Limb Injuries II
Lukáš Dadák
Learning Objectives
̶ Student will learn about amputation and semiamputation.
̶ Student will learn about other limb injuries and their first aid.
Amputation, semi-amputation
̶ Loss of part of limb / incomplete amputation
First Aid:
̶ Stop bleeding on the injured limb
- massive bleeding = arms, thigh → tourniquet
- fingers, forearms → pressure bandage.
̶ Transport the patient for treatment by EMS
̶ Care to the amputated body part
̶ Prevent fainting
Amputated tissue
̶ Do not hurt yourself! Take gloves.
̶ Rinse off the dirt.
̶ Cover with gause.
̶ Put it into a plastic bag.
̶ Put all into another bag of water and ice cubes
̶ Wet, but not soaked.
̶ Cool, but not frozen.
Why? – To decrease cellular metabolism, decrease detrimental effects of hypoxia, decrease
rate of necrosis – prolong viability of amputate – better chance to be replanted.
First Aid
https://www.solen.cz/pdfs/med/2009/04/12.pdf
Wet and cool but not frozen
 Hours of operation
 Weeks of rehabilitation
A moment of inattention ...
Replantation
Decollment
̶ Undesired separation of two or more
physiologically and functionally fused
structures
̶ Subcutaneous hemorrhage
̶ Pale skin poorly perfused
̶ FA: immobilization, EMS
https://www.barnardhealth.us/forensic-radiology/soft-tissue-injuries.html
Case courtesy of Dr Matt Skalski, Radiopaedia.org, rID: 22762
Crush syndrome
https://www.zzsmsk.cz/Tisk.aspx?clanek=2061
Crush syndrome
̶ backfilling, earthquake
Cause:
̶ ischemia of muscles and other soft tissues,
̶ leakage of fluid into the tissues
̶ absorption of substances from damaged tissues
Symptoms:
̶ soft tissue swelling
̶ hypovolemic shock
̶ later renal failure
FA: SSSABC
̶ Extrication
̶ transport by EMS
https://www.zzsmsk.cz/Tisk.aspx?clanek=2061
Acute limb artery occlusion
̶ Pain,
̶ Cold, pale skin
̶ Paresthesias / anesthesia
̶ Paralysis
̶ No pulsation on periferal artery, prolonged CRT
FA:
̶ sit up, hang the limb below
̶ do not eat, drink, smoke
̶ EMS
https://www.cevnitesin.cz/index.php/cs/pro-
pacienty/nemoci-tepen
Learning Outcomes:
̶ Student masters first aid during amputation.
̶ Student is able to recognize the symptoms of backfill syndrome.
̶ Student is able to describe the symptoms of acute limb artery
occlusion.
Resources
̶ http://www.solen.cz/pdfs/med/2009/04/12.pdf
̶ https://www.wikiskripta.eu/w/Crush_syndrom
̶ https://www.medicinapropraxi.cz/pdfs/med/2011/10/08.pdf
Simulation Centre, Faculty of Medicine, Masaryk University
2020