Paramedics bring a 24-year-old man who was involved in a motor vehicle accident to the emergency department of a small community hospital. At the accident scene, the medics noted that he had sustained a traumatic amputation of his right thumb. They were able to retrieve the severed digit and bring it to the hospital. The patient undergoes initial wound care and hemostasis with a compression dressing. The hospital does not have a facility for digit replantation and reconstructive surgery, and a decision is made to transfer the patient to a nearby tertiary care center. Five minutes later, the nurse asks, "How do you want me to preserve his severed digit?" The nurse brings an insulated cooling container to transport the severed thumb. Before putting the plastic bag in the container, the nurse asks, "What should we use to fill up the container?" Which of the following is the most appropriate response?

Question

Paramedics bring a 24-year-old man who was involved in a motor vehicle accident to the emergency department of a small community hospital.  At the accident scene, the medics noted that he had sustained a traumatic amputation of his right thumb.  They were able to retrieve the severed digit and bring it to the hospital.  The patient undergoes initial wound care and hemostasis with a compression dressing.  The hospital does not have a facility for digit replantation and reconstructive surgery, and a decision is made to transfer the patient to a nearby tertiary care center.  Five minutes later, the nurse asks, "How do you want me to preserve his severed digit?" The nurse brings an insulated cooling container to transport the severed thumb.  Before putting the plastic bag in the container, the nurse asks, "What should we use to fill up the container?"  Which of the following is the most appropriate response?

Quizplus · Accepted Answer

Explanation: Severed digits or appendages should be brought to the hospital immediately for attempt at replantation. Amputated parts generally tolerate cold ischemia time (ie, temperature of 1-10 C [33.8-50 F], goal 4 C [39.2 F]) better than warm ischemia time (ie, temperature range between body and ambient temperature). Due to their small muscle mass, digits can tolerate longer ischemia times than other body parts. Once the severed digit is wrapped in saline-moistened gauze and placed in a sealed, sterile bag, the bag should be placed in a chilled container to best preserve it and reduce warm ischemia time. To maintain a temperature of 1-10 C (33.8-50 F), ice should be mixed with saline or sterile water (50/50 mixture) and the digit-containing closed plastic bag should be placed in the mixture. If the container is filled with saline or water or if it is not filled up at all, it will be less likely to maintain that temperature range (Choices C, D, and E). (Choice A) Care must also be taken to not overly cool the digit; placing it directly on ice can cause frostbite and severely damage it. For this reason, dry ice should also not be used. Educational objective: Traumatic amputation of a body part requires rapid transport of the appendage and reduction of warm ischemia time by cooling the amputated part to a goal temperature of 1-10 C (33.8-50 F). However, the body part should not be cooled below this range to avoid inducing frostbite. References: Indications and surgical techniques for digit replantation. (http://www.ncbi.nlm.nih.gov/pubmed/12102407) Digit and hand replantation. (http://www.ncbi.nlm.nih.gov/pubmed/20012069)

Paramedics Bring a 24-Year-Old Man Who Was Involved in a Motor