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How bad is amputation?
September 25, 2012 4:00 PM   Subscribe

How likely is it that someone who has just amputated the end of their pinky finger will go into "shock?"

So I was watching a friend play a video game the other day, where the character was in a Saw-like situation: he had to amputate a part of a finger in order to save the life of his son. He took a swig of alcohol, used a sterilizing fluid on his finger, got a tool to cauterize the wound, and lopped the tip of his pinky finger off with a knife and sealed the wound.
An unknown amount of time later, but probably not any more than 30 minutes, another character showed up, and he had great difficulty escaping from the police, who had surrounded the building and were coming in to arrest him for a crime he hadn't committed. By great difficulty, I mean "could barely walk or stand up or move in any reasonable fashion."

Given that he had not lost a significant amount of blood, was not injured anywhere other than his pinky, and that people routinely amputate parts of their body either for fun or survival and then go through great physical duress, the depiction of him being that weak seemed a bit implausible to me. After looking up the various kinds of actual shock, and then looking up "acute stress reaction" on wikipedia, I was more convinced that it was a dramatic representation, not a realistic one. I've broken two toes and walked around on them for hours before bothering to see a doctor.

Are there any doctors out there who can weigh in on this? With a prepared, intentional self-amputation, given about 30 minutes or so and proper motivation/adrenaline, would it be reasonable to expect him to walk more than ten feet in ten seconds or be able to stand up by himself?
posted by GoingToShopping to Health & Fitness (49 answers total) 4 users marked this as a favorite
 
A relative of mine got their thumb caught in a rope in a boating accident and he pulled all of the flesh off the thumb. He said it hurt like hell, but he didn't go into shock and it took like twenty minutes to get back to shore. The main concern was bleeding to death.
posted by Sphinx at 4:04 PM on September 25, 2012


Aron Ralston amputated his own arm and then climbed down a mountain.
posted by Wordwoman at 4:06 PM on September 25, 2012 [2 favorites]


It's pretty much impossible to bleed to death from a wound below the elbow unless you like tear half your ARM off so clinical shock (from loss of fluid) isn't an issue. Unless you have a clotting disorder I guess.
posted by fshgrl at 4:07 PM on September 25, 2012


My father cut off three of his fingers at the first knuckle in from the fingernail on a table saw, and by all accounts was able to find the pieces, walk upstairs from the basement, and tell my mother he needed to be taken to the hospital.

I suspect the game writers were wimp desk jockeys who've never actually had a major injury in a situation where they were responsible for self-rescue. But then I have a lot of problems with suspension of disbelief in the action genre in most media, book, game or movie.
posted by straw at 4:09 PM on September 25, 2012 [1 favorite]


My husband cut his finger with a kitchen knife while making a salad. The cut was minor, with insignificant blood loss. He walked around for a minute after cleaning the wound and nose dived onto the tile floor. He is not typically squeamish. I don't think that this was technically shock, but he certainly would have had difficulty running from the police in this case.

I told him he should have been tearing the romaine anyway (after the EMT left).
posted by deadcrow at 4:13 PM on September 25, 2012 [20 favorites]


The main character of the game in question had already gone through quite a bit before cutting his pinky off, fwiw
posted by empath at 4:14 PM on September 25, 2012 [2 favorites]


Shock is a term used loosely in general parlance. In medical speak it reflects a state of inadequate oxygen delivery to vital tissues. In the case of trauma, decompensated shock results from loss of large amounts (like 1-2 liters or more) of blood at least initially, though infection and severe injury can result in shock due to other mechanisms downstream of the initial injury. All of that said, people often reflexively get queazy and even pass out at the sight of this kind of injury -- technically not shock in medical terms.
posted by drpynchon at 4:17 PM on September 25, 2012 [6 favorites]


Empath has it, at least with regards to the character's "shock." Previous to the finger-cutting excursion, he was may have also been involved in several bad accidents. We'll leave it at that to avoid any spoilers.
posted by roomwithaview at 4:19 PM on September 25, 2012


Yeah, I know the game we are talking about here, and I think, given everything else that is going on for the character in question, being a little messed up for a while seems pretty reasonable.
posted by Rock Steady at 4:19 PM on September 25, 2012


I cut my big toe clean off where it joins the foot, well except for a small 1cm wide patch of skin holding it dangling from my foot. I lost a bit of blood didn't go into shock, but then when I got to the hospital there was a lot of running around and getting me into surgery so that may have mean I didn't have time to go into shock. It didn't hurt at all except where the skin still joined stung. The doctors said that was because I'd cut nerve endings.

