5. PRIMARY SURVEY
• A : Can speak , full ROM of neck
• B : Equal breath sound
• C : BP 112/64 mmHg , PR 92 bpm
• D : E4V5M6
• E : Traumatic amputation right thumb, active bleeding
As picture , full ROM of MCP joint , sensory intact
6.
7.
8.
9. SECONDARY SURVEY
• A : No drug/food allergy
• M : No current medication ,no smoking
• P : No underlying disease
• L : Last meal 9.00 am (4 hr PTA)
• E : ถูกลิฟท์ยกปูนทับนิ้วโป้งขวาขาด เลือดไหลชุ่ม
ปวดมาก นำนิ้วที่ขาดใส่น้ำแข็งมา
20. • Thumb amputation
• Pediatric patient
• Multiple digits lost (lost > 3 digits)
• Mid-palm , wrist , major amputation
ABSOLUTE INDICATION
21. CONTRAINDICATION
• Patient factors
- Severe Co-morbid
- Associated life threatening injury
- Old age ( age > 70 years)
- Major psychiatric disorder
• Mechanism of injury
- Multiple level amputation
- Extremely contamination
- Severe avulsion or crush