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Odcięta ręka lub noga – jak udzielić pierwszej pomocy?

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Większość przypadków amputacji urazowej dotyczy palców lub ręki na poziomie nadgarstka czy przedramienia. Podczas udzielania pierwszej pomocy kluczowe jest zatamowanie krwawienia oraz prawidłowe zabezpieczenie odciętej części ciała.

Do większości przypadków amputacji urazowej dochodzi w zakładach pracy, w których używa się takich narzędzi czy urządzeń jak piła tarczowa, tokarka czy rębak do drewna. Amputacja może nastąpić także w wyniku wypadku samochodowego.

Wskutek urazu może dojść do całkowitego oddzielenia się palca, stopy lub większej części kończyny. W niektórych przypadkach jednak część kończyny pozostaje połączona z ciałem np. pojedynczym płatem skóry i mięśni.

W jaki sposób udzielić pierwszej pomocy?

 

1. Zadbaj o własne bezpieczeństwo

W przeważającej liczbie przypadków do odcięcia części ciała dochodzi wskutek wypadku z maszynami przemysłowymi lub urządzeniami tnącymi. Osoba udzielająca pierwszej pomocy powinna w pierwszej kolejności upewnić się o własnym bezpieczeństwie. Należy sprawdzić m.in. czy urządzenie, które spowodowało uraz, jest wyłączone i nie stwarza już zagrożenia.

Następnie powinno się założyć rękawiczki ochronne. Jeżeli nie są dostępne, można wykorzystać plastikową torebkę czy foliowy worek. Krew i inne płyny ustrojowe to materiał potencjalnie zakaźny. Ekspozycja na krew wiąże się z ryzykiem zakażenia takimi wirusami jak HIV, HBV czy HCV.

2. Zatamuj krwawienie

Wskutek urazu amputacyjnego następuje przerwanie ciągłości skóry, mięśni, ścięgien, kości, nerwów i naczyń krwionośnych. Konsekwencją jest bardzo silne krwawienie. Krwotok może zagrozić życiu poszkodowanego, jeśli amputacji uległa np. noga czy cała ręka. Z tego powodu niezwłocznie należy zatamować krwawienie.

Unieś uszkodzoną kończynę

Pierwszą czynnością, którą należy wykonać w przypadku masywnego krwawienia, jest uniesienie kikuta powyżej poziomu serca. Elewacja kończyny ułatwia odpływ krwi i może znacząco ograniczyć krwawienie. Uszkodzona kończyna powinna pozostać uniesiona aż do przyjazdu pogotowia.

Uciśnij ranę

Na ranę należy zastosować bezpośredni miejscowy ucisk. W tym celu do miejsca krwawienia powinno się przycisnąć gazę czy bandaż. Jeśli materiały te nie są dostępne, można użyć elementu odzieży, np. koszuli czy bluzy. Ucisk należy utrzymywać także podczas wykonywania kolejnych czynności.

Załóż opatrunek

Na ranę należy nałożyć opatrunek. Można wykorzystać gazę i bandaż albo elementy garderoby. Zaleca się umocowanie opatrunku przy pomocy elastycznego bandaża.

Jeśli opatrunek zaczyna przemakać krwią, nie należy go zdejmować – zamiast tego trzeba dołożyć kolejne warstwy opatrunku.

Jeśli krwotok jest obfity, załóż opaskę uciskową

Jeżeli amputacji urazowej uległa noga czy ręka, może dojść do krwotoku tętniczego. Inaczej niż w przypadku krwotoku żylnego krew wypływa pod dużym ciśnieniem i znacznie trudniej ją zatamować. Obfite krwawienie może doprowadzić do zgonu, dlatego w takiej sytuacji można zastosować opaskę uciskową.

Prawidłowo założona opaska uciskowa skutkuje zamknięciem tętnic, które doprowadzają krew do miejsca zranienia. Opaskę umieszcza się około 5 cm powyżej rany. Można w tym celu wykorzystać bandaż, pasek, szalik czy chustę. Podczas zakładania opaski należy użyć dużej siły – zbyt słabo zaciśnięta opaska nie ograniczy krwawienia, a może nawet je nasilić.

3. Wezwij pogotowie

Po zatamowaniu krwawienia należy wezwać pogotowie ratunkowe.

Jeśli na miejscu obecne są inne osoby, można zlecić im wezwanie pogotowia na wcześniejszym etapie udzielania pierwszej pomocy – od razu po wypadku lub podczas zabezpieczania miejsca zdarzenia.