Now if my father hadn't been there to stick a tourniquet on me and drive me the 90 minutes to the nearest hospital, as opposed to my mothers idea of just having me bleed into the bath tub so I didn't stain the carpet who knows.

Oh and they sewed my toe back on and it healed wonderfully. That little bit of skin was enough to keep the toe alive.
posted by wwax at 4:28 PM on September 25, 2012 [3 favorites]


Yeah, my mom cut off her pinky and definitely was not in a state of shock. If anything, from what I understand, she was stone cold ruthless and calm.
posted by jadepearl at 4:32 PM on September 25, 2012


Regarding the previous experiences of the protagonist, do you guys really think that would go so far? Assuming he had a half hour or whatever to recoup, and considering that people such as Mr. 127 hours had gone through at least equivalent duress, is the whole "not able to stand" thing not a bit suspicious? Keep in mind this wasn't fainting from surprise or anything like what happened in Deadcrow's situation, this was an extended period of general crappiness at moving.
posted by GoingToShopping at 4:34 PM on September 25, 2012


I typically faint at relatively minor injuries to my hands. Most of the time I have the time to find something soft and horizontal before it happens but not always. Pretty dizzy afterwards.

Amputating, however, would not only give me some rest, but a true shock, I'm absolutely positive.
(Then again, I'm a musician).
posted by Namlit at 4:36 PM on September 25, 2012


When I was in college I witnessed a freshman chop off part of his pointer finger with a mat cutter in the art department. He gave a choked scream, grabbed the stub of his finger, and then fainted onto the floor. So, at least one person in history was completely incapacitated by the loss of a digit.



I was the only other person in the building. He kind of regained consciousness after a few minutes but was really woozy and sick. I made him lay down on the floor and I kept his hand above heart level by taping it to the leg of the table with duct tape. I called his roommate and I called 9-1-1. I located the missing chunk of finger (YUCK) and put it on the table. Everyone was amused by the duct tape. Afterwards, I went home and got drunk because I couldn't get the severed finger out of my mind.

I ran into the freshman a few days later and asked how he was doing (they were able to reattach the finger). He had absolutely no idea who I was! He didn't remember a thing. One minute he was cutting up mat frames, the next he was in the ambulance.

posted by Elly Vortex at 4:37 PM on September 25, 2012 [14 favorites]


drpynchon has it. The medical term "shock" is different from the general, usually temporary, inability to think or function that most lay people mean when they use the term.
posted by megatherium at 4:38 PM on September 25, 2012 [2 favorites]


In fact I have to stop reading this. Not well.
posted by Namlit at 4:39 PM on September 25, 2012 [7 favorites]


I broke my arm (not badly) playing basketball many years ago. I tried to keep playing for a few minutes, then spent another 10 minutes gathering my stuff and getting ready to go home. I didn't end up going into shock until about 20 minutes after the trauma, but at that point I could barely stand up and was muttering gibberish according to my friends. I think human trauma response varies wildly.
posted by no regrets, coyote at 4:39 PM on September 25, 2012


It's not just physical, it's psychological. He lost a kid in a car accident, his wife left him, he had another kid get kidnapped, and he is under suspicion for it, and he is being taunted and tortured by the man that is holding his son hostage. He has been in a car accident and literally called through broken glass. In terms of the story, he is basically a broken, hopeless man at the point that this happened to him
posted by empath at 4:40 PM on September 25, 2012


Is this question maybe helpful, maybe?
posted by vivid postcard at 4:45 PM on September 25, 2012


FFS, at this point you owe it to us to identify the game
posted by phearlez at 4:54 PM on September 25, 2012 [5 favorites]


drpynchon is totally right here but he may have been a bit technical with his response. Let me see if I can put it in plainer terms.

