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Traumatic Amputation/Cauterization
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_sexorcist_ wrote in little_details
Hey! I have a question for the medical types among us, regarding cauterization of an accidental amputation.

I've Googled a few different terms, including "cauterization", "cauterization amputation", and "cauterization treatment". The trouble I've been running into is the two main focuses of results- modern use of cauterization, and Civil War battlefield amputations, neither of which are quite what I'm looking for.

My story is set post apocalyptic by only a few decades, so society is still rebuilding, with none of the technology they had pre-impact, but with the added benefit of people beginning to develop magical abilities (won't get into the details of that here, but magic is relevant!) During the scene in question, my characters are out in the middle of nowhere, the closest humans are the ones who are trying to kill them, so they have no help.

In one of the skirmishes, one of the characters gets his arm pretty much blown off, up to just above the elbow. Like, we're talking a stump of raw hamburger looking flesh where arm used to be. None of the magic users can heal, but one of them has a flare for fire, and she does the first thing she can think of- she grabs onto the wound (wound seems like a weak word for that) and blasts it with a pulse of intense heat to cauterize it and keep him from bleeding out in minutes.

Obviously he's going to pass out from the pain, because yikes, but all the sources I've found assume hospitalization, even in a surgical tent of some kind, would be available. All my characters have are some bandages, and there are no hospitals, only doctors that are few and far between.

Could he survive this? Would he die simply from shock? If he survived the initial trauma, would he just end up dying from infection days later? The sources I've found seem to agree that cauterization raises the risk of infection, but I can't find any solid numbers on that, if there even are any. And on the off chance that he makes it through all that, what kind if timeline are we looking at for him to be up and walking around and able to travel?

Thanks for any help you can give. Also, my stomach is highly angry at me for reading about this all evening. :P

This was a treatment for that sort of injury, and many lesser ones, in the Middle Ages; the technique then used hot oil. I presume some people survived, as they went on using it; I think even medieval battlefield surgeons would have given up a method that had 100% mortality. But it was hellishly painful and did a lot of damage. Look up Ambroise Paré: He came up with a less dreadful treatment for wounds.

You might also want to look for sources on Roman military medicine and Roman surgery generally. Cauteries were part of Roman practice. I believe they did lessen the risk of infection.

You won't find a lot on the quantitative aspects, I think, as those methods were used mainly before the invention of statistics, and we can't exactly carry on experimental testing of ancient and dangerous surgical practices now. But perhaps a textbook on military medicine would have information on time to recover from injuries.

Ugh, yeah, I read that they would use boiling tar, and I can't even...that would hurt.

I'll check out the Roman angle, for sure. Thanks! :D

Checking my bibliography, I think I relied on Ralph Jackson, Doctors and Diseases in the Roman Empire, and Graham Webster, The Roman Imperial Army. You may also find some information in Spencer Rogers, Primitive Surgery.

I'm definitely not a medical expert; but as an aside, if you go with cauterizing the wound, you might want to look up "burn treatment" for details to include in the after-care. I'd guess just for a start that this would include making sure the patient gets lots of fluids.

Given the circumstances that's probably the closest thing to a viable treatment they could bring to bear, especially if it was in the middle of a battle. Cauterization increases the risk of infection, but "elevated risk of infection" is usually preferable to "he punched out all my blood!"

The character might be conscious for awhile after all of that, too; shock and adrenaline do interesting things to people suffering from abrupt mechanically-induced weight loss syndrome. After that wore off, though, he'd be down for the count. How long depends on the character and post-flambé care; a strong, healthy person well taken care of could be beginning to move around with some difficulty after several days, while an average person being in the back of a wagon or something for a few weeks would be believable as he got back what he could of his strength and endurance. The hardest people in the world wouldn't just bounce back from something like that though, even if they made a full recovery with the obvious exception.

If the apocalypse is within living memory and people are actively rebuilding, it's not really believable that they'd have none of the technology or knowledge. Unless a mindwipe was involved, every last book was destroyed, etc., people would still know about germ theory, they'd still have some knowledge on how to treat or prevent infections, and would probably have at least some medications kicking around (or brewed up from scratch). That goes quadruple for any kind of world which would be especially violent, as that sort of thing would apply lots of pressure to work on recovering medical knowledge, or at least trial-and-error the older techniques back. So overall the character's odds depend on how much knowledge is retained - some absolutely would - and how competent people attending him afterwards would be.

Just so you know, your comment nearly made me snort chocolate milk up my nose. XDD And yeah, it's less that they don't HAVE the knowledge, it's just that it got dicey there for a while that humans would even survive, so the resources are still scattered and falling apart. They've just begun to get to the point of "well, we're not dying by the hundreds in this makeshift town anymore, we can finally start sending people out to gather all the crap we need from all the ghost towns." So they have the knowledge and some supplies, but most of that is in the small communities left over, and my characters are days of walking from any friendly population.

Fun stuff happens when a meteor obliterates a chunk of Europe and people have to survive without sunlight for a while in a mess of acid rain and freezing temperatures. :P

Sometimes people did die of the shock, or of infection in the burns afterwards, but it really is an appropriate treatment in that situation. One advantage that your character might have is a basic knowledge of germ theory: his companions might attempt (if not be entirely able) to keep the wound covered and clean.

Otherwise there's a lot of variables involved with "up and about" and "travel". Some people in Sierra Leone (including children) who suffered hand/arm amputations at the hands of militias managed to get up, stay with their family group and keep walking for days immediately after the attack because the alternative was certain death. Others were carried, others stayed behind. Obviously, this is an extreme situation, but it's going to depend more on outside events and your characters than any strict timetable.

Obviously he's going to pass out from the pain, because yikes

Not necessarily. Quite apart from the adrenalin of battle - people can absorb really horrendous injury and keep going, sometime barely notice, if they're pumped up enough - people who live in violent societies that have no analgesics or anaesthesia have a far more everyday relationship with pain than we do; it just doesn't shock them as it would us.

I'd anticipate that the bone was pretty mangled, right? In most hospital amputations the bone is cut back significantly so that there is plenty of padding of muscle and skin to close around it. I'm not sure if cauterization would work well on bone instead of soft tissue. Doctors will usually cut back a few inches of healthy bone to provide the padding, and your characters might have to go in after the battle to do some damage control. If the wound was at the elbow then probably about mid-humerus would be amputated. Removal of the elbow joint also takes away any chance of a lower-arm prosthetic.

You could also look up post-3rd degree burn treatment; if your guys get sterile bandages that they change twice a day or something that might help. In some situations honey has been applied topically and has been seen to help, but it looks like only certain kinds of honey has been researched. Of course, once the wound is cauterized, there's a chance that the nerve endings will be seared enough that it won't be as painful (I've never had an arm amputated myself!) so you could factor that in to your immediate treatment and travel plans.