Saturday, January 5, 2013

Traumatic Amputation in a Car Accident

In a car accident, my character’s arm is trapped and severely injured. Emergency personnel are working to get him out, and it looks like his arm is severed. What determines whether his arm can be saved?

This is a case of traumatic amputation—usually as the result of an accident.

The first factor will be what shape he’s in otherwise. If he’s had a lot of bleeding, shock may set in. Other trauma (head, abdomen, etc) may take precedence in treatment. In this case, there would be consideration of amputating the arm to get him out of the wreckage and save his life.

Your scenario would suggest that these other injuries are not present—which can be the case in a car wreck. Bleeding and shock must be controlled.
Once he’s freed, he may have:
1) A severe crush injury—this would likely require amputation. Very difficult to salvage a limb in this case.
2) A relatively clean complete severing of the arm—better chance of limb salvage and replantation (ie, reattachment).
3) A partial amputation—incomplete severing of the arm. The sharper the edges of the cut, the better. Best chance of replantation.

Upper limbs have a better chance of a good outcome in replantation.

The proper way to care for the completely severed arm is to wrap it in DRY clean towels or a sheet, and then wrap it in plastic. This may sound like the opposite of what to do, but getting the wound wet can worsen the situation.

The stump should be carefully cleaned and protected; loose tissue should be preserved as-is—no trimming or forcing into the anatomic position.

In the ER, the doctor will use the Mangled Extremity Severity Score (MESS) to determine the likelihood of successful reattachment. The score takes into account the type of amputation (partial, complete, clean, dirty), circulation, health of the limb and general health of the patient (younger people have better outcomes) temperature, paralysis (in the case of partial amputation) and numbness. The best chance of replantation is within six hours of the injury.

After replantation, bleeding, shock, and infection are all considerations.
For hand amputations, sometimes medical leeches are used to improve circulation. Yes, this is a real treatment. It’s odd to see a medical leech at work on a patient in the ICU.

Questions? Comments?
Kelly has worked in the medical field for over twenty years, mainly at large medical centers. With experience in a variety of settings, chances are Kelly may have seen it.

Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous.
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  1. Replies
    1. Yeouch is right.
      One good thing--the more severe injuries tend to hurt less than the really bad ones.
      Cheers, Kelly

  2. Ugh. That's some good writing, because I feel queasy now.

  3. Crime scenes present a unique combination of problems for detectives. Commonly referred to as crime scene cleanup or trauma scene cleanup, specialized training is needed by those who may attempt to remove blood and bodily fluids from a crime, trauma or accident scene.biohazard clean up.