Severed arm

[PCP]

Read a story about a person who lost their arm just below the elbow due to a blast that occured at a gravel pit. The story states that a blast had gone off which caused rocks the size of a baseball to go flying in the air . This person was blocking their face by putting up their arm and by doing so, a rock severed their arm just below the elbow due to the velocity behind the rock from the blast.

My question is upon arrival would you do the direct pressure with elevation, brachial pressure point or go straight to using a tourniquet?

I know the area where this occured and the time between dispatch and the arrival time would be approx. 8-10 minutes. With that in mind and the severity of the injury my initial thought would use the brachial pressure point with elevation, then bandage the severed limb and last if needed put on the tourniquet.

That is of course if there is substantial amount of bleeding.

I have never done a call with a severed limb before so not sure how much blood loss occures or how active the bleeding is or would be on arrival.

What do you think you would do?

[Bieber]

The current treatment guidelines for hemorrhage go something like...

Significant Hemorrhage? (Yes) > Direct Pressure > Hemorrhage Controlled? (No) > Tourniquet

Although I think there is a "Consider Cauterization with Lightsaber", but only if you're a Jedi Master...

[PCP]

Just call me Master Yoda!

[Vorenus]

Hm... first, direct pressure. If that doesn`t work, Tourniquet (we are not allowed to bring our lightsabers into work - a shame!).

Then lines, O2, possible pain management, get the rest of the arm and let`s go (though I`m guessing, that the edges of the wound`ll be too messy to get it easily back on).

[PCP]

Would you not want to attempt to use the brachial pressure point along with elevation of the limb first before going straight to the tourniquet?

[Vorenus]

Would you not want to attempt to use the brachial pressure point along with elevation of the limb first before going straight to the tourniquet?

Oh, but yes. But in my mind that move is somehow linked with the direct pressure, so that`s what I meant.

[Just Plain Ruff]

i would also suspect that with a blast like this that you are not only going to have a severed arm like the story said but with the rock flying at significant force to sever the arm that it would also cause spinal or head injuries.

I was an EMT on a call where a man had his arm severed in a car wreck. His arm was outside the car when another car sideswiped him and took his arm several blocks down the road before the driver realized that he had an arm attached to his side mirror or something like that.

The damage to the arm was massive but there was minimal blood loss or bleeding. The trauma surgeons said that the blood vessels had constricted so that blood flow was nearly ceased. They were unable to save the arm though, too much damage.

[Happiness]

Tourinquet is your last option and if you have to do it you make sure it is as close to the end of the stump as possible. When doing this you have to keep in mind that by using a tourinquet the chance of reatachment decreases substantualy.

[HERBIE1]

I have never used a tourniquet to control bleeding. The only times I have had difficulty with massive bleeding have been abdominal and chest trauma, where massive pressure is about all you can do. Even with the most massively injured limbs, I have always been able to control the bleeding with compression dressings, direct pressure, pressure points, etc. As Ruff mentioned, the blood vessels tend to contract and clamp down with a traumatic amputation- unless they are severed on a diagonal/bias, or shredded.

[crotchitymedic1986]

Alot of times there isn't as much bleeding as you would think, as these injuries are frequently from blades or from crush type injuries where the arteries and vessels have a clean cut (this one may have been different), i have usually been able to control bleeding with multi-trauma dressings and tight ace wraps.