Amputation for Certified Emergency Nursing (CEN)
Included In This Lesson
Study Tools For Amputation for Certified Emergency Nursing (CEN)
Outline
Amputation:
Definition/Etiology:
A traumatic amputation is the loss of part of or the entire extremity. This is usually caused by external sharp or blunt forces. You can have something sliced right off, or crushed to the point of separation. The most affected areas are the fingers, toes, arms and legs.
Pathophysiology:
Patho usually applies to a disease process and our discussion here is about trauma as opposed to disease, sooooo the patho of amputations would be the separation of skin, muscle, and bone from itself due to an external force.
Clinical Presentation:
The clinical presentation for these is usually fairly obvious, you know, something is missing. When they arrive, depending on the severity and location of the amputation, we definitely need to assess for shock related to hypovolemia. We need to determine the amount of soft tissue injury and the degree of wound contamination. This is directly proportional to the mechanism of injury and timeline. If the part was removed with a clean guillotine cut from a sushi knife, you are going to have much less complications then if they were crushed under a vehicle in a motor vehicle collision.
There are also some definite factors that will inhibit good outcomes:
- Crush wounds
- Long period of time since amputation (>6 hours)
- Proximal amputations
- Nerve injuries
- Systemic hypotension
- Severe contamination
- Concurrent medical conditions
- Age
- Poor nutritional status
Collaborative Management:
If they come in with a tourniquet…do not remove it. Let the doc make that assessment. If you can determine the mechanism of injury, it will put your mindset on looking for any other issues. As with any trauma, ABC’s are first and foremost. Actually, with major trauma, and especially with amputations, i like to use the MARCH PAWS mnemonic:
M-Massive bleeding
A – Airway
R – Respirations
C – Circulation
H – Hypothermia / head (LOC)
P – Pain
A – Antibiotics (lifesaving Ancef)
W – Wounds
S – Splinting
You use what you like, but just understand that many nurses can get tunnel vision when a major injury like an amputation comes in. What i mean here is that if we get the guy who had his leg torn off above the knee, we wind up focusing on that, and forget to check if he is breathing or has a pulse.
OK….what do we do with the amputated part? Come one guys, say it with me. Cover the part with dry sterile gauze. Place the part in a bag, then place the bag on ice. NEVER PUT AN AMPUTATED PART DIRECTLY ON ICE!
You will want to get X-rays of the amputated part as well as the stump to assess the amount of bone damage. Please do not lose the body part going back and forth to radiology!
Evaluation | Patient Monitoring | Education:
Clearly, we need to monitor for shock. Cardiac monitoring is a must. These patients can have a change in their hemodynamic stability very quickly. We need to assess for continued bleeding, so watch your dressings for saturation. Most severe traumatic amputations are going to the OR so education is not something we are going to be terribly concerned about. Perhaps some education to the family member about chainsaw safety or letting go of the firework before it goes off, you know that sort of thing.
Linchpins: (Key Points)
- Life and Limb
- Tunnel Vision
- Wrap, bag, Ice
Transcript
For more great CEN prep, got to the link below to purchase the “Emergency Nursing Examination Review” book by Dr. Laura Gasparis Vonfrolio RN, PHD
https://greatnurses.com/
References:
- Emergency Nurses Association. (2022). Emergency Nursing Orientation 3.0. Cambridge, MA: Elsevier, Inc.
- Sheehy, S. B., Hammond, B. B., & Zimmerman, P. G. (2013). Sheehy’s manual of emergency care (Vol. 7th Edition). St. Louis, MO: Elsevier/Mosby.
Plan 1
Concepts Covered:
- Cardiovascular
- Emergency Care of the Cardiac Patient
- Cardiac Disorders
- Circulatory System
- Nervous System
- Skeletal System
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of Pancreas
- Disorders of the Thyroid & Parathyroid Glands
- Hematology
- Gastrointestinal
- Upper GI Disorders
- Liver & Gallbladder Disorders
- Newborn Complications
- Lower GI Disorders
- Multisystem
- Neurological
- Central Nervous System Disorders – Brain
- Renal
- Respiratory
- Urinary System
- Respiratory System
- Noninfectious Respiratory Disorder
- Test Taking Strategies
- Note Taking
- Basics of NCLEX
- Prefixes
- Suffixes
- Medication Administration
- Gastrointestinal Disorders
- Respiratory Disorders
- Pregnancy Risks
- Labor Complications
- Hematologic Disorders
- Fundamentals of Emergency Nursing
- Factors Influencing Community Health
- Delegation
- Perioperative Nursing Roles
- EENT Disorders
- Basics of Chemistry
- Adult
- Emergency Care of the Neurological Patient
- Acute & Chronic Renal Disorders
- Emergency Care of the Respiratory Patient
- Respiratory Emergencies
- Studying
- Substance Abuse Disorders
- Disorders of the Adrenal Gland
- Behavior
- Documentation and Communication
- Preoperative Nursing
- Endocrine System
- Legal and Ethical Issues
- Communication
- Understanding Society
- Immunological Disorders
- Infectious Disease Disorders
- Oncology Disorders
- Female Reproductive Disorders
- Fetal Development
- Terminology
- Anxiety Disorders
- Cognitive Disorders
- Musculoskeletal Trauma
- Intraoperative Nursing
- Tissues and Glands
- Vascular Disorders
- Renal Disorders
- Eating Disorders
- Prenatal Concepts
- Microbiology
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Depressive Disorders
- Personality Disorders
- Psychotic Disorders
- Trauma-Stress Disorders
- Peripheral Nervous System Disorders
- Integumentary Disorders
- Neurologic and Cognitive Disorders
- Integumentary Disorders
- Newborn Care
- Basics of Mathematics
- Statistics
- Labor and Delivery
- Proteins
- Emergency Care of the Trauma Patient
- Hematologic System
- Hematologic Disorders
- Developmental Considerations
- Digestive System
- Urinary Disorders
- Postpartum Care
- Basic
- Musculoskeletal Disorders
- Bipolar Disorders
- Metabolism
- Cardiovascular Disorders
- Concepts of Population Health
- Musculoskeletal Disorders
- EENT Disorders
- Postpartum Complications
- Basics of Human Biology
- Postoperative Nursing
- Neurological Emergencies
- Prioritization
- Disorders of Thermoregulation
- Writing
- Community Health Overview
- Dosage Calculations
- Neurological Trauma
- Concepts of Mental Health
- Health & Stress
- Endocrine and Metabolic Disorders
- Childhood Growth and Development
- Prenatal and Neonatal Growth and Development
- Concepts of Pharmacology
- Integumentary Important Points
- Emotions and Motivation
- Renal and Urinary Disorders
- Developmental Theories
- Reproductive System
- Adulthood Growth and Development
- Psychological Emergencies
- Growth & Development
- Basics of Sociology
- Somatoform Disorders
- Reading
- Intelligence and Language
- Oncologic Disorders
- Med Term Basic
- Med Term Whole
- Central Nervous System Disorders – Spinal Cord
- Muscular System
- Neonatal
- Learning Pharmacology
- Pediatric
- Psychological Disorders
- State of Consciousness
- Sensory System