MANAGEMENT OF AN ENTRAPPED PATIENT WITH A FIELD AMPUTATION

作者：Bunyasaranand John C^*; Espino Erasmo; Rummings Kelli A; Christiansen Gregory M

来源：Journal of Emergency Medicine, 2018, 54(1): 90-95.

DOI：10.1016/j.jemermed.2017.08.097

• field amputation
• extremity amputation
• emergency medical system (EMS)
• damage control resuscitation (DCR)
• LIMB
• traumatic amputation protocol (TAP)

Background: Emergency surgical amputations are rare and resource-intensive lifesaving interventions. Most emergency medical services (EMS) lack a formal protocol to manage these high-risk but low-occurrence events. There has been limited attention in the EMS community to address this issue. Without a literature-based approach, the EMS community has been offered little guidance on managing surgical field amputations. Case Report: A 38-year-old man was terminally entrapped below the waist in an industrial auger. As a last resort, the decision to initiate a field amputation was made. We outline an adaptive strategy to address the circumstances surrounding this entrapment scenario. Why Should an Emergency Physician Be Aware of This?: A carefully pre-planned protocol may lead to increased overall survivability for entrapped patients requiring emergent field amputation. Based on the lessons learned from the outcome of this case, previous cases, and a literature review, we have devised a simplified planning tool in the form of a "LIMB'' mnemonic to aid EMS services in developing their own traumatic amputation protocol (TAP). "LIMB'' is an acronym for: Lists of resources and equipment, Initiate TAP checklist, Manage the extrication, and Bring the patient in. The LIMB mnemonic may also be used as a checklist to assist EMS personnel in performing a field amputation. We offer rescuers a starting point to develop their own TAP capable of being executed in their own rescue environment.

• 出版日期2018-1