Tuesday, October 09, 2012

How to make a finger survive

Seeing this very dramatic story, I came to think of what we see in movies, somebody looses a finger, and they put it on ice and rush to the Emergency room. I wondered if this was really the best way, and asked our old pal, Pascal MD. Quoths he:

Reminds me precisely of Chapter 1 in my Emergencies course last year.
The problems with separated body parts are several. Globally, anything other than "internal organs" has a high tolerance to blood circulation deprivation, especially if the nerves were severed too and no muscle activity uses up their cell energy. (Otherwise, lactic acid build-up would soon cause great damage.) But they still need:
- Not to dry up. It destroys the cells.
- To remain cold. This slows the metabolism and hence the damage.
- Not to freeze. Frost creates sharp microscopic ice crystals that tear the cells apart. So far, real-life "deep freeze cryogeny for humans" is nothing but a scam.
- Acidity isn't the only problem. Fluid concentration also is. Pure water causes osmotic shock that destroys the cells. And cells destroyed equals dead tissue.

The ideal solution of course, is something akin to what that article mentions: the piece of skull that they had to temporarily remove was "grafted" elsewhere inside the person's body. With the blood vessels reconnected, the tissue can safely survive indefinitely. Whether it endures some modifications is another story. (For instance, muscle that doesn't "work" and contract regularly undergoes atrophy. Same with bones, as seen in astronauts.)

Now, the best option for a detached body part until you rush to the hospital, is to keep it very cool, but above ice temperature; moist, and not in pure water or concentrated liquids (sea water is too salty). Ideally, normal saline serum at a temperature of about 5 or 6° Celsius.
Often, one doesn't have that under hand. But it's easy to improvise, as I've taught my students!
Normal saline concentration is precisely NaCl at 9g/l. A perfectly flat large spoonful of table salt is precisely 4? grams. So, either two of these in a one-litre bottle of mineral water, or one flat spoonful of table salt in a half-litre bottle. Tap water is OK, it's very clean germ-wise. But mineral water bottles from a nearby store have the advantage of often being sold straight out of the cooler...
For larger amputations (a hand, an ear or nose) that don't easily pass through a bottleneck, just find a larger container such as a tupperware box, and prepare more "hand-made saline serum".
After that, the results still depend of course on how much time elapses before starting surgical repair.

Joke: a guy arrives at the hospital, with all his fingers missing.
The surgeon exclaims: "But you should've brought them! We could have reattached them for you."
The guy says: "Oh yeah? And how was I supposed to pick them up?"

Bear in mind that often, a knocked-down tooth is ALSO a body part that can be surgically reattached by a specialist.

A less ideal option that still work better than nothing, is to put "it" in a wet piece of cloth, and then inside some ice cubes. This way, it stays moist, and is cooled without freezing from direct contact with the ice. Hopefully.
Milk has been suggested. Cool, natural fresh milk MIGHT be okay as a make-do substitute. But anything sweetened, flavored, or prepared from powder is likely to be catastrophic, because osmolar concentrations (and added substances) will usually be all wrong.

So, in answer to your suggestion, about one normal ice cube to keep your half-litre of improvised normal saline moderately cold is okay. Think of it like a summer beverage: nicely cool, but NOT FREEZING. Estimating the temperature with your lips or (remaining) finger is quite reliable.
Then again, often the main problem is the exact opposite, with your precious cargo having to endure the heat on the road. Maybe keep a stock of ice cubes on the side, and add one whenever things get too warm. But watch out for the dilution effect on your saline serum.


Tommy said...

Good information EO.

But, certainly something that I didn't expect to see on your blog.

To be safe though I guess, I should carry a cooler full of ice cubes with me at all times. Just in case. :-)

Eolake Stobblehouse said...

Yes, and a thermos bottle with saline solution, and a mobi keyed to the nearest ER on a GPS map.

Well, just goes to show how versatile and eclectic this blog is!
Also, I felt such a well written instruction deserved a wider audience than just me.

Tommy said...

And all this time, I thought the Thermos was for the Vodka..

You can keep the saline solution in a plastic cup. :-)

Anonymous said...

Well since this was in Idaho, USA that has very mediocre and half-assed medicine for the bulk of its citizens, whose governor is fighting the Health Care and Affordability act, then one cannot help but wonder - Did she get this so-called great care because she is a beauty queen and therefore the doctors knew for a fact her notoriety would mean they would also reap notoriety themselves, I ask who was the visiting doctor that day that made this possible because anyone else would have died on their table.

Pascal [P-04referent] said...

"Actually, pilgrim, this here bottle of whiskey is jest fer disinfectin' dem apache arrow wounds an' rabid wolverine bites. Not completely useless against fleas or skunk smell, either."

More seriously, check out the Wikipedia page on skunks for a clever smell-removing recipe that's said to work marvels. Not everyone enjoys "a mixture of garlic, rotten eggs and burnt rubber" sticking to them for weeks. Hunh. Go figure...
"Eclectic", you said?
Guys, do you have any idea how HARD it is to reach an eclectician here in Lebanon?

Just for reference, here's the online page where my students can download Dr Pascal's courses: http://drpascalrassi.blogspot.com/
But the Emergencies were given in French, so for you fellas a translation was required. And the University where I gave them is actually going down due to amateurish management, so I won't be translating "the entire megillah" for this year's second run.

This above blog is where I'll be publishing any online articles in the future. When I find the time.
(But right now, I'm very busy completing my Referent's post on the new Caricatures Affair. It's got lots of daring material. For instance, "blasphemating" the whole of Humankind at once, no less!)

I wonder if the embassy of Ecuador still has some spare rooms? One side, Julian, COMING THROUGH!

Goes to show. You just never know when a little first care field know-how will come in handy... (pun intended)
That's why I love to spread the knowledge. A little bit of prevention spares us Doctors a lot of complicated work later on, and in the end everybody benefits from it!

(P.S.: I still have some bandwidth left, so if you like my blog, feel free to preform some mouth-to-mouth... I mean mouth-to-EAR! Expect rewards and fan-exclusives in the future.)

Ooh, freaky! My captcha:
8 licybomb

Pascal [P-04referent] said...

Oops! Bad link.

The finger said...


Eolake Stobblehouse said...

You used the same template that I used to make


... Though I changed everything on it, basically.
Found a photo of old books, turned it nearly monochrome and blue/green, tiled it, etc.

I had to splinter off that blog from this one, because all the ereader talk made this blog a bit *too* eclectic for many. It's not easy being blue/green.