Amputated limbs are something that you don’t come across very often, especially in day-to-day life. It happens more often in machinery accidents, in traumatic car crashes. But it is something that you may come across, so we will look at it and how we deal with amputated parts. The first thing we need to understand is, when we do deal with an amputation, the first priority is always going to be stemming the blood flow. So we do our primary survey, no more than 90 seconds. We are looking for life-threatening problems. And one of the life-threatening problems you may well come across in an amputation is arterial bleeds. We are going to cover arterial bleeds in a later section. But arterial bleeds need to be controlled immediately. You basically have five to six litres of blood in your body, and that will leave your body very quickly with an arterial bleed.
So, how are going to deal with the bleed itself? Well, all the same principles apply as they would for any bleed. Elevation, blood doesn’t like running uphill; pressure over the wound site. Again, once we apply pressure, bleeding starts to slow. But we now might start to go into things like battlefield dressings, or trauma dressings; which are much larger, much thicker, and basically stem an awful lot more bleeding than a normal size one, two, three, four, five ambulance dressing. So we’re now into the next level of actual dressings that we’re going to use. We also might fall into the realms of tourniquets. Because if an arterial bleed is heavy, then we may fall into requiring a tourniquet sooner rather than later to stem the blood loss.
What are we going to do with the actual limb or part of the body that’s been amputated? And it could be the tip of the finger, it could be the arm, it could be the leg. We have got to deal with them properly because nowadays, technology has moved on so fast that actually, the amputated part may be salvageable. It may be able to be restitched, the nerves reattached, and that limb may be actually workable again in the future. But we have to deal with it correctly to allow that to happen. So what do we do? Well, the first thing, once we have got the patient under control, the bleeding under control and the situation managed, we take the limb no matter what it is: Finger, toe, leg, arm, and we wrap it in cling film. Ordinary cling film that you would use every day in the kitchen. What the cling film does is it forms of a barrier of infection, it keeps it clean, and it keeps everything under control in one area.
Once we wrapped it in cling film, we then wrap that in either towels or thin blankets; something to protect the limb. Because next what we are going to do, is we’re going to place that limb in cold, ice water, ice itself, something that will cool the limb down. But we never ever apply any ice or cold directly to the stump, where it’s been amputated from, or the actual limb itself. We want to cool it, but we don’t want to burn it. And if we put ice directly on the wound ends, what we do is we kill the nerves, and then it is not salvageable; it’s not usable. The nerve is dead, we have destroyed the nerve itself. And consequently, when they come to try and reattach, it won’t take. So we have to cool the limb, but we don’t freeze it. We don’t want anything directly on the skin. So we wrap it in cling film first, then we wrap it something to give it a little bit of insulation, and then we submerge it in cold; ice or ice water. Patient and limb must be then transported, at speed, to the appropriate receiving hospital. Quite often, these are transfers that are done by helicopter, because it might need to be going to a specialist unit to have the nerve work and the arm reattached. So again, we need backup, and we need correct back up on its way to us. But how we deal with that limb is very important.
Another thing that sometimes comes into this is teeth. Children in particular. Remember they have two sets of teeth: Milk teeth, which will regrow, and then normal teeth. When their full adult teeth start to grow and you lose an adult tooth, there’s no more coming on behind. Teeth can be reset, the same as limbs can be reset; as long as we follow a few rules. One of those rules and the most important one is; once the tooth has been knocked out, as long as the root has come out with the tooth and the tooth has not just snapped, we can actually reset that root, especially in children. But it needs to be kept in milk. So basically, we take the tooth, we put it in a cup of milk-calcium, and then we take the child to the nearest dentist with the milk, and the tooth can be reset and reset into the jaw and will regrow. The sooner the better, but it can actually be reset as long as we look after it in milk. So we’ve looked at how we deal with major limbs, we’ve looked out how we deal with teeth. Just because something has been amputated doesn’t mean it can’t be salvaged, but we need to make sure we look after it correctly.