4. Zabezpiecz poszkodowanego przed wychłodzeniem i zapewnij mu komfort

Po zatamowaniu krwawienia i wezwaniu pogotowia należy zadbać o prawidłową temperaturę ciała poszkodowanego. By uchronić go przed wychłodzeniem, można użyć koca termoizolacyjnego albo kurtki czy bluzy.

Należy także utrzymywać z poszkodowanym kontakt słowny. Ma to na celu uspokojenie chorego i zapewnienie mu komfortu psychicznego. Podczas rozmowy łatwiej również zauważyć niepokojące objawy, które mogą wskazywać na pogorszenie stanu poszkodowanego – np. wystąpienie wstrząsu hipowolemicznego.

5. W przypadku wstrząsu hipowolemicznego zastosuj pozycję przeciwwstrząsową lub boczną

Nagłe zmniejszenie objętości płynów fizjologicznych w łożysku naczyń krwionośnych skutkuje niedotlenieniem narządów w organizmie. Powoduje to zaburzenia wydolności i pracy narządów, w tym serca i mózgu. U poszkodowanego może wystąpić wówczas wstrząs hipowolemiczny.

Objawami wstrząsu hipowolemicznego są m.in. bladość skóry, nadpotliwość, osłabienie, senność oraz utrata przytomności.

Jeśli u poszkodowanego wystąpiły symptomy hipowolemii, ale nie doszło do utraty przytomności, można zastosować pozycję przeciwwstrząsową. Pacjenta układa się na plecach, a jego nogi powinny być uniesione powyżej poziomu głowy.

W przypadku utraty przytomności poszkodowanego należy ułożyć w pozycji bocznej bezpiecznej.

6. Zabezpiecz odciętą część ciała

U osób, u których doszło do amputacji urazowej, niekiedy możliwe jest przeprowadzenie replantacji. Jest to operacja polegająca na przyszyciu odciętej części ciała. Zabieg obejmuje odtworzenie ciągłości nerwów, ścięgien, kości oraz naczyń żylnych i tętniczych. Przeprowadzenie replantacji jest możliwe tylko wtedy, jeśli prawidłowo zabezpieczono odciętą część ciała.

Jeśli amputacji uległo np. kilka palców lub odcięta część ciała jest w kilku kawałkach, każdy należy osobno zabezpieczyć.

Odciętą część ciała należy owinąć czystym materiałem lub opatrunkiem. Następnie należy włożyć ją do plastikowej torebki lub pojemnika i szczelnie zamknąć. Tak zabezpieczoną część ciała wkłada się do pojemnika wypełnionego wodą z lodem. Włożenie części ciała bezpośrednio do lodu mogłoby doprowadzić do odmrożeń tkankowych i martwicy.

Obniżenie temperatury odciętej części kończyny skutkuje przedłużeniem żywotności tkanek. Schłodzenie części ciała do temperatury 4 st. C. umożliwia przeprowadzenie replantacji nawet do 18 godzin od wystąpienia urazu.

Czego nie robić w przypadku amputacji urazowej?

 

1. Nie oddzielaj niecałkowicie odciętej kończyny od reszty ciała

Jeśli u poszkodowanego doszło do amputacji niecałkowitej i część kończyny utrzymuje się z resztą ciała np. pojedynczym płatem skóry czy mięśni, nie należy go odcinać. Mogłoby to doprowadzić do nasilenia krwawienia i głębszych uszkodzeń tkankowych, co zmniejszyłoby szansę na przeprowadzenie replantacji. Ponadto u poszkodowanego mogłoby dojść do napadu paniki, co utrudniłoby zatamowanie krwawienia.

Do amputacji urazowej może dojść wskutek wyrwania części ciała. W takim przypadku na kikucie i odciętej części ciała mogą pozostać zwisające fragmenty mięśni, ścięgien i nerwów. Ich także nie należy usuwać.

2. Nie przemywaj rany środkami dezynfekcyjnymi

Rany nie należy przemywać środkami dezynfekującymi. Użycie tego typu preparatów mogłoby pogłębić uszkodzenie tkanek. Do przemycia rany można zastosować wodę pitną lub sól fizjologiczną.

3. Nie stosuj opaski uciskowej, jeśli krwotok nie jest obfity

Opaskę uciskową należy założyć jedynie, jeśli krwotok zagraża życiu poszkodowanego. W przypadku amputacji najgroźniejsze zwykle są urazy dotyczące nóg. W przypadku odciętego palca dłoni czy fragmentu dłoni zazwyczaj nie ma konieczności zakładania opaski uciskowej.

Opaska uciskowa może doprowadzić do martwicy tkanek i w konsekwencji utraty całej kończyny.

Źródło: mp.pl

 

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