Initial Management of Traumatic Amputations

Initial management of amputations by the referring institutions should generally involve the following steps, not necessarily in this order:

1. ABCs

2. General condition of the patient is assessed - rule out other injuries.

3. Examine injured parts to define the injury.

4. IV with crystalloid.

5. First generation cephalosporin antibiotic or other appropriate coverage for the given injury or in case of allergy.

6. Tetanus toxoid if indicated.

7. Aspirin suppository is administered if there are no contraindications and microvascular surgery is anticipated.

8. The patient is kept NPO in case surgery is required.

9. X-ray radiographs are obtained of  the amputated part and injured extremity to define the bony injury.

10. Place the amputated part in a slightly moistened sterile dressing.  Do not soak it.

11. Put the wrapped amputated part in a container and then on ice - do not submerge the part in ice - do not freeze the part.

12. Wrap the hand or extremity in dry gauze and splint.  Elevate the injured extremity.

13. Transport supine in most cases.  For single finger or less critical injuries the patient can be transferred sitting up if indicated.

14. Transport if stable and indicated.  Transport with a copy of the chart and a copy of all x-rays and any other diagnostic tests.

For Referral to the Microsurgical Unit at CPMC - Davies Campus:

Driving Directions

Call 415-600-0600  and ask for the attending microsurgeon on call. 

If a patient is accepted for transfer,  transport to the Emergency Room at CPMC - Davies Campus must be arranged first. 

Phone 415-600-0600