Conn. man: Cutting off arm was surreal experience

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From mysuncoast.com

Metz says he started thinking about amputating his arm 12 hours into his ordeal, and it took him about six hours to "psych" himself up.

He used a saw blade to cut off most of his arm. Paramedics completed the amputation, and doctors will be replacing it with a prosthetic.
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http://www.mysuncoast.com/Global/story.asp?S=12652552
 
"Paramedics completed the amputation"


:unsure:


That must have been a heck of a call to med control...
 
That's exactly what I was thinking.
 
Those medics are going to have a great story...

Hey John, guess what I did the other day...it was slightly outside the scope of practice...
 
Thats pretty hard core. My old preceptor almost had to do a field amputation once. Guy was stuck in a burning car, burning alive. Arm was crushed and stuck. Fire had not arrived and there was no time. Right as he was about to start the arm became free.
 
Even though hindsight is 20/20...

...couldnt he have applied the tourniquet during the 6 hour psych up period, and cut off blood flow that way, to dull the pain?
 
Paramedics completed the amputation, eh?

I can only imagine what the ER doc thought when he got that call!

One of our extrication guys almost amputate a guys leg off with the cutters to free him from his vehicle in a situation like the one schulz described. While he was getting ready for that, the rest of the crew managed to pop something free and they guys leg came out.

I frankly cannot imagine having to do that to myself. I hope to God I never have to make that choice. Or make the call to the ER to do that to someone else.
 
lightsandsirens5 said:
Paramedics completed the amputation, eh?
Click to expand...

I actually heard on the news that they completed the amputation at the hospital, not in the field. I could be wrong though.
 
Doctors were unable to reattach the arm but said his attempt to cut it off saved his life because it prevented the spread of toxins from the decaying limb.
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Can someone explain more about these toxins from the decaying limb? What are they, and what happens if they spread to healthy tissue?

Also, if I understood correctly, his limb was decaying in the first place because blood flow to it had been cut off. If there was no blood flow to it, then how were these toxins going to spread?
 
JJR512 said:
Can someone explain more about these toxins from the decaying limb? What are they, and what happens if they spread to healthy tissue?

Also, if I understood correctly, his limb was decaying in the first place because blood flow to it had been cut off. If there was no blood flow to it, then how were these toxins going to spread?
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Hmmm.......a good question, well put, requiring a good answer..........which I dont have. Anyone else?


I would not think his flesh would start to decay so quickly, but I could be wrong. Is it possible they are talking about crush syndrome? That realasing his arm would release the products of ischemic skeletal muscle breakdown like potassium, myoglobin, phosphorous, etc. It would not be an issue while his arm was still stuck, but would swamp his system as sson as circulation was restored to his arm. Bloodflow would then carry those Rhabdomyolysis by-porducts into the rest of his body. Except by mostly severing his arm, he prevented that?
 
Your guess is as good as mine; this sort of situation is in a galaxy far, far away (B)) from my scope of practice. But common sense would dictate that, if toxins were present in the decaying arm, severing the arteries would not allow said toxins to spread into the rest of the body and throwing the pt into septic shock.
 
Crush injury causing rhabomyolysis.

Muscle tissue death leads to release of some products, such as myoglobin(causes acutre renal failurs), histamines(causes vasodilation[shock]in the body and bronchoconstriction in the lungs), phosphate and potassium(messes with the heart), purines (more renal damage) Lysozomes(cell digesting enzymes) and others.

Just because blood flow is cut off doesn't mean it won't be restored when pressure is released from the affected extremity, which is why in EMS we'll get large bore IVs in, start flooding with fluids(6-12liters in the first 24 hours, 1-2 of which just before releasing the crushed extremity), and sodium bicarb.


Can also give Albuterol and Calcium Chrloride.
 
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Ah, OK, thanks.

Now, how long does it take for tissue to start dying? How long does it take for it to start decaying, and releasing these toxins?

In other words, once you cut off circulation to a limb, how long do you have that it's safe to remove the impediment and restore circulation (assuming it wasn't immediately possible in the first place), before it's too late and it becomes unsafe to restore circulation without these other measures being available to mitigate the effects of these toxins?
 
Also, if this man had somehow managed to free himself, after about three days, without attempting amputation but rather by some other means removing or destroying the constriction, then those trapped toxins would have been released into the rest of his body. How long would it have taken for those trapped toxins to actually kill him? I'm asking to see whether or not he hypothetically had time to free himself by some other means, call 911, and get emergency treatment to remove or mitigate those toxins from having any permanent harmful effect.
 
For when the cell death starts, depends, as there are 3 different ways that the crush injury can release the toxins. Immediate trauma killing the cells, direct pressure squeezing the cells (usually in first hour or so) and then the decay from lack of blood flow. From my reading, muscles can stand up to 4 hours without blood flow before they start degrading.

So, it can be as little as one hour, but can be 4+ hours.





As for when it's deadly, it depends. Some of the stuff can be pretty close to instantaneous, like the potassium and phosphate release, messing the heart and putting it in to dysrhythmias.

Other things, like the renal failure, could take longer to happen, and you might not die from it, but you will have to be on dialysis the rest of your life from not having working kidneys.
 
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A crush injury leads to either compartment syndrome or crush syndrome.
http://docs.google.com/viewer?a=v&q=cache:iJCPYhzTbbYJ:www.ncemsf.org/conf2003/lectures/bittenbender_crush.pdf+crush+injury&hl=en&gl=us&pid=bl&srcid=ADGEEShuGoctdhecaPZFtWBlXRxeRw6otcUHD8bHfCEXtvwfZzc43zEElZ132AKjpflKe1yiSDxA8NUlyQke9IfKKYoc7s9aiKiieWd40AtTVTfmWbaePzTqWFlBJKjnyCFWO0-FW4FT&sig=AHIEtbSwWW7m1X-ZNYjmY6OT3VEjTPA0-g
please see link for a good lesson in it if your not familiar.

depending on protocols, we normally give sodium bicarb, and can also give calcium and albuterol if needed. this is in addition to fluid to and pain management.
 
This sounds like quite the event, I can just immagine it

"Yes good morning it's Brown from Ambulance, what's that, no I am one of the helicopter doctors, no, no that's my alter ego ... anyway, can I speak to one of the orthopaedic registrars or consultants please...."
 
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