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swatsurgeon
02-15-2005, 16:50
Tomorrow I'll present a case that will utilize many of the issues discussed in recent threads....this will include not just medical issues but others as well.
Something to ponder until I upload the pics and story tomorrow (around 10 am EST).....
stay tuned for an act of bravery, self preservation and guts.
I'm sure the QP's will offer other words as well.

swatsurgeon
02-16-2005, 04:42
He's the scenerio.....
40 something year old male trapped under his car for 3 hrs. Car is sitting on his hand, no one responds to his calls for help. He needs his medications (he has multiple medical problems) and knows he needs to get free soon or he could develop serious problems and likely die. Takes out his pocket knife and self amputates his hand, snaps the bones by standing up quickly, walks back to his house (~500-700 yrds), calls 911 and is brought to us.....awake, alert, 'dealing with the pain. Was very glad he keeps his knife sharp...I have to find out what knife it was.
He is a retired marine (some special unit he won't talk about)...retired due to arm disability from a GSW to the shoulder that destroyed nerves to the arm....self applied a tourniquet, held direct pressure on the wound, covered in a cloth.
Says he did it to survive, that it hurt more than he expected but that didn't stop him, he knew he had to get free so his wife wouldn't find him dead...not the way he wanted to "go out".
Brave?, Crazy? Ballsy? Insane? or just someone taught the survival instinct that is so honed that he used his skills, physically and mentally to survive.

Martin
02-16-2005, 05:21
I take it that the death threat by the car was because of the medication issues, please correct me if that is wrong.

Did he apply the tourniquet after the severing of the hand and what/how did he use to do it?

ccrn
02-16-2005, 10:28
I'm wondering what medical condition he has that would be so urgent as to amuptate his own hand and would be life threatening within a few hours?

Was he bleeding into the hand?

Severe brittle diabetes?

Severe liver failure requiring lactulose rx?


PS
What kind of knife?







Edit spelling

Bill Harsey
02-16-2005, 10:33
We can talk about this being the right thing or not to have done but he's already done it.

Is/was the hand re-attachable?

Roguish Lawyer
02-16-2005, 11:50
Wow. :munchin

swatsurgeon
02-16-2005, 15:26
the hand was infact re-plantable but the patient did not want to go through the procedure despite the fact we offered it.....
the urgency of meds, we now find out were depression/PTSD related.
he felt the immediate threat of being trapped and it did a number on his head.
He's doing well so far.

ccrn
02-16-2005, 16:03
I second that "wow"

hurly
02-16-2005, 16:45
Truly amazing what the mind can conjure!

casey
02-16-2005, 17:50
His will to live overwhelmed his ability to accept death. Good job.

NousDefionsDoc
02-16-2005, 18:21
Woodpecker Lips

swatsurgeon
02-16-2005, 22:54
ahhhhhhh...new news.
NDD may have nailed it.........we have a small psych issue now. Yes he cut it off but the story is changing and this may have been 'staged/planned'....damn, ruins a good story...at least I have good pics!!

casey
02-17-2005, 06:22
We can talk about this being the right thing or not to have done but he's already done it.

Is/was the hand re-attachable?


Ok, now I can post this. Is it just me or does anyone else see the Mr. Harsey(brilliant/innocent) subtle Addams Family reference here? I've been holding this back for days ......

ccrn
02-17-2005, 07:57
Is it just me or does anyone else see the Mr. Harsey(brilliant/innocent) subtle Addams Family reference here? I've been holding this back for days ......


I'm picking myself up off the floor for the second time in two days.


...NDD may have nailed it...


I thought this was a reference to being tough, not crazy.


People might not be happy with my position but I'm not giving this pt props for this-

NousDefionsDoc
02-17-2005, 10:25
It was a reference to being tough. He also quite obviously needs psych help.

greg c
02-18-2005, 15:27
Now that you mention it, that bone looks like an awfully clean break for being snapped by "standing up really fast."

-G

DoctorDoom
02-19-2005, 23:43
x

Hooahman
02-20-2005, 04:23
Also, why would he not want a limb back?! and your right! after looking a little more closely the bone on his arm seems a bit flat for a sudden break. Maybe preped in the ER for the reconnect? if not this guy has some issues. and all over some PTSD pills? hmmmmmmm.

my .02

Eagle5US
02-20-2005, 13:07
Dude gets a wheelbarrow for his nads.:eek:

Eagle

greg c
02-20-2005, 13:25
Speaking of nads, when I was a medical student doing my ER rotation, a gentleman came in with a towel shoved down his pants- it appears he had tried to circumferentially cut off the skin around his penile stump. I say stump because he had already cut his penis off years earlier.

His pathology it seems was a VERY strict upbringing in Catholicism, with significant inherent guilt and obvious psychiatric disorders stemming from that.

THAT was a bizarre night...

-G