We were notified one cold winter’s afternoon in February that a farm accident victim with a bad leg injury was coming in from a small town twenty-five miles west of Bemidji.
When the ambulance arrived, they had a barely conscious young boy with his right leg wrapped in many layers of bloody dressings from groin to ankle. The ambulance driver told us that he had been driving a tractor out in the field, spreading manure from the cow barn, when a large chunk of frozen manure got stuck in the tines of the spreader and locked it up. He stopped the tractor and went back to free up the tines but had neglected to disengage the power takeoff. He kicked the manure chunk to get it loose, and when it popped free, the large tines started spinning and caught his boot, pulling his whole leg into them before they locked up again. Somehow he managed to free himself, get back on the tractor, and drive himself off the field. What a monumental effort that must have been.
We quickly got him into the emergency room, and I started two large-bore IVs for lab work and warmed normal saline fluids while the nurses cut off his snowmobile suit and clothes. His right leg from groin to foot was a real mess. Thankfully, his genitals were unharmed. All the soft tissue left in the injured area was severely lacerated and bleeding with manure, his clothing, and remnants of boot ground into it. Luckily, his femoral artery was intact, though totally denuded and faintly pulsating. If that had been severed, the young kid probably would have died out in the field. We wrapped him in warm blankets and quickly took him to the OR. By the time I got him anesthetized, the blood and lab work were ready. He was anemic, having probably lost close to three units of blood on the tractor and in the spreader.
We worked on him for three hours, cutting away dead tissue, irrigating debris and manure out of his wounds, and controlling the bleeding. I transfused him with three units of warm whole blood, so that by the end of the case, he was stable and had good vital signs. His leg was quite a sight. There weren’t more than a few inches of normal skin anywhere, and a lot of muscle had been destroyed. He woke up in a lot of pain, and in the recovery room, we gave him narcotics and antibiotics. Amazingly, he could still wiggle his toes.
The surgeon called Minneapolis to send their air ambulance.
I didn’t hear anything more about that case until six months later, when the doctor from that little town called us to say he was home and doing well. He walked with a slight limp but, miracle of miracles, had no infections during the whole course of his treatment.
Ron Whitchurch is a nurse anesthetist and author of 50 Years in the OR: True Stories of Life, Loss, and Laughter While Giving Anesthesia.
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