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swatsurgeon
06-27-2009, 18:53
Does anyone know the art of field amputations that requires no cutting?
Hint: you only need 2 things to complete it and SUSTAIN it.

ss

The Reaper
06-28-2009, 10:30
Det cord and a blasting cap?

Sorry, couldn't resist.

TR

Ambush Master
06-28-2009, 10:44
Det cord and a blasting cap?

Sorry, couldn't resist.

TR

Beat me toit!!!!:D

Red Flag 1
06-28-2009, 10:49
Det cord and a blasting cap?

Sorry, couldn't resist.

TR

You beat me to it TR.

RF 1

Priest
06-28-2009, 13:30
Cravat and Stick cinched down extremely tight? Like an old school castration.

swatsurgeon
06-28-2009, 15:38
Det cord and a blasting cap?

Sorry, couldn't resist.

TR


Say goodbye to the leg, the pelvis,....the patient. Nice try but no cigar.

ss

swatsurgeon
06-28-2009, 15:41
Cravat and Stick cinched down extremely tight? Like an old school castration.


So you shut down the blood flow with a tourniquet....think some of the evil humors could leak out and make the patient sick? So, missing one element of the no cut/no blast amputation. As a hint, this element you need is likely NOT accessible under typical field circumstances but can be utilized when available...hopefully ASAP after tourniquet application.
ss

Brush Okie
06-28-2009, 15:42
axe and tourniquet?

swatsurgeon
06-28-2009, 15:44
axe and tourniquet?

remember, this is a no cut amputation.........scissors, axe, det cord, harsey T2, leatherman could be used but i'm after the no cut version.

Ambush Master
06-28-2009, 15:48
High Voltage?!?!

Priest
06-28-2009, 17:07
A couple of questions:
1. Is it a blunt trauma/ crushing transection?
2. Does this method work on any extremities or limited to, say, phalanges?
3. Do these 2 items ligate the vein and artery? Or do the 2 items simply
refer to the removal of the appendage?
4. I'm also assuming that, like all field amputations, this is a 'stop-gap'
procedure and will require additional surgery.

Is a vice one of the items by chance?

ps. I really appreciate you putting these on here. I have always enjoyed reviewing your case studies. Thank you very much for this.

Sdiver
06-28-2009, 17:57
1) A Bullet
2) Whiskey

For the field amputation that you refer to, I'm assuming that it would be a dangling limb.

Put the bullet in the pts mouth, for him/her to bite down on.
Pour whiskey over the wound, to help in sterilization, pour whiskey down gullet of pt., to help in pain control, pour a couple of shots down the gullet of field medic, cause it's gonna be messy.

After above 2 items are in place, grab hold of dangling limb and ......PULL/YANK as hard as you can.

Then take a couple more shots of whiskey for good measure.....if there's any left.

:munchin

DinDinA-2
06-28-2009, 20:18
Ligature using wire (high temp) and metal rod. May need multiples.

Red Flag 1
06-28-2009, 20:36
Does anyone know the art of field amputations that requires no cutting?
Hint: you only need 2 things to complete it and SUSTAIN it.

ss

I would think one element would be a heat source. This to control bleeding and provide a means to keep the wound "clean".

I do believe that ice and a tourniquet were used as a means of blunting pain for the surgical event in the 1860's with fairly good success. Doubt that is any of the answer you are looking for though.

That leaves the actual method of amputation. I wonder if a wire, not unlike a Gigli Saw could be used?

Other things come to mind like a passing train, or shotgun blast to finish the job.

This is really a pretty good question SS!

My $.02.

RF 1

swatsurgeon
06-28-2009, 21:59
I would think one element would be a heat source. This to control bleeding and provide a means to keep the wound "clean".

I do believe that ice and a tourniquet were used as a means of blunting pain for the surgical event in the 1860's with fairly good success. Doubt that is any of the answer you are looking for though.

That leaves the actual method of amputation. I wonder if a wire, not unlike a Gigley Saw could be used?

Other things come to mind like a passing train, or shotgun blast to finish the job.

This is really a pretty good question SS!

My $.02.

RF 1


I do believe that ice and a tourniquet were used as a means of blunting pain for the surgical event in the 1860's with fairly good success. Doubt that is any of the answer you are looking for though.

good call.....no cut..if ice is available the limb is packed in ice with tourniquet in place. No pain (nerve dies after tourniquet on long enough and the limb will not release its evil humors with such a slow metabolic rate and you can preserve normal physiology while waiting to do formal (cut) amputation. This practice is old but still used...works very well on patients that have little ability to tolerate the amputation acutely or need more time to deal with the issues. Mostly used for gangrene issues in days past but is a useful technique if a) ice is available, b) no one around who can do proper amputation.
The hot wire won't work to well but the poker in the fire was a method used to cauterize a vessel....thread/rope/twine is always better on a larger vessel or just keep the tourniquet on above the site of amputation until definitive care can be performed on the amputation site.