In medicine, shock is typically used when you are in a physiologic state where your blood pressure is running low due to something else very seriously wrong with you, like a bloodstream infection or a massive heart attack, or severe blood loss. From your description, this video game character has no reason to be in that kind of shock - the closest would be shock due to blood loss and you mentioned that the blood loss was minimal.

When lay people refer to 'shock', it seems to me sometimes they mean that someone is psychologically incapable of handling themselves well due to some kind of mental/physical trauma they've just gone through. Based on what empath says about the game, perhaps that's what they're trying to convey.

I should add that when people faint at the sight of blood, that is not shock, that is something called a vasovagal reaction or vasovagal syncope, and it can happen with anything from a small cut to the sight of a needle without any blood at all, depending on how strong a certain person's vasovagal reaction is (some people are prone to these, I don't consider myself squeamish at all but I got lightheaded the first time I was in the operating room for an open abdominal surgery).
posted by treehorn+bunny at 5:04 PM on September 25, 2012 [1 favorite]


I think there's a big difference between losing part of a digit unexpectedly in an accident and being directed by someone you are terrified of to cold-bloodedly cut off your own digit.
posted by SweetTeaAndABiscuit at 5:13 PM on September 25, 2012 [1 favorite]


You're not going to go into volume shock due to loss of blood from having your pinky amputated, but you might go into neurogenic shock.

Sometimes when people are suddenly put in a very stressful situation (such as when they have just sustained a serious injury) the nervous system will go into a state of parasympathetic arousal which will cause a severe drop in heart rate coupled with systemic vasodilation (the heart slows down and the blood vessels relax). This causes the blood pressure to drop dramatically and suddenly, leading to inadequate perfusion of tissues.

If you've ever cut yourself and felt queasy and weak in the knees when you saw the blood, or fainted when someone pranked you by sneaking up behind you and suddenly shouting, that is the effect I am describing here. The queasiness, weakness, and/or fainting happen because your stomach, legs, and/or brain are not getting enough oxygen. It's the same effect as you get when you lose a lot of blood, though fortunately it's usually only a passing effect and people usually recover quickly. (There are other ways to cause neurogenic shock that are not so easily recoverable, such as brain trauma, but I don't think they apply in this case.)

(Oddly, it's just as common for people to have a sympathetic response rather than parasympathetic, which is where your body suddenly dumps a lot of adrenaline and your heart rate and blood pressure go *up*, your pain is dampened, and your senses are heightened. This sympathetic response is basically the opposite of the parasympathetic one and is the classic "fight or flight" response. It's always seemed a lot more useful than the parasympathetic response to me and I do not know why some people experience one effect and some people the other.)
posted by Scientist at 5:21 PM on September 25, 2012 [2 favorites]


My grandmother (then aged about 75) chopped about half her pinky finger off in the lawnmower; all she did was go inside and phone for a cab to take her to the hospital (not an ambulance, not MY grandmother!)..... while waiting for the cab to arrive, she spent the time yelling at Grandpop: "see what happened! It WOULDN'T have happened if you'd just cut the grass when I told you to! Are you listening to me?!?"

Shock? No, no shock..... just Grandmom, being her usual charming loveable self.
posted by easily confused at 5:33 PM on September 25, 2012 [2 favorites]


SPOILER

It's Heavy Rain for the PS3 and you should play it if you can.

END SPOILER
posted by Rock Steady at 5:35 PM on September 25, 2012 [1 favorite]


Commonly, shock is used to describe and acute stress reaction, of which there are two types. One type gets you all charged up and ready to go (momma lifting a car off her baby, the olympian who ran his leg of the relay race on a broken bone, etc) and the other sort does the opposite, like fainting at the sight of blood. This could, I suppose manifest as what you describe.

He wouldn't go into medical shock (in the case of an open wound it would be volume shock due to blood loss) and that usually only happens with torso wounds or wounds above the knee or elbow. So not a pinky. Volume shock does involve altered mental status, however, so that could make it difficult to run away, because you'd be on the verge of losing consciousness.
posted by Grandysaur at 6:22 PM on September 25, 2012


I cut the fleshy tip off of a finger, which was hanging on by a tiny piece of skin. I'd been exposed to worse trauma and it didn't phase me too much. But when I went to wash the wound, the cold water hit it and I had to find a horizontal surface immediately. I guess I was out for about half an hour, then got up and washed it with warmer water.
posted by StickyCarpet at 6:27 PM on September 25, 2012


would it be reasonable to expect him to walk more than ten feet in ten seconds or be able to stand up by himself?

