|
the metabolic 'washout', i.e., reperfusion injury gets worse the longer the tourniquet is on. This is why we release it in "controlled" circumstances, i.e., where there is plenty of equipment, meds, personnel, etc to resuscitate the patient from the effects of the reperfusion injury. ...best in a hospital, worst in the field
One thing Doc T and I learned about in our fellowship was how to attenuate/reduce the potential for the reperfusion injury. I have done it in the field when dealing with a trapped limb that sooner or later we'll get free but know the 'washout' of lactic acid, potassium, etc will be significant once we free them
I promised Bill Harsey I would show a leg I freed with his T-2 folder...I had to cut through the hamstrings to get a guy off of an auger/post hole digger....I forgot a scalpel and I forgot the Gigli saw blade (it's a pull type flexible blade held by two handles) for the field amputation. Our 'kit' was disassembled and I rushed to get out to the field. They flew me out there and thankfully the femor (thigh bone) was very broken but the muscle belly was still attached.
Thank goodness I always carry that knife!!!!!!!!!!!!
Pic 1 leg in bag, just cut him off
pic 2 tourniquet on thigh, where I cut was the bottom muscle under the thigh
pic 3 the amputated leg torn to shreads, foot torn up boot still on.
BTW he's going great, I'm going to skin graft the stump next week.
__________________
'Revel in action, translate perceptions into instant judgements, and these into actions that are irrevocable, monumentous and dreadful - all this with lightning speed, in conditions of great stress and in an environment of high tension:what is expected of "us" is the impossible, yet we deliver just that.
(adapted from: Sherwin B. Nuland, MD, surgeon and author: The Wisdom of the Body, 1997 )
Education is the anti-ignorance we all need to better treat our patients. ss, 2008.
The blade is so sharp that the incision is perfect. They don't realize they've been cut until they're out of the fight: A Surgeon Warrior. I use a knife to defend life and to save it. ss (aka traumadoc)
Last edited by swatsurgeon; 02-02-2005 at 09:52.
|