Ice is not available on most field deployments but if someone can be casevac'ed and no one around to do amp back in a field aid area/hospital....ice it with tourniquet.


ss

swatsurgeon
06-28-2009, 22:03
How to get through the bone is another question to ponder....saw, gigli or otherwise is a great option if available. A leatherman tool has a saw.....
shotgun no good in my opinion, good knife like Yarborough and something to strike onto its spine would/should work....I have heard reports of someone stomping down on a femur...hips and proximal thigh were elevated 8-10 inched off of the ground...just never know where it's going to snap though...not my first choice!
ss

Brush Okie
06-28-2009, 22:15
How to get through the bone is another question to ponder....saw, gigli or otherwise is a great option if available. A leatherman tool has a saw.....
shotgun no good in my opinion, good knife like Yarborough and something to strike onto its spine would/should work....I have heard reports of someone stomping down on a femur...hips and proximal thigh were elevated 8-10 inched off of the ground...just never know where it's going to snap though...not my first choice!
ss

I seen a shotgun amputation (attempted murder) and you correct, bleeding was impossable to stop and they had to cut the arm back a little ways.

FCWood
06-29-2009, 14:44
How to get through the bone is another question to ponder....saw, gigli or otherwise is a great option if available. A leatherman tool has a saw.....ss


Yes, as SS stated, the gigli would be great for bone. If necessary it could be used to cut entire leg (skin and all, not that Id say do it) in an emergency, but would definitely leave the surgeon to trim up tissue later. I have done this to several types of large animal, (calves & foals), during troubled still-born/dead deliveries (my dad was an older veterinarian so I helped a lot/did most of the manual labor) so lighter human bones would be even easier.

FCW

Red Flag 1
06-29-2009, 16:29
Thanks SS!

A word to the wise.

Application of a tourniquet ("T") is a simple life saving measure that is frought with complications, as SS pointed out. Once the "T" is applied, all tissue below dies. Should the "T" be relaxed, any metabolic toxins from the dying tissue below enter systemic circulation and place the patient at risk of dying, 18 D's and medics know this. So why would anyone loosen or relax a "T"?

A "T" stops blood flow and after a time kills the nerves below, providing surgical anesthesia. In the process, it hurts like hell!! It is very compelling to respond to the patient's pleas to loosen the "T" just a bit. Bad move!!

My time in anesthesia practice has given me a respect for the amount of pain a "T" brings to the patient. From time to time, surgery on limbs have taken longer than thought. Limb surgey generally requires a "T". Long before there is any pain to the surgical site, "T" pain becomes an issue dictating a change from regional anesthesia to general anesthesia. A "T" hurts that much.

Think before using a "T".

My $.02.

RF 1

Brush Okie
06-29-2009, 19:05
Thanks SS!

A word to the wise.

Application of a tourniquet ("T") is a simple life saving measure that is frought with complications, as SS pointed out. Once the "T" is applied, all tissue below dies. Should the "T" be relaxed any, metabolic toxins from the dying tissue below enter systemic circulation and place the patient at risk of dying, 18 D's and medics know this. So why would anyone loosen or relax a "T"?

A "T" stops blood flow and after a time kills the nerves below, providing surgical anesthesia. In the process, it hurts like hell!! It is very compelling to respond to the patient's pleas to loosen the "T" just a bit. Bad move!!

My time in anesthesia practice has given me a respect for the amount of pain a "T" brings to the patient. From time to time, surgery on limbs have taken longer than thought. Limb surgey generally requires a "T". Long before there is any pain to the surgical site, "T" pain becomes an issue dictating a change from regional anesthesia to general anesthesia. A "T" hurts that much.

Think before using a "T".

My $.02.

RF 1

Also bleeding is sometimes eaier to control than most people think. A severed vein or artery will sometimed stop bleeding on its own or can be applied with pressure and elevation. It will sometimes contract up and the end will seal. The turnequte is over used mant times in the past by untrained personnel. also blood loss tends to look worse than it really is. While it may look like a lot of blood, many times it is not as much as people think. The human body really is amazing in how it responds to trauma.

cdwmedic03
06-30-2009, 03:00
Cool stuff SS!



