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View Full Version : Cutting off half a hand - what happens?



senka
04-12-2011, 04:04 PM
Yet another question for which I couldn't find any reliable information on the internet:

One of my characters looses the upper half of the left hand (the four fingers except for the thumb) by a clean cut with a sharp blade.
The thing happens in a forest, there's no possibility to get to a doctor or anything like that. There are other persons around, but just "normal people", no nurses, doctors etc. They have a vehicle with some stuff like a first aid box in it, but it's not near the place the accident happens (around 30 minutes to walk).

So what would happen? Is there a possibility the character could bleed to death or is the injury not so dangerous? If the character could bleed to death, how long would it have to bleed until it gets dangerous (so how much time do the ohthers have to stop the bleeding)? And what would theoretically happen after what time if they did just nothing?
If the character would probably not bleed to death from such an injury, or if the bleeding is stopped, would there be other significant consequences like shock (from blood loss or other)? Or passing out or anything? Would the character be able to walk back to the vehicle alone? Might there be circular problems afterwards and how long will they last (minutes, hours, days)?

The cutting-off-the-hand-scene has to happen that way, I just want to describe the consequences as realistically as possible so I want to know every detail that could be important. Thank you for your help!

icerose
04-12-2011, 06:28 PM
My knowledge is limited so I'll answer what I know.

There would be a fair amount of blood, there are some serious veins in the hand {I meant fingers here and typed hand, so for clarification hands have arteries fingers do not} but no arteries. There wouldn't be the arterial bleed out, but you would have heavy bleeding. I doubt they would bleed to death, especially if someone has a shirt and can wrap it. You'd want someone to shred some clothing or use a bandanna to wrap up the wound, keep dirt out, help the blood to clot. The exception would be if he had the rare blood condition where it doesn't clot. Hemophilia.

As to whether or not he could walk thirty minutes to a vehicle I'd say would depend on your character. Some people get a fairly minor cut, see blood, pass out, ect. If he has a strong constitution and a will to live, sure. But he would wrap that wound, even if alone with his own shirt if he had to. A smart person would rip or cut the shirt into strips, it'd be difficult with one hand if he was alone, but he could do it. A non-trained person would probably wrap up the shirt whole around the wound. A real gutsy and not highly trained person would probably try to sear the wound closed, which though it will stop the bleeding opens it up to severe infection.

Shock would definitely be an issue, some people go in shock from trauma visual or physical, others it doesn't seem to reach them. I don't know why, perhaps a doctor will come along and explain why. And passing out from injuries is highly unpredictable. If he had to pull something out of the wound or set the bone he would probably pass out for a while. With the loss of blood if he took it slow, he might not pass out, he'd be dizzy, light headed, weak, his head would be pounding, the wound would throb and shake.

And there's always people outside the normal realm too. There was a man hiking in Utah. (made the news) He didn't tell anyone where he was going or take a radio with him. Two very stupid things. A boulder shifted and landed on his hand. He was there for almost a week pinned under the boulder, drinking his own pee to stay hydrated (which saved his life) then he took out a pocket knife, cut off his hand, applied a tourniquet and walked two hours out of the desert until he was finally picked up and taken to the hospital. He is an extreme example of what you're probably looking for.

Maryn
04-12-2011, 07:22 PM
The novel I'm attempting to sell (everyone who has fingers, cross them, please) has a character who loses his hand at the wrist, severed with a sharp blade a long way from medical help.

I did some research, with the aid of people here, and learned that if the people around have the sense to cauterize the wound (metal object heated in a campfire will do), that will stop much or all of the bleeding. Shock is still a risk, and the injured person who's in shock needs to lie down, not walk for help. If he's not in shock, the adrenaline rush from the injury could easily keep him going for that half hour, or far longer.

Maryn, not offering to shake hands

GeorgeK
04-12-2011, 07:43 PM
There would be a fair amount of blood, there are some serious veins in the hand but no arteries.

Whoever taught you that, don't listen to them again, ever.


