Synopsis
Prioritise survival and haemorrhage control, protect the residual limb without blind clamping, package an amputated part correctly, minimise warm ischaemia through direct specialist transfer, and integrate replantation, revision amputation and lifelong rehabilitation decisions.
- Control catastrophic haemorrhage first with direct pressure, packing or a commercial tourniquet placed as distally as effectively possible; record the exact application time and never use blind vascular clamps.
- Do not shorten, complete or repeatedly debride the stump in the emergency department. Cover with a sterile saline-moistened dressing and protect bone, nerves and vessels for specialist revision or replantation.
- Handle the part gently, remove only gross loose contamination, wrap it in sterile gauze moistened with saline and place it inside a sealed, labelled plastic bag.
Key red flags
Uncontrolled stump bleeding, shock, coagulopathy, hypothermia or associated torso and pelvic injury requires simultaneous resuscitation and operative haemorrhage control; replantation discussion must not delay survival care.
Investigation priorities
Identify haemorrhage, hypothermia, coagulopathy and associated life threat.
Management branches
A complete or near-complete traumatic amputation arrives with potential major haemorrhage.
- Run catastrophic haemorrhage and ABCDE care, using pressure, packing or the most distal effective tourniquet and recording its time.
- Activate blood-component resuscitation, TXA when indicated, warming and immediate trauma, orthopaedic and plastic or vascular support.
Key medicines
Tranexamic acid for significant traumatic bleedingFor an adult within 3 hours of injury, give 1 g intravenously over 10 minutes followed by 1 g intravenously over 8 hours when active or suspected major bleeding meets the trauma protocol.
Immediate intravenous open-injury prophylaxisGive the trauma network's specified intravenous agent at the current adult weight-based dose as soon as possible and ideally within 1 hour; record allergy, agent, dose and time and apply exposure-specific additions through microbiology.