Reading this thread brings back fresh to mind the litany of patients which I had the privilege of caring for while directing the hand/microsurgery and burn units at the Yale Univ. Med. Ctr. It's fairly safe to say that none of these horrific injuries of all imaginable "amputateable" body parts was self-inflicted or even remotely anticipated by the patient. They were all "accidents."
While we all try to be safe all of the time, unanticipated life changing events do happen. If you are witness to a traumatic amutation of any body part, following these guidelines should ensure that the patient has the best possible chance to maximize a functional recovery:
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1. First, be certain that the patient is receiving proper first aid/medical attention--the "ABCs" of Airway, Breathing, Circulation. Apply pressure to stop bleeding at the site of the amputation. Be aware that tourniquets can cause more damage than good.
2. Retrieve the amputated part.
3. Do NOT try to clean, wash, or scrub the part. The microvessels at the cut end are very easily damaged, and that additional damage may prevent a successful replantation.
4. Place the part in a clean, DRY sealable ZipLoc type baggie. For larger parts, use clean plastic garbage bag if available. The amputated part will not dry out if sealed in a baggie. Do NOT add water, or any other liquid to the baggie. None of those materials is physiologic, and they will all produce swelling and more damage of the critical microvessels. Even soaking parts in "physiologic saline solution" used in IV's has been shown to cause swelling and damage of the "stump" microvessels. These vessels are the essential elements needed by the microsurgeon to re-establish circulation, and any additional damage may preclude a reattachment. Milk has been advocated for soaking knocked-out teeth (w/o strong scientific basis). Replacing lost teeth, however, does not involve any microvascular surgery, so the milk is not harmful in that scenario.
5. Place the sealed bagged part in a container with WET ice. Snow is good, too. A styrofoam cup or a cooler is fine. Never use DRY ice. In the absence of blood circulation, dry ice will rapidly cause severe frostbite damage to the amputated part and may well render it unsuitable for reattachment.
6. Be absolutely certain that the amputated part accompanies the patient to the hospital. Alert the transport personnel, EMTs, etc, and physically hand the part to one of those in charge. Yes, we have had to send someone back to the scene to recover the "forgotten" part, and not a rarity either. It's easy to understand though, in a situation as emotionally charged as these often are. [/list]
Bottom line: be as safe as you can out there. However, if bad stuff happens, try to maximize the potential for a functional recovery by following these guidelines.