One of my characters looses the upper half of the left hand (the four fingers except for the thumb) by a clean cut with a sharp blade.

There is no, "upper," when describing a hand. The word you are looking for is, "distal."



The thing happens in a forest, there's no possibility to get to a doctor or anything like that. There are other persons around, but just "normal people", no nurses, doctors etc. They have a vehicle with some stuff like a first aid box in it, but it's not near the place the accident happens (around 30 minutes to walk).

So what would happen? Is there a possibility the character could bleed to death or is the injury not so dangerous? If the character could bleed to death, how long would it have to bleed until it gets dangerous (so how much time do the ohthers have to stop the bleeding)? And what would theoretically happen after what time if they did just nothing?

Without some means of controlling the bleeding he'd almost certainly exsanguinate. The hand actually normally has a dual arterial supply from the radial and ulnar arteries and sharp clean cuts have a tendency to not stop bleeding on their own like the way crush injuries tend to. An arterial spasm can temporarily slow the bleeding but most likely that would pass and without some sort of treatment he'd probably bleed out in somewhere of the ballpark of a quarter to half an hour. The good news is a tourniquet would work and the warm ischemic time for the rest of the hand is such that even if they left it on for an hour or more, most likely they could save the rest of his hand.



If the character would probably not bleed to death from such an injury, or if the bleeding is stopped, would there be other significant consequences like shock (from blood loss or other)? Or passing out or anything? Would the character be able to walk back to the vehicle alone?

Any of those are possible. It just depends upon the blood loss.



Might there be circular problems afterwards and how long will they last (minutes, hours, days)?
Circular?




The cutting-off-the-hand-scene has to happen that way, I just want to describe the consequences as realistically as possible so I want to know every detail that could be important. Thank you for your help!

senka
04-12-2011, 08:36 PM
Oops, not circular problems, circulatory problems/disturbances/disorders... Should type slower...

Edit: So according to what you say, he will bleed heavily, then the others will have to help out with a tourniquet (I guess the usual thing like made of a pair of socks and a shirt or something would work?) and then the bleeding will stop and he'll be okay for the next, let's say, 12 to 24 hours until they reach a hospital?

GeorgeK
04-12-2011, 08:44 PM
Oops, not circular problems, circulatory problems/disturbances/disorders... Should type slower...

In a reasonably healthy person there is not likely to be any long term sequela of hypovolemia. (No long term effects) However in the short term they will probably tire easier and maybe even be a little short of breath for a few weeks until the red cells have normalized. Someone with underlying anemia, cardiac disease or a host of other problems could have acute blood loss trigger a variety of things including but not limited to a heart attack.

Steve Collins
04-12-2011, 09:47 PM
Senka, good question. I don't want to impose or hijack your thread but George obviously knows his stuff. I have a quicky, in my WIP the MC uses an axe to amputate the foot of a road crash victim trapped in a burning car. It is amputated at the ankle but he first applies a tourniquet above the knee. Would that restrict the blood flow?

Thank you all.

icerose
04-12-2011, 10:12 PM
Whoever taught you that, don't listen to them again, ever.



Ah sorry, I didn't reread my reply. I was still stuck on fingers in my head and leapt to hand. My bad.

To OP. I meant fingers have no arteries.

GeorgeK
04-12-2011, 10:22 PM
Ah sorry, I didn't reread my reply. I was still stuck on fingers in my head and leapt to hand. My bad.

To OP. I meant fingers have no arteries.

Fingers are fed by the digital arteries. If there are veins, by definition there must be arteries. If it can bleed it has arteries.

Kitty Pryde
04-12-2011, 10:23 PM
Ah sorry, I didn't reread my reply. I was still stuck on fingers in my head and leapt to hand. My bad.

To OP. I meant fingers have no arteries.

How d'you suppose oxygenated blood reaches the fingers then? Google 'digital arteries'.

icerose
04-12-2011, 10:37 PM
So I'm even mistaken about that. Good to know, thanks for the correction. We were taught in health class that only the big major body vessels were arteries. So one in each arm, one in each leg, two in the neck ect. I will definitely have to research that more for my own knowledge.

