From Saturday Morning Breakfast Cereal. Funny, funny, very sick awful comic.
Seriously, I recently had a guy with a complex ear laceration. He had rolled his ATV and tore the hell out of his pinna (the upper ear) and almost pulled it off of his scalp. It was as challenging a laceration as I am willing to tackle myself without Plastic Surgery backup. I finished a very nice job of putting it back together, but it just wouldn't stop bleeding. Ears are, like the scalp, very vascular, but you can't use epinephrine on them to blanch the blood vessels and stop the bleeding. So direct pressure is the only option, but that can be tricky with the complicated three-dimensional structure that is the ear. And this wound was really just ooozing and oozing and would not stop. So I created a bolster to go behind the ear, and an absorbent pad to go over the ear, and I wrapped an ACE bandage around the head several times, really tight, to create a pressure dressing. And it worked beautifully -- finally, the bleeding seemed to be stopped.
As I stepped away from the patient, I noticed his scalp (he was bald). It was a deep purple hue. I realized that my clever pressure dressing had effectively created a tourniquet for the scalp. What the hell was I going to do? I couldn't just leave it like that, could I? If I loosened the dressing, the bleeding would stop again. Maybe I should just leave it on. What were the ill effects of a scalp tourniquet left on overnight? I'm pretty sure there's no good research on that topic. So how long was it going to take for a good solid clot to form so the bleeding would not restart? Maybe an hour or two.
"How's your scalp feeling?" I ventured to ask him.
"It's OK, maybe a little tingly."
"Um, you may find it a little uncomfortable when you get home. If you do, it's OK to loosen that wrap I put on, after a couple of hours."
"OK, thanks doc."
There just is no instruction manual for this job.
08 September 2008
Posted by shadowfax at 8:25 AM