Backboard for leg amputation from wood chipper

[LACoGurneyjockey]

A close friend and coworker told me about this call the other day, I'll describe it as best I can.
40 yo male got his right leg caught in a wood chipper, fully amputated just distal to the knee. Upon arrival BLS FD had extricated from wood chipper, applied TK, controlled bleeding, and had pt supine on ground. AOx4, BP 110/60, HR 100, RR 22, SPO2 98%, skin warm dry pale. No other injuries, no neck/back pain, no KO, GCSx15 and purposeful movement of hands. Placed position of comfort on gurney and rapid transport to trauma center about 40 minutes away w/o change enroute.
Would you have boarded this patient?
How could one assess CMS of an amputated extremity?

Oh and by the way, patient had a T10 spinal fracture and paralysis of the remaining leg.

 

[abckidsmom]

The suspense on this one was kind of blown.

Yes, I probably would have put him on a backboard. Easier to move him, and the wood chipper experience is not a smooth easy experience: it has a ton of shaking and jerking as it eats your leg.

I don't have any trouble skipping immobilization on the stuff that's just BS, but when the patient is getting a trauma team alert, I'm stuck in 1998 on that one.

 

[chaz90]

I feel like we're missing something about how this injury happened. A direct amputation of a leg of course wouldn't cause this kind of SCI. Furthermore, you didn't mention anything about assessment of the other leg. Was it already paralyzed at time of EMS contact? Keep in mind too that you shouldn't expect "neck and back pain" with an injury at T10. It's nowhere close to the neck, and he may have been too distracted by the missing leg to notice other symptoms in his back.

To answer your question, I highly doubt I would have used spinal precautions on this patient based on what you presented to us. This still depends of course in assessment findings of the other leg and assessment of the remaining portion of the injured extremity. Hindsight is 20/20. As many on here have mentioned, choosing to forgo spinal precautions isn't saying there is no chance the patient has a SCI. It's simply deciding that the potential for injury is low enough based on clinical findings that a likely useless intervention doesn't need to be utilized.

 

[Akulahawk]

Given that it's quite likely that I would have picked up on the paralysis of the lower extremities, I probably would have also done a quick dermatome check as well and while I might not be exact as to which vertebrae is busted with SCI, I'd have a pretty good idea... So I would institute some form of spinal motion restriction and a C-Collar wouldn't be indicated. My first choice would have been a vacuum mattress. Second choice would be a LSB that's padded well. Third choice would be either LSB or a scoop stretcher and straps. All of these make for easy moving/handling of the patient. Even a break-away flat would work just fine.

Here's the thing... the mechanism of injury for the amputation itself doesn't necessarily describe a potential for injury to T10. Something else that's not being described caused the injury to T10 and the SCI located there. I would have known that there was a T-spine injury from my exam and would have looked for a potential cause of that. Why? Knowing that MOI would allow me to search for additional injuries. Sure, we have to be speedy, but we also have to think too. Sure, the amputation is gruesome, but I still have to do an exam and look for other injuries, and bleeding is apparently currently controlled, so I don't have to worry about that leg right now... Someone else can bandage that stump while I do other stuff.

Oh, and woodchippers with amputation make me think about the woodchipper scene from Fargo...

 

[abckidsmom]

Oh, and woodchippers with amputation make me think about the woodchipper scene from Fargo...

Definitely. Eww.

 

[Akulahawk]

Definitely. Eww.

Exactly...

 

[mycrofft]

I have yet to meet anyone who has seen firsthand a wood chipper (Asplundh) accent.
EDIT: ACCIDENT. My apology

 

[mike1390]

Well I guess thats your accomplices in the wood chipper eh?

 

[Jawdavis]

Yes. My biggest thing to think about would be "how did he get in there". Unless he was just like "g i wonder what this would feel like" there had to be some way or reason his leg got caught in there. If his remaining leg on the torn up side was in fact paralyzed that does indicate some disturbance prox to the injury so I would want to stabilize that.

How did he know he had a T10 fracture?

 

[Handsome Robb]

I'm assuming via X-ray at the ER later...

Personally I wouldn't backboard this patient unless he had neurological deficits in the intact extremities. Probably would use a scoop to make him an easy package to handle.