GeorgeK
04-12-2011, 10:53 PM
health class.

That explains it. You actually paid attention in class. I think we might have had the same book for that one. You made the understandable assumption that the textbook was right. It's sad when the classroom text books are so oversimplified that they cease to be of any real value.

icerose
04-12-2011, 11:04 PM
That explains it. You actually paid attention in class. I think we might have had the same book for that one. You made the understandable assumption that the textbook was right. It's sad when the classroom text books are so oversimplified that they cease to be of any real value.

Heh, probably. Agreed there. I'm looking forward to furthering my own studies and I'm glad you were able to correct my misinformation.

Maryn
04-13-2011, 12:44 AM
George and icerose, this sort of eye-opener always makes me wonder what else I've accepted as absolute fact which is, in fact, not even slightly true.

In my case, most of the material in any class taught by a really successful coach.

Maryn, poorly educated until she took over

icerose
04-13-2011, 01:38 AM
George and icerose, this sort of eye-opener always makes me wonder what else I've accepted as absolute fact which is, in fact, not even slightly true.

In my case, most of the material in any class taught by a really successful coach.

Maryn, poorly educated until she took over

I, unfortunately, seem to have far more than I ever wanted. Which is partly why I'm so excited to be going back to college soon. The kicker though is that on face value without further study you can't even tell which is fact and which one has a whole lot of truth missing.

History is a very good example of this.

JayMan
04-13-2011, 05:31 AM
I did some research, with the aid of people here, and learned that if the people around have the sense to cauterize the wound (metal object heated in a campfire will do), that will stop much or all of the bleeding.

No! I don't know who told you this, but cauterization (something that Hollywood is quite fond of) is very rarely a good idea in the field. Surgical cauterization is one thing, but taking hot objects out in the wilderness and branding an open wound is generally a very bad idea. At best, you'll stop the bleeding but cause second and third degree burns, destroy a lot of good tissue, and drastically increase the chance of wound infection.

You would not only be wounded, but also burned. It might be a last resort, something to do when there's absolutely no other option, but cauterization should not be a go-to move.

skylark
04-13-2011, 06:56 PM
Speaking as an "ordinary person" with a bit of (somewhat out of date) first aid training, I wouldn't try a tourniquet at all. I'd apply direct pressure to stop the bleeding, hold the person's hand up as high as I could (above the heart = less bleeding), and get them to the car so someone else could either make a phonecall or drive them to medical treatment.

I can't think of anything in a first aid kit that I'd actually use for an injury that serious. I wouldn't be confident of my ability to bandage well enough to stop that sort of bleeding.

The alternative would be to send one of the other people running back to the car to summon proper medical assistance. That might be better anyway, especially if the injured person looked to be in shock. Depending on how many people are around, maybe they can make a makeshift stretcher and we can start carrying the casualty towards the road.

There's no way I'd try cauterisation when there's a car 30 minutes walk away. 2 days, maybe.

I'd also be getting someone to rescue the fingers and put them in a coolbox, if anyone has such a thing. There might be some chance they can be reattached. (George's comment about maybe being able to save the rest of the hand suggests I might be being overoptimistic here...but I wouldn't know that in the situation.)

That's my line of thinking as a non-expert, at least. You did say the people there were non-experts.

JayMan
04-13-2011, 08:55 PM
Just want to say I agree with everything skylark said, in my limited experience having worked as an EMT. Apply a tourniquet only if direct pressure/elevation don't stop the bleeding.

Also, could someone really die from blood loss after finger amputation? I don't have enough knowledge to say anything authoritatively, but I would assume that the relatively small area of the fingertips would allow it to clot before that would happen, especially if pressure was applied. Apparently, 19th century railroad workers considered loss of finger to be a "minor" injury:
http://www.stanford.edu/group/spatialhistory/media/images/publication/railroad_accidents.pdf