I've had the distinct displeasure of amputating a finger on each hand in separate incidents. I also tore my big toe almost completely off 3 years ago. (All were reattached with reasonable degrees of success, btw although one is now just "decorative" and has no feeling or function. In one of the incidents, I also removed the fleshy tips from 3 of the other fingers.

I'm an EMT and although I wasn't at the time of my first digit removal, I was able to recognize this was a very survivable event. Bled far more than I'd ever have expected though. I was an experienced pro (and seasoned EMT) by the time of my last incident so aside from some serious profanity and the embarrassment of having my ambulance crew have to come to my home and carry me out to the rig, it was no big deal. Of course, the pain from that event has been on-going and as I type this my entire leg is throbbing from having walked on that mangled foot all day today.
posted by blaneyphoto at 6:44 PM on September 25, 2012


Also, this one time my ambulance unit responded to a warehouse where a guy had stuck his hand in a chopping machine (intentionally for some reason) and the machine lopped off all his fingers and shot them all over the warehouse. He was fine, but asking his co-workers to go search for his fingers was pretty interesting...
posted by blaneyphoto at 6:47 PM on September 25, 2012 [1 favorite]


The question asks for medical opinions and though IANAMD, I have been the subject of medical opinion on this topic. When I was a teenager I split open the tip of my finger while (improperly) operating a lawn mower. I was functional afterwards, but when my parents called our family doctor, he told them I should lie down in case I passed out due to shock. This was 10-15 minutes after it occurred. So I think there is probably a range of reactions and different people do respond differently.
posted by notme at 7:01 PM on September 25, 2012 [1 favorite]


Um, i have no real or helpful input, but this is like the most shiver-inducing thread ever; jesus christ why do you people keep sticking your fingers in things!! [faints]
posted by alleycat01 at 7:01 PM on September 25, 2012 [7 favorites]


Sorry Scientist, what you're describing is a vasovagal reaction, not neurogenic shock.

Neurogenic shock results from a spinal cord injury, not a pinky finger injury.
posted by treehorn+bunny at 7:31 PM on September 25, 2012 [1 favorite]


Ha! I was just about to come in here all "vasovagal syncope!" Some of us have extra-ticklish vagus nerves (warning: not the proper medical term!) and keel over from relatively minor pain or blood loss, but yeah, that's not "going into shock."
posted by nebulawindphone at 7:40 PM on September 25, 2012


Yup, depends on how big a wuss you are whether you pass out or not. I've had two friends lose fingers in ropes--one when a horse pulled back, the other when her husband was cutting down a tree. One passed out, the other didn't. Knowing them, you would be able to predict who handled it and who made a major fuss (after being revived.)

Interesting reactions from posters. Some of ya'll are just, "Hey, lost a digit, whatevers." Others can't hardly bear to read about it.
posted by BlueHorse at 7:43 PM on September 25, 2012


Years ago I was cutting some onions in the middle of the night. The knife slipped and cut into the top of the middle finger, just at the edge of the nail. It was a really small cut, less than 3/4 of an inch across and not deep at all. I rinsed with tap water to get rid of the blood, put a band-aid on my finger, staggered into the living room and collapsed. When I regained consciousness I felt the arm of my ex-girlfriend around me and I whispered her name. Then after a minute or so I realized it was my own arm. It took another twenty minutes or so to make tea. The sugar helped.
posted by deo rei at 7:55 PM on September 25, 2012 [2 favorites]


Deo rei just reminded of an incident that happened when I was pregnant. It was Christmas Day and we were opening packages and for some reason my husband handed me his pocket knife to cut the ribbon. It slipped and sliced into the top of the side of my finger and came out the other side, all just under the skin on top of the bone. I think I just wrapped it with a paper towel and kept Christmasing. I do have an interesting scar on my finger now, matching little slit-marks on each side of my finger.
posted by SweetTeaAndABiscuit at 8:23 PM on September 25, 2012


My father has injured himself a fair number of times - having worked in a machine shop for about 40 years, woodworking, and doing a lot of repairs around the house. Although he's never lost a digit, he did slice his pinky in half lengthwise, and now has two separate pinky nails and an immobile joint. I don't recall him passing out as part of the story, but will have to ask him again because of this thread.

