AMPUTATION
Amputation is detachment of a body part, such as an ear, finger, or foot. It is usually associated with a serious force or crushing injury, such as an animal bite. The immediate threats to life are bleeding and shock (see page 60).
If a body part is detached, apply firm pressure to the site of the bleeding where the tissue loss has occurred. Manage any serious bleeding (see page 54). Cover the wound with the cleanest available bandage, and then wrap firmly. Do not attempt to reattach the detached body part. If a digit is hanging on by a small “bridge” of skin or muscle, attempt to bandage it without completing the separation.
If the body part can be easily recovered and the victim can be brought to a hospital within 6 hours of the injury, do the following:
1. Gently rinse the body part if the cut end is contaminated with dirt.
2. Wrap the body part in clean cloth or gauze and keep the covering moist. The ideal solution is saline (not ocean water, because of infection risk), if that is available; if not, fresh water will do. Do not immerse the part in a bag of water; merely keep the covering moist. Keep the body part cool by placing it on ice after wrapping it securely in a bandage, cloth, or towel. To avoid a frostbite injury, do not apply ice directly to the body part or immerse it in ice water.
The application of a tourniquet to stop bleeding is essentially a decision to sacrifice the limb in order to preserve life. If any salvageable part of the limb is still attached, do not apply a tourniquet to stop bleeding until you have exhausted all pressure techniques (see page 54). If the limb is completely severed and the bleeding is torrential, a tourniquet may be applied until the muscular walls of the arteries constrict and bleeding can be controlled by direct pressure. Tie a cloth or rope circumferentially an inch or two above the wound and tighten it just enough to allow direct pressure to stop the bleeding (see page 56). After 5 to 10 minutes, loosen the tourniquet briefly to see if the bleeding can be controlled with pressure techniques alone.
