by Kimberly Allen, RN
In the US there are approximately 2 million people living with amputations. A significant number of them are veterans retuning from Iraq and Afghanistan that lost limbs in battle or due to an IED. Traumatic loss of limb is always more difficult for the victim to cope with and many feel that civilians like the victims of the Boston marathon bombings will have an even more difficult time recovering from their injuries. Why? Because one minute your a normal healthy individual and the next you’re not. Many believe this is because even though soldiers are healthy and active before a traumatic loss of limb they are aware there’s a distinct possibility of traumatic injury. On the other hand, the people that were victims of the bombings in Boston went to a civilian event with absolutely no expectation of being injured only to find themselves victims of a terrible traumatic event.
There are over 30,000 traumatic amputations every year and the care the victims receive immediately following the traumatic event plays a significant role in not only reducing morbidity and mortality rates among the victims of traumatic limb amputations but how well and how rapidly they recover. Any traumatic limb amputation is a devastating and profound injury with significant long term implications. One of the reasons these injuries are so devastating, both physically and emotionally, is that they usually affect young and healthy people. Unfortunately, this has been a predictor of poor outcomes. What matters most to these victims is their quality of life after the injury.
The first priority when treating a victim with a traumatic limb amputation is stopping any hemorrhagic or arterial bleeding. Severe blood loss is one of the leading causes of preventable death in traumatic limb amputations. The only thing that comes before stopping the bleeding is being sure your victims airway is open. If there is an arterial bleed and you attempt CPR before stopping the bleeding you’ll only be pumping the blood out of the body with every compression increasing the blood loss dramatically which increase the risk of death. Frequently these types of trauma occur in situations where there are other victims so speed is as essential as safety. This means you’ll most likely need to use a tourniquet to halt the bleeding. However, correct placement is crucial to it’s effectiveness. Placement of a tourniquet depends on the location of the traumatic injury and is taught in basic first aid.
Immediate surgery is only indicated when there is uncontrolled bleeding, compromised blood flow or compartment syndrome as well as if there’s gross contamination present. All other surgeries should occur only after resuscitation and stabilizing of vital signs. In most cases repair of traumatic amputations requires several surgeries. Doctors have found that by giving the tissue time to heal between surgeries improves the physical recovery time. Another major factor affecting recovery is pain. There is a tremendous amount of pain associated with limb amputations, especially those that result from traumatic injury. Use of opiate or ketamine analgesics as soon as possible after injury can not only control the immediate acute pain but also decrease chronic pain. Phantom limb pain is a type of neuropathic pain that develops in as much as 80% of amputees. It is also important that this pain be controlled. Effective pain management has a significant impact on how well and how quickly a person is able to recover.
The psychological impact is as significant as the physiological impact and requires just as much and in many cases more care. The person that has suffered the loss of limb, especially an unexpected traumatic loss, will need time to grieve that loss. They will go through the various phases of grieving including denial, anger and bargaining as well as numbness. Estimates are that more than half of those that suffer a traumatic limb amputation go on to develop PTSD.
Fortunately since the Iraq and Afghanistan wars, with the amount of soldiers returning with traumatic limb amputations, many programs have been developed to assist people with traumatic limb amputations adjust to life after the loss of a limb. There are also much more advanced prosthesis’s available today that fit better and are almost pain free making them easier to wear and use. Once the physical repairs are complete and the tissue has healed the psychological healing and care will have the most impact on how well a person recovers from a traumatic limb amputation and fortunately there are more organizations than ever before to help the victims with the recovery process.
Kimberly Allen is a registered nurse with an AND in nursing. She has worked in ACF, LCF and psychiatric facilities, although she spent most of her career as a home health expert. She is now a regular contributor to HealthAndFitnessTalk.com, dispensing advice and knowledge about medical issues and questions. You can reach her with any comments or questions at firstname.lastname@example.org.