Red Flag,

Sir, I do not mean to speak out of turn here. But the education we (68Ws, TC3, etc.) are receiving on TQ application includes guidlines for removal, as soon as tactically feasible (but not removed if left in place for more than 6 hours). It is also being put out that ischemic damage is rare in instances where TQ's are in place less than 2 hours. This is all applied in the tactical setting, so if I took your statement out of context sir I apologize in advance.


Q: What can be done to mitigate/manage the effects of reperfusion injury in either the tactical or non-tactical setting?
(I don't mean to hijack the thread or get to far off topic)

Red Flag 1
06-30-2009, 08:01
Cool stuff SS!



Red Flag,

Sir, I do not mean to speak out of turn here. But the education we (68Ws, TC3, etc.) are receiving on TQ application includes guidlines for removal, as soon as tactically feasible (but not removed if left in place for more than 6 hours). It is also being put out that ischemic damage is rare in instances where TQ's are in place less than 2 hours. This is all applied in the tactical setting, so if I took your statement out of context sir I apologize in advance.


Q: What can be done to mitigate/manage the effects of reperfusion injury in either the tactical or non-tactical setting?
(I don't mean to hijack the thread or get to far off topic)

We liked to keep "T" times at or below two hours in surgery.

My point was to be prepared for physical pain one must deal with once a "T" is placed. As Brush Okie pointed out, there are other things that may be of value.

I do think we are getting a bit off topic here but probably worthy of discussuion, IMHO.

My $.02.

RF 1

cdwmedic03
06-30-2009, 08:45
We liked to keep "T" times at or below two hours in surgery.

My point was to be prepared for physical pain one must deal with once a "T" is placed. As Brush Okie pointed out, there are other things that may be of value.

I do think we are getting a bit off topic here but probably worthy of discussuion, IMHO.

My $.02.

RF 1



Ah, gotcha RF 1.... I was secretly trying to incite a discussion.:D

I did find an interesting study on TQ's and their use both in the civilian sector and military, while looking for some info on reperfusion injury. Here's the link.....http://www.americanheart.org/downloadable/heart/1102626431437f.tourniquet.LC.7Dec04Final.pdf (note: the interesting stuff starts on Pg. 6)...

swatsurgeon
06-30-2009, 11:09
A few things.....
You are taught to place the tourniquet because of the circumstances under which you applied it.....need both of your hands to do other things and you saw a wound that had the POTENTIAL to have the patient bleed out....so apply the tourniquet (SOP). When things have calmed down you can loosen it to see if the a) bleeding wasn't really too bad and can be controlled by some other means, b) the wound wasn't as nasty as you originally thought and a tourniquet wasn't needed at all. But if you see the limb is gone/almost gone, do NOT loosen the tourniquet...blood is life and every red cell lost in the field is one closer to shock.

The reperfusion injury can only be attenuated/reduced with the reversal of the ischemia sooner. If you mis-apply a tourniquet for 30 minutes, the reperfusion injury is less than if were on an hour...etc., but what had been discussed in the medical literature is given IV and po.....antioxidants, vit A, C, E, mannitol, antiinflammatories. If you can give an oral form of mega vitamin, allopurinol, celebrex (doesn't ruin your platelet function) than you are attenuating the reperfusion injury. If the limb is not going to be amputated, we would do fasciotomies to release the pressure of the referfused muscles which SWELL like hell after a prolonged ischemic period. These can be closed later...I'll post pics when I find a few.

Moral of the story, apply the tourniquet when needed, keep it on to prevent loss of blood (life), LOOSEN ONLY WHEN OTHER APPROPRIATE MEDICAL TREATMENTS ARE AVAILABLE or unless it was put on and not really needed.

ss

sofmed
10-19-2011, 21:07
Wow! I can't believe I missed this thread. Great stuff!! Going back to sitting back and reading now. :rolleyes:

whocares175
11-02-2011, 23:23
just curious....any photos of the cutless amputation? i really learn better from pictures..... :D

swatsurgeon
11-03-2011, 01:11
Value of Preoperative Physiologic Amputation *
WILLIAM H. MoRE-rz, M.D., WALTER R. VOYLES, M.D., CHARLES B. THOMAS, M.D.
From the Department of Surgery, Medical College of Georgia, Eugene Talmadge
Memorial Hospital, Augusta, Georgia
Annals of Surgery
November 1961

Physiologic amputation, afforded by local
hypothermia and tourniquet application
above the affected tissue, grants this interval,
free of the harmful effects of the involved
part, in which to prepare the patient
for operative amputation.