Prehospital Field Amputation Leads to Improved Patient Outcome

Industrial accident leads to extrication by amputation Your aeromedical team responds to a 29-year-old female whose right hand has been entrapped between the inside of a hopper wall and industrial auger for five hours. She’s found in a semi-erect position on top of a platform. Although she’s in pain, she expresses that she’s losing sensation to her hand. Upon physical examination, you find that her right hand is entrapped proximal to the metacarpophalangeal joints, excluding the patient’s thumb. Multiple attempts at freeing the hand are made to no avail. Upon arrival of a second aeromedical team with an emergency medicine physician and hand surgeon on board, the circumstances are explained to her and it’s recommended that she undergo endotracheal intubation and a complete amputation of the hand. Nerve blocks of the hand are performed by anesthetizing the median, ulnar and radial nerves at the level of the wrist. The patient, still in a semi-erect position, undergoes rapid sequence intubation with etomidate and succinylcholine. Sedation is maintained by administering push doses of ketamine, versed and fentanyl. Hemodynamic monitoring and wakefulness are conducted with field telemetry and serial physical exams. To prepare for significant hemorrhage, the patient is administered fresh frozen plasma and Type O-negative blood through an inline warmer. Furthermore, although the patient had a single peripheral IV line, an intraosseous line is also placed.
Source: JEMS Patient Care - Category: Emergency Medicine Authors: Tags: Trauma Patient Care Source Type: news