Amputation Scenario

Group Members
Michael Pham

Nick Cafkules

Max Packett

Taylor Malone

Instructors
John Salinksy
Mary Kjartanson

Class
M - Th 8 AM - 12:30 PM

Scene Size up
Upon arriving on scene, EMTS see a Lifeguard unsuccessfully attempting to staunch the
bleeding on a injured mid twenties male. Scene appears safe and EMTS approach patient after
applying standard precautions. There is one patient and this is a mechanism of injury case.

Primary Assessment
EMT1: Requests ALS and issues command for lifeguard to maintain manual inline stabilization
while taking over direct pressure and applying a dressing to the amputated arm. However
bleeding continues and EMT1 determines the need for a tourniquet. After applying the tourniquet
two inches proximal to the wound bleeding stops. Airway is determined to be patent due to
patients ability to verbalize pain. Breathing is rapid but adequate with a pulse oximeter of 93%.
EMT1 acquires a nasal cannula and begins O2 therapy at 2Lpm titrating up prn till O2 is
stabilized at least at 94%. Pulse is strong and irregular at right radial. Skin is cool, pale, and
potentially diaphoretic (but cannot be determined due to having just been removed from water)
with a capillary refill >2 seconds. A blood sweep reveals lower extremity abrasions that are
deemed superficial and non life threatening. Considering the possibility of hypovolemic shock,
EMT1 uses a towel to dry patient and then wraps in blanket to maintain warm body temperature.
Patient is a priority patient and EMTs expedite transport. EMT1 requests EMT2 to obtain
SAMPLE history.

Secondary Assessment
EMT1 begins secondary assessment by performing a rapid IPA assessment. No DCAPBTLS to
head, neck, abdomen, pelvis, or back present except for crackles bilaterally in lungs. EMT1

immediately applies a c-collar after completing IPA of neck. Abrasions on lower extremities and
full amputation of patients left forearm. EMT1 obtains PMS of lower and remaining upper
extremity and secure to spine board once again obtaining a secondary PMS after fully secured.
VITAL SIGNS produce a BP of 168/94, Pulse 130, respirations are at 22 breaths per minute with
a O2 stable at 95%. Manage secondary wounds prn

Treatment and interventions

Treatment included applying a nasal cannula because patient's O2 levels were below 94%.
Additionally, direct pressure and tourniquet were applied to the injury. Final intervention
includes transport to the nearest trauma center.

Reassessment
Reassess every 5 minutes
AVPU - AOx3
GCS of EYES:4 VERBAL:5 MOTOR:6
Airway Patent
Breathing 24 BPM with O2 of 95%
Circulation remains cool, pale and diaphoretic with capillary refill still being >2s. Pulse is strong
and tachycardic at right radial.