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Field Amputation

Field Amputation: VLOG by Cynthia Griffin D.O., NRP
Vlog Notes!
Indications for field Amputation
This is where we chose Life over Limb.
1. Pt is unstable and there is no other way to extricate them
2. Pt is somewhat stable yet there is no other way to extricate them, may have time sensitive injuries, may need time sensitive surgery, pt needs blood, pt has a bleed you can’t get to
3. Pt is at risk of dying due to the environment (stable or unstable). Pts life is in imminent danger.
Fire, Cold, Oncoming train, Submersion, Structural collapse, Chemical Exposure
4. Pt has a completely mutilated nonsurvivable limb retaining minimal attachment
5. Pt is dead and their limbs are blocking access to potentially live casualties
Example Cases:
Vehicle will explode
Chemical Spill
Gross Instability at the Scene
Rapid Deterioration
Progressing Fire
Rising water
Contraindications:
Having an alternate means of extrication.
Make sure to ask everyone onscene for their ideas.
Make sure all of their clothing around that part has been removed.
Giving analgesia might help.
Some sources say if entrapped in proximal portion and not limb, but this is not true.
Support Personnel
FF – for scene safety or HAZMAT and ICS
HAZMAT
HURT
HOIST team
Police – scene protection
2nd Ambulance – transport of the limb if delayed and pt critical
HEMS – blood, TXA, pt transport
Materials & Equipment
Meds
Sedation & Pain: Need to be able to control pain, may help in extrication
Ketamine – ideal agent
Versed – consider lower doses since this pt is prob already hypotensive
Fentanyl
Morphine
Propofol – beware hypotension
Etomidate
Rocc – if you need them paralyzed, not ideal to have them paralyzed
Succ – avoid since there might be hyperK – although more of a concern w prolonged
Blood & Plasma
TXA
Antibiotics
Cefazolin (Ancef) 2g (25 mg/kg)
If allergic to cephalosporins, Clindamycin 600mg IV (10mg/kg)
If dirt in wound, Gentamicin 1.5-2.5 mg/kg IDW
Tetanus Toxoid 0.5ccIM (if not current w/In past 5 yrs)
Equipment
PPE: Gowns mask, goggles, Gloves (sterile preferred)
Cutting: Use cot to have instruments & equipment available
[Article about cutting tools –Man or Machine? An experimental study of prehospital emergency amputation – C Leech 2016] used CT assessment of the proximal bone
All completed amputation within 91 sec
Cadaveric study
Gigli Saw – 91 sec, quick and can be used in tight spaces, sharp, need elbow room
Stryker Bone Saw - can use with one hand
Hacksaw – 88 sec, took 3 cuts bc jammed on bone, sharp knife, saw blade injury, need to support and traction leg, difficult to angle hacksaw, needs 2 angles, good quality/soft tissue/bone cuts
HURST Tool – large, on large bones can splint
- carbon steel edge curved blades – Holmatro Device in UK (
Original author: Cynthia Griffin, DO
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