Amputation, traumatic

Surgical acute pain amitriptyline may be beneficial for adjunctive use for pain control as well as nighttime sedation. Patients recovering from amputation, traumatic or surgical nerve injuries (intercostal nerves, branches of the brachial plexus, inguinal and genitofemoral nerve, etc.). Consider starting dose of 12.5-25 mg qhs and increase to 50 mg as tolerated. Monitor for urinary retention/constipation that may coincide with post-operative symptoms. Consider nortriptyline or desipramine to reduce side effects. 

Field tourniquets must be capable of reliably applying enough pressure to occlude arterial bleeding. If a tourniquet applies enough pressure to stop only the venous flow, then the rate of blood loss from an arterial wound will most likely increase. It should be noted that some small blood seepage may continue in the case of traumatic amputation due to medullar blood flow even with a properly tightened tourniquet. 

Fracture and traumatic amputation. Closed and open brain injury. 

Pathology — Impairment — Disability — Handicap. Pathology is the underlying cause of the disability. In this context, it refers to diseases and traumatic events such as amputations and spinal chord injuries. Impairment, the effect of the pathology on the body, describes the loss of specific functions. For example, the individual cannot move his or her right leg. Disability often refers to one or more impairments that interfere with specific activities. Examples include an inability to walk or feed oneself. Handicap generally implies the loss of one or more of life s major functions. 

The level of amputation is selected based on the potential for healing and future function. Vascular surgeons, who may or may not have special training in prosthetic rehabilitation, perform most amputations. Orthopedic surgeons, who complete a course in prosthetics as part of their residency, perform amputations necessitated by trauma, malignancy, and other nonvascular causes. Factors influencing the level of vascular amputation include the local blood supply, the nutritional state of the patient, and the probability of successful fitting. Level selection for traumatic amputations or major tumors is based on the nature of the injury and the viability of the remnant tissues. 

FIGURE 33.19 Rate of oxygen consumption and walking speed for surgical (gray), traumatic (black), and vascular (white) amputees for various levels of amputation (HP = hemipelvectomy, HD = hip disarticulation TF = transfemoral KD = knee disarticulation TT = transtibial). (From Ref. 6.)... 

J. M. Casillas, V. Dulieu, M. Cohen, I. Marcer, and J. P. Didier (1995), Bioenergetic comparison of a new energy-storing foot and SACH foot in traumatic below-knee vascular amputations. Arch. Phys. Med. Rehabil. 76 39-44. 

Tertiary injuries are caused when the victim s body is thrown against a solid surface such as a wall or a tree. Essentially the victim becomes secondary shrapnel. These injuries are much the same as those seen after a person is ejected from an automobile during a high-speed collision. Commonly seen are broken bones, traumatic amputations, and head/brain injuries. Because of their transonic pressure wave, high explosives frequently cause tertiary injuries (Eigure 6.17). 

An acute injury arising out of, and in the comse of, employment resulting from exposure to traumatizing physical or chemical agents in the workplace. Examples include amputations, fractures, eye loss, lacerations, and traumatic deaths. The Occupational Safety and Health Administration (OSHA) states that the industries with the highest risk for occupational injuries include construction, mining, manufacturing, and wholesale. Occupational Injury and Illness Classification System (OIICS)... 

People with diabetes account for 60 percent of non traumatic lower Umb amputations. 

How does OSHA define amputation An amputation is the traumatic loss of a limb or other external body part. Amputations include a part, such as a limb or appendage, that has been severed, cut off, amputated (either completely or partially) fingertip amputations with or without bone loss medical amputations resulting from irreparable damage amputations of body parts that have since been reattached. Amputations do not include avulsions, enucleations, deglovings, scalpings, severed ears, or broken or chipped teeth. 

Yet another widely untold story reaches beyond the deaths on the job, violent assaults, amputations, chemical burns and the other hundreds of thousands of traumatic injuries every year. It is the mental trauma of co-workers who are eyewitnesses to grisly deaths and gruesome injuries. 

Bussmann JBJ, Schrauwen HJ, Stam HJ (2008) Daily physical activity and heart rate response in people with a unilateral traumatic transtibial amputation. Arch Phys Med Rehabil 89 430-434. 

An injury is a traumatic wound or other condition of the body caused by external force including stress or strain. The injury is identifiable as to time and place of occurrence and the part or function of the body affected, and is caused by a specific event or series of events within a single day or work shift. Injuries include cases such as, but not limited to, a cut, fracture, sprain, or amputation. 

Diabetic wound is a complication of diabetes mellitus which is characterised by the slow healing of normal wounds specially produced at the body extremities leading to diabetic foot ulceration etc. It leads to approximately 20% cases of hospitalisation, amputations, morbidity and 50% of non-traumatic lower limb amputations [10, 11]. Diabetic wounds are accelerated by the microorganisms like Staphyloccocus aureus. Pseudomonas, Streptococci etc. [11]. Medicinal plants have been extensively used for thousands of years to cure ailments like diabetes, blood pressure, infection etc. Herbal, Unani, Chinese, traditional or folklore all state the beneficial effects of such plants [12, 13]. 

Vehicle-borne improvised explosive devices (VBIED car bombs) Typicolly 1-3 kg of commercial expbsive under the fbor of the car directy beneath the driver s seat Traumatic amputation and other lower-limb, abdomen and pelvic injury... 

The most significant form of tertiary injury in these attacks is probably traumatic amputation. Older work from Northern Ireland shows a relationship between extremity of amputation and survival (that is to say, those with more distal amputations had increased survival), and this is probably perpetuated today. 

Because these amputations are avulsive rather than guiUotine-like, tissue damage occurs proximal to the level of amputation as blood vessels, nerves and tendons are tom from the Umb. Re-implantation is therefore rarely, if ever, possible and precious surgical time should not be wasted in attempting it. In addition, the level of the surgical amputation is likely to be significantly proximal to the level of the traumatic amputation. 

---