 

[Household6]

I think I'd choose a backboard. I'm assuming that the area in the vicinity of the wood chipper probably isn't the most level, stable, clear surface? Assuming the patient is average size and build, I think I'd find it easier to backboard them out of the area. Sometimes I do trust my feet more than a Stryker. I think we could carry them out much smoother than a bumping, jostling cot.

 

[Christopher]

I think I'd choose a backboard. I'm assuming that the area in the vicinity of the wood chipper probably isn't the most level, stable, clear surface? Assuming the patient is average size and build, I think I'd find it easier to backboard them out of the area. Sometimes I do trust my feet more than a Stryker. I think we could carry them out much smoother than a bumping, jostling cot.

Either a backboard, scoop, or reeve's sleeve...but not because I was worried about spinal immobilization.

 

[Household6]

Either a backboard, scoop, or reeve's sleeve...but not because I was worried about spinal immobilization.

Yea, I think so. And depending on the disposition of the patient, he might be better off (emotionally) secured supine so he can't see his injury.

 

[CANMAN]

Yea, I think so. And depending on the disposition of the patient, he might be better off (emotionally) secured supine so he can't see his injury.

I would venture to say he is she is going to be highly aware their leg is gone regardless of what position you secure them in.

There are plenty of studies out about this kinda stuff. Although you state bleeding is control this person needs bright lights, cold steel, and most likely blood products. Therefore I would toss on the cot and beat feet to the trauma center, maybe slide onto a Reeves sleeve at most.

 

[Tigger]

I would still like to know how the spinal cord injury occurred, doesn't really make a lot of sense.

 

[exodus]

Definitely backboard, he probably was working on the edge clearing a jam and slipped in. Once in, he fell backwards hitting his back on the 1/4" piece of metal that forms the chute. That's a lot of pressure on a small area, easy to break a bone with.

And even with NEXUS, the patient should be back boarded. He has a major and painful distracting injury. He won't be able to properly give you assessment answers if he's leg just got ripped off.

 

[Tigger]

Definitely backboard, he probably was working on the edge clearing a jam and slipped in. Once in, he fell backwards hitting his back on the 1/4" piece of metal that forms the chute. That's a lot of pressure on a small area, easy to break a bone with.

And even with NEXUS, the patient should be back boarded. He has a major and painful distracting injury. He won't be able to properly give you assessment answers if he's leg just got ripped off.

I'm picturing this. Not seeing many possibilities.

Also, backboards do not work for unstable fractures anyway. Probably would have scooped him due to the leg.

 

[exodus]

I was picturing something like this:

Standing on the back pushing stumps in, or clearing a jam when the it gets pulled in unexpectedly tripping him and he falls sideways trying to get ahold of the side, but instead hits his back on that piece of thin metal.

What I'm trying to say, there's are ways for him to injure himself, and even using something like the nexus, we can't do a proper assessment when he has that painful of a leg injury. This isn't a an old lady who will develop pressure sores on the ride over there, this is a healthy man who is working for a living. Pad and immobilize.

 

[Handsome Robb]

I was picturing something like this:

Standing on the back pushing stumps in, or clearing a jam when the it gets pulled in unexpectedly tripping him and he falls sideways trying to get ahold of the side, but instead hits his back on that piece of thin metal.

What I'm trying to say, there's are ways for him to injure himself, and even using something like the nexus, we can't do a proper assessment when he has that painful of a leg injury. This isn't a an old lady who will develop pressure sores on the ride over there, this is a healthy man who is working for a living. Pad and immobilize.

How'd he go in leg first then though? I see your point and it is a very valid one.

Personally, Household, you wouldn't be able to keep me from at least looking at my leg to see how much was gone. I'm a weirdo though.

I'm wondering if he didn't get knocked into the woodchipper by a piece of equipment or a log being carried by a piece of equipment and the initial blow is what caused the spinal fracture and the leg happened second.

 

[exodus]

How'd he go in leg first then though? I see your point and it is a very valid one.

Personally, Household, you wouldn't be able to keep me from at least looking at my leg to see how much was gone. I'm a weirdo though.

I'm wondering if he didn't get knocked into the woodchipper by a piece of equipment or a log being carried by a piece of equipment and the initial blow is what caused the spinal fracture and the leg happened second.

Pulled in by a branch that has a Y at the end, or one that comes out perpendicular, so it kinda hooks on the foot. Whenever I'ved used a large chipper, it has always pulled them out of my hand so I can see it pulling someones leg in if it gets caught.