and wrist Slows the blood movement through dressing Offers a local - - PowerPoint PPT Presentation

• Focal pressure applied only to the proximal

end of artery in the upper arm and elbow

• Focal pressure applied to BOTH the proximal

and distal ends of the artery in the forearm and wrist

• Slows the blood movement through dressing

– Offers a local hemostatic solution

• Chitosan provides for improved attachment & apposition
• f the dressing to the injury site
• Chitosan binds red blood cells and

platelets on the dressing’s surface – Provides for localized clotting independently from the normal clotting cascade* ➢mitigates risk of emboli formation

• Strong adherence to damaged tissues and

physiologic seals wound

• Chitosan swells, gels and sticks together
• Gel-like clot without an exothermic reaction
• Completely independent of the body’s

clotting mechanism – BENEFITS

• Need direct pressure after application

• Indications and contraindications
• Every amputation does not require a

tourniquet

• Most catastrophic-explosion
• Mortality from injury or multiple amputations
• r explosive mechanism

• Absolute limits of tourniquet time have never

been firmly established or universally accepted

• SAFE DURATION-45 minutes to 4 hours
• 2 hours most widely accepted figure
• Wilgis produced the rational for 2 hour limit

• Amputated part placed into moist gauze

(COMPLETELY COVERED)

• Gauze placed and sealed in a plastic bag
• Plastic bag placed into a plastic bag with

water and ice

• AMPUTATED PART MUST BE COMPLETELY

COVERED

• Directly on or in ICE -

FROZEN

• Submerged in Listerine,

Gatorade, milk, dry ice, etc.

• Surgical team – 24 hours a day

– hand & microsurgeon

• Two available per day

– Postoperative nurse experienced with microsurgery (1-2 years training)

• National standard
• NO health system provides this coverage in

central Ohio

• What is a hand &

microsurgeon?

– Bone – Ligament – Joint – Tendon – Nerve – Artery/vein – skin – Orthopaedic – Orthopaedic – Orthopaedic – Ortho/plast/gen – Neurosurgeon – Vascular surgeon – Plastic surgeon

• Must be a thoroughly trained and

accomplished hand surgeon (5 years)

• Must be a competent microsurgeon (10 years)
• Must have experienced postop management

• Hand and microsurgery needs to be

regionalized at one center

– Expertise – Reduces delay to repair

• Health systems currently drive

decentralization

• Health system don’t mandate competency

• Hand & Microsurgery Associates is 1/51

recognized groups capable of replantation, revascularization and care of the mangled hand and upper extremity

• Only group in Ohio recognized by ASSH
• Only group in Ohio with 6

replantation/microsurgeons

• Only 170 replantation/microsurgeons in USA