Cadaveric Prehospital Amputation: Which Reciprocating Saw Blade Offers the Most Efficient Amputation.

OBJECTIVE: Field amputations are a low-frequency, high-risk procedure. Many prehospital personnel utilize the reciprocating saw. This study compares the efficiency, speed, and degree of tissue damage of different reciprocating saw blades found commercially. METHODS: Amputations were performed on two human cadavers at different levels of the upper and lower extremities. Four different blades were used, each with a different teeth-per-inch (TPI) design. The amputations were timed, blade temperature was recorded, subjective operator effort was obtained, amount of splatter was evaluated, and an orthopedic physician evaluated the extent of tissue damage and operating room repair difficulty. RESULTS: The blade with fourteen TPI was superior in overall speed to complete the amputations at 1.07 seconds per one centimeter of tissue (SD = 0.49 seconds) and had the lowest fail rate (0/8 amputations). The three TPI, six TPI, and ten TPI blades all required a "rescue" technique and were slower. The blade with fourteen TPI caused the least amount of tissue damage and was deemed the easiest to repair. Secondary outcomes demonstrated the fourteen TPI blade had generated the least amount of heat and produced the least amount of splatter. All blades had a perceived effort of "easy" to complete the amputation. CONCLUSION: While all blades were able to achieve an amputation, the overall recommendation is use of a fourteen TPI blade. It did not require any rescue techniques, provided the most straightforward amputation to repair, had the least amount of biohazard splatter and temperature increase, and was the fastest blade overall.

Use of Knives and Multitools to Perform a Cadaveric Limb Amputation.

BACKGROUND: An austere field amputation can be a life-saving procedure for an entrapped patient when standard equipment is not available or operable. The objective of this study was to use hand tools to perform cadaveric amputations in < 2 minutes. METHODS: Timed guillotine amputation of the extremities on three cadavers was attempted using four available hand tools: a multitool, a rescue tool, a hunting knife, and a fixedblade knife. The primary outcome was successful amputation of the extremity in < 2 minutes. RESULTS: Amputation success was different among the tools. The multitool amputated 78% of attempts; the hunting knife, 67%; the rescue knife, 56%; and the fixed-blade knife, 44%. The distal tibia/fibula and radius/ ulna were amputated successfully in 100% of attempts, whereas none of the tools could amputate the femur. The multitool received the best subjective ranking - 1.4 (p = .001) - by amputators, with the fixed-blade knife receiving the worst score. CONCLUSIONS: In the rare circumstance that an emergent field amputation requires a hand tool, the multitool is a capable instrument for a distal extremity amputation.

Orogastric tube placement during trauma arrest.

Misdirection of nasogastric tubes into the cranial cavity of trauma patients is a well-understood complication that has been well documented in the literature. As a result, recommendations have been established in the use of nasogastric tubes where trauma or suspected skull fractures are identified. Orogastric tube placement is also a commonly performed procedure during trauma resuscitation attempts and is often necessary during patient management. However, no literature currently exists demonstrating misdirection of orogastric tube placement into the spinal canal following trauma and as such, no similar recommendations exist. We review a case of orogastric tube misplacement into the spinal canal due to atlanto-occipital dissociation and suggest a recommendation for prevention.