury and incomplete amputation of

one lower leg. in any crush injury heavy fluid resusitation is essential before

extrication to avoid acute renal failure. in this scenario, as the pt is trapped

so life saving limb amputation is necessary at the scene. time is crucial, so if

a surgeon could not available, assuming that the scene is in far remote area.

in this case supposing to be in wilderness, can an EMT iniate amputation,

while ligating bleeders and securing haemorrhage with onlline medical

direction? AS this is a life saving procedure in this scenario, so I suggest that

EMTS, specialy working in far remote areas or wilderness should have short

courses to handle such a situation. I know that this life saving amputation in

a trapped pt should be done by surgeon it is very difficult for EMT to perfom

amputation even then sometimes to save a life, this topic can be considered.

What makes this patient critical? It seems as if you are so focused on one issue that you may be forgetting a few basic things that you can do for a patient as an EMT-B. Focus on the patient and not a mangled body part. If you let your own emotions get carried away, that will lose the patient faster than the situation they are actually in.

If this patient is still conscious, you may kill the patient when you start sawing or chopping on their extremity. Even a knife can be traumatic depending on the location and alertness of the patient. Believe it or not but unconscious patients will still get some medication for patient and maybe something like Versed as a sedative even though they do appear unconscious. Whatever shock condition they are in will be enhanced at the hands of an inexperienced and minimally educated provider. Yes, there are many stories of individuals sawing their own body parts off but this is not the situation.

You also have NO way to maintain their BP once any pressure is relieved or as they go deeper into a shock state.

Stop watchinig the TV shows and start learning a little more about the body's responses to trauma and what you can do as an EMT-B.

I do not know why you say that my scenario is very clear . I said so I suggest that

EMTS, specialy working in far remote areas or wilderness should have short

courses to handle such a situation.

I do not say you should doing amputation by your self. I discuss it only.

 

[VentMedic]

I do not know why you say that my scenario is very clear . I said so I suggest that

EMTS, specialy working in far remote areas or wilderness should have short

courses to handle such a situation.

I do not say you should doing amputation by your self. I discuss it only.

No it is not clear.

What makes you think this patient is critical?

Patients have been entangled in wrecked or entrapped with partially amputated extremities for hours and even days until they have been found.

 

[falcon-18]

I think this thread needs some clarification.

Falcon,



Are you a Paramedic in the United States and what are your protocols?

Or, are you asking specifically about the U.S. EMT?

In the U.S., the EMT has only 120 hours of basic first-aid.

No, I am not from US . I just discuss. this Q come to me when I am

reading PHTLS book sixth edition.

 

[VentMedic]

No, I am not from US . I just discuss. this Q come to me when I am

reading PHTLS book sixth edition.

Please do us all a favor and put your country in your profile since this is a multinational site.

No, in the U.S. an EMT would probably not be doing an amputation. The situation would have to be very, very dire with absolutely no other options. Even at that they may have to answer to a medical review to keep their certification..

 

[Mountain Res-Q]

Okay, so from the wilderness standpoint that you mentioned...

If the patient is trapped due to this crushing (let's say it is a bolder that has fallen and crushed/trapped a limb) then one of two things will happen:

1. He will be dead faster than we can get there.
2. He will be alive when we got there and, in all honesty, he will live a little longer for us to get a surgeon in.

However, playing this game: Amputation in the wilderness setting is not something I believe any WEMT, WFR, or OEC class teaches... LOL... Under what cirrcumstances would it be a critical procedure to save the life (keeping in mind the above)? If we are incapable of getting the surgeon in (lets say weather is now preventing a helo) then how would we get the pt. out in the timely manner that an pre-hospital surgical amputaion requires? However, let's say that it was required to save a life (even temporarily, pre-getting-your-cert-pulled and getting investigated and arrested)...

It could be done, but it would not be pretty or skilled... case in point... this is a true story (and a good one)... COULD YOU DO THIS?

http://www.cbsnews.com/stories/2003/05/02/national/main551979.shtml

Long story short, he was rock climbing when a boulder rolled on to his arm, pinning him against a rock face for sevral days, realizing that no help was coming and that he was going to die there, he actually amputated his own arm with a dull pocket knife and no anesthesia. He also had to use a rock to shatter his radius and ulna because the knife was not going to cut through bone. He then still had to get out of there and get help, which meant crawling out of the wilderness and even, at times, doing some one armed rappel work... Chiling stuff... The kinda of stuff that gives me SAR nightmares...

 

[falcon-18]

No it is not clear.

What makes you think this patient is critical?

Patients have been entangled in wrecked or entrapped with partially amputated extremities for hours and even days until they have been found.[/QUOTE]

I do not see any one like this. but it is good to hear that.

What makes you think this patient is critical?

good Q...

I will answer. you mean if the pt in critical do tourniqute, and it will stop bleeding and ontrol BP.oh , it is great, so if this pt is in the mountain and the weather is very cold and he become hypothermia, or this pt have head trauma, may be he had a hemorrahge and he need surgeon to do opration and he need you to save his life . what you will do?
yes. I will not do amputation by myself. I discuss...

 

[VentMedic]

What makes you think this patient is critical?

good Q...

I will answer. you mean if the pt in critical do tourniqute, and it will stop bleeding and ontrol BP.oh , it is great, so if this pt is in the mountain and the weather is very cold and he become hypothermia, or this pt have head trauma, may be he had a hemorrahge and he need surgeon to do opration and he need you to save his life . what you will do?
yes. I will not do amputation by myself. I discuss...

Hopefully you as a rescuer can alleviate the some of the factors of the environment.

You can NOT treat any of the things mentioned as an EMT. You may make matters worse by cutting off the extremity. You can not control pain. You can not control BP either high or low. Get the surgeon enroute or an advanced practitioner that might be able to help.

A tourniquet not stopping the bleeding?

Okay, you are getting way too deep into the "what ifs" and haven't understood the basic realities of what you CAN do.

What are you a student of if you are already a Paramedic in your country? Even a Paramedic in this country would be addressing all the issues before considering amputation.

Why are you so concerned with what the U.S. EMT does? It is an entry level position that only addresses the basic principles of first-aid.

 

[falcon-18]

Hopefully you as a rescuer can alleviate the some of the factors of the environment.

You can NOT treat any of the things mentioned as an EMT. You may make matters worse by cutting off the extremity. You can not control pain. You can not control BP either high or low. Get the surgeon enroute or an advanced practitioner that might be able to help.

A tourniquet not stopping the bleeding?

Okay, you are getting way too deep into the "what ifs" and haven't understood the basic realities of what you CAN do.

What are you a student of if you are already a Paramedic in your country? Even a Paramedic in this country would be addressing all the issues before considering amputation.

Why are you so concerned with what the U.S. EMT does? It is an entry level position that only addresses the basic principles of first-aid.

please, let us talk in this subject. we have one coutry it is EMS country we discuss in it. did you see what Mountain Res-Q said you can go back and see it.

A tourniquet not stopping the bleeding?

sure it is. did you think it is stop bleeding in brain. that is what I mean.

Even a Paramedic in this country would be addressing all the issues before considering amputation. also in my country
thanks VentMedic . I know my job.