A few years ago he was laying new linoleum in the kitchen and had cut himself, so my step-mom gave him a bandaid. Later, she was in the basement doing laundry when he lopped off part of his thumb cutting a tile. He walked into the basement, clutching his hand in bloody dish towel and announced, "A bandaid isn't going to do it this time." My step-mom made him wait while she changed clothes and they went to the hospital. No fainting.

The one time I was present for a major injury of his, I recall lots of blood on the garage floor and him asking me to get my mother, but no fainting or stumbling then either.

I could totally see other stressors factoring in to how one's brain deals with traumatic injury, so that could be part of the character's reaction. I think personality matters too. My father is generally even-keeled, so I suspect that could go a long way into how he reacted. And I think his ability to remain humorous while bleeding is generally awesome.
posted by youngergirl44 at 9:45 PM on September 25, 2012


Totally about vasovagal syncope. As Scientist explains, stress can drive the blood right out of your brain, leading to wooziness, nausea, fainting. Some people stay woozy for as long as a couple of hours after the original trigger. Different people have different stressors - I've seen a tough-as-nails rugby player who was absolutely immune to gore come very close to fainting before an important school exam, and all nurses have at least one story about someone with high pain tolerance and a general air of fearlessness who went green at the mere thought of a needle.
The closest I ever came to fainting - other than once when I skipped lunch after blood donation - was watching a minor operation on a baby in nursing school. It still makes me a little ill to think about it. The baby wasn't fussed at all.

The videogame character would probably have benefited from a short lie-down followed by a light snack and long drink of water before he fled the authorities.
posted by gingerest at 10:28 PM on September 25, 2012


My mom cut off the tip of one of her fingers and while it was painful as hell, from what I gather, I think she was pretty lucid the whole time.
posted by town of cats at 11:23 PM on September 25, 2012


Even one's own reactions can differ between incidents. I have a cat who is generally very sweet, but goes insane with fear upon occasion, especially when it's time to put him in a carrier. When I got the big ol' scar on my leg from him, I just laughed and carried on doing what I was doing. On the other hand, the time he got me in the arm during our second-to-last move, I suddenly got really sick and dizzy and had to sit down. Not even the full version of what laymen mean by "shock", but a totally different reaction to what was actually less damage. I have no idea why my body did that that time, and no other time I can recall.
posted by Because at 3:59 AM on September 26, 2012


I used to work in a tattooist/piercing shop.

Great job.

After the customer had been pierced, I'd give them after care instructions, taking time to talk them through it. And watching carefully. Most of the time people were attentive, sometimes busy and not wanting to be held up but sometimes...

Sometimes they'd gradually get paler, go a sort of fine greenish shade. By which time I was round the other side of the desk, catching them as they fainted. Standard procedure was to make sure they were OK, lie them on their back and lift their legs up until they came round.

It was invariably the biggest, butchest blokes who would faint like this. It's cruel but watching them come round and realise they'd fainted in the middle of the shop was hilarious.

I guess this was vasovagal syncope which, in these cases, was quite disproportionate to the wound!
posted by BadMiker at 4:20 AM on September 26, 2012 [2 favorites]


If I have any blood loss at all I pass out. Even a minor cut will do it. Both of my daughters are the same way. Everyone has a different tolerance in which their body can stress or loss of blood.
posted by sybarite09 at 6:16 AM on September 26, 2012


My grandfather was driving in a very rural area in a blizzard and came to a tree that had fallen, blocking the road. He had an axe in the trunk and started to clear a path. Of course, since I'm telling this story in this thread, you know what happened. He accidentally chopped off his thumb, but finished the chopping and clearing before driving himself to the hospital.
posted by valeries at 7:53 AM on September 26, 2012


To flesh out more actual responses, my friend, an ER doctor, had a patient who cut off his finger at a construction site. He stapled it back on with a staple gun before going to the hospital.
posted by StickyCarpet at 8:04 AM on September 26, 2012


I could totally see other stressors factoring in to how one's brain deals with traumatic injury, so that could be part of the character's reaction.

As bratty teens we were in an attic room, teasing this guy with a large charged capacitor. He fell backwards into a TV on a stand in such a way that he thought he had fallen through the window. He went into some kind of "shock," turned white and cold and sweaty. We covered him with a blanket elevated his feet and all that and he recovered in a short while.
posted by StickyCarpet at 8:17 AM on September 26, 2012


A professor I TA'ed for one semester managed to sever the first knuckle of a finger in his car door on the way to campus one morning; he bandaged it up and taught his morning class before getting medical attention. I was sitting in on that class and he seemed fine (though apparently they weren't able to reattach the finger tip), but there were a few students who told me afterward that they genuinely thought THEY were going to pass out at the thought of the whole thing. So yeah, another anecdote in support of the fact that mindset plays a factor ...
posted by DingoMutt at 9:40 AM on September 26, 2012


General answer first, spoiler answer second (I've played through the whole game three times).

Yes, it's totally possible to be freaked out, woozy, etc after half an hour. It depends on the person, their stress levels, how they respond to stress, blood pressure, etc. I once ripped part of a fingernail off while messing around on a playground (as an adult, mind you; it was late at night and I was bored and felt like wandering around) and had to go sit down for a solid 40 minutes or so before I felt able to get up and walk back home, and I had to stop a couple times at the beginning of the walk back. Cutting your own finger off? Yeah, I would say that feeling weak afterward would be fairly realistic.

Short answer without revealing spoilers: That guy also went through a lot before cutting off his finger; enough that he already was not doing very well to begin with and really should have been at a hospital.

SPOILER ANSWER BELOW

In the game, before he cuts off the piece of his finger, that character is made to crawl through several hundred feet of broken glass in a claustrophobic space, work his way through a field of high-voltage electrical wires, and drive a mile the wrong way on a highway at top speed, at the end of which he flips over and barely manages to break out of the car before it explodes. That's all in the same day. By the time he cuts his finger off, he's got a broken or cracked rib, cut-up arms and legs, has been zapped by about 10,000 volts a few times (unless you manage to get through the whole field without making a mistake), he's stressed, feverish, and sleep-deprived. So yeah. It makes total sense that after all that he's limping along.
posted by Urban Winter at 11:42 AM on September 26, 2012 [1 favorite]


Addendum to my "experience" example above, and apologies for the double post: I also had not eaten for nearly 36 hours before that happened, so I'm sure that factored into it. I was pretty annoyed at myself for feeling so weak after such a minor incident, but I later realized exactly why.
posted by Urban Winter at 11:45 AM on September 26, 2012


"Given that he had not lost a significant amount of blood, was not injured anywhere other than his pinky, and that people routinely amputate parts of their body either for fun or survival and then go through great physical duress, the depiction of him being that weak seemed a bit implausible to me. "

In my life I have three times required stitches to hold together cuts to my hands; drove a brad nail into a finger (right through the bone) till it poked out the other side and have numerous other cuts and contusions that have bled a fair bit including a tumble off a horse that scraped up about 12" inches of skin on elbows and knees. I've given blood. I've had wisdom teeth out including one that was horizontally impacted. None of these things have particularly affected me. For example I drove myself across town to the hospital with the brad still in my finger.

However the time I hit my thumb with a hammer (and eventually temporarily lost the nail) I was able to walk myself over to first aid but then I apparently passed out for about 10 minutes. Passing out was proceeded by a sort of snowing of my vision like on old TVs except only the white bits overlaying the screen without any black. I've had that sensation before on a half a dozen occasions but never fainted before though I've felt woozy. But the bizarre thing, and the one that goes to your question, I once got that sensation from a paper cut. Brad through the finger: no problem. Paper cut: watch out floor. So it really varies even in a single person.
posted by Mitheral at 6:31 PM on September 27, 2012


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