Two weeks ago, PBS science correspondent Miles O’Brien was on assignment in Japan and The Philippines when he dropped a heavy case of equipment on his left forearm. He eventually ended up in surgery, where doctors told him they had to decide whether to take his "life or limb."
O’Brien, 59, candidly wrote about the accident that led to the amputation of his arm below the elbow in a blog post “Just a Flesh Wound.”
"A shark attack would be interesting,” he wrote yesterday. “An assassination attempt would be intriguing. Skydiving mishaps always make for good copy. An out-of-control quad copter that turns on its master would be entertaining (and would come complete with a grim, potentially viral, video). ... No, the reason I am now one-handed is a little more prosaic than those scenarios."
The former CNN aviation reporter and third-generation pilot had a banal accident, but one with nearly fatal consequences -- acute compartment syndrome, the result of elevated tissue pressure within a close muscle space that results in cell death.
The syndrome can occur when a weighty object crushes the muscles, causing pressure in the fascia, the "sausage casing" that envelops the muscles and separates them from each other, according to Dr. Alex Jahanhir, an orthopedic trauma surgeon at Vanderbilt Medical Center in Nashville. The leg has four muscle compartments and the arm has multiple ones, he said.
"It can happen in your muscles anywhere in your body -- the arms, legs and frankly, even the buttocks," said Jahangir, who sees about four to five cases a month at Vanderbilt's trauma center.
"We see it whenever you have the fracture of an arm or leg," he said. "We see a lot of people who are alcoholic pass out on an arm or leg for 24 to 48 hours and they get crushed by their own body weight."
The Centers for Disease Control and Prevention reports acute compartment syndrome can result from bomb blasts and explosions.
A blunt trauma, scorpion bites, earthquake accidents can all can cause the muscle to swell within the fascia or compartments. The blood is unable to circulate and feed the muscle with oxygen or transfer the carbon dioxide.
"The nerves and muscles die," said Jahangir. "You can lose muscle and nerves within eight hours."
O’Brien didn’t seek medical attention for a day, according to his blog post. Instead, he described how he was wrapping up a shoot on Feb. 13 when he was stacking the television equipment that crushed his arm.
"Ouch!" he wrote. "It hurt, but I wasn’t all '911' about it. It was painful and swollen but I figured it would be okay without any medical intervention. Maybe a little bit of denial?"
That night the swelling and pain increased, he recalled. By the next day, he asked the hotel clerk for a doctor referral and was quickly admitted to the hospital when they suspected life-threatening acute compartment syndrome.
"Over the next few hours, I endured probably the longest, most painful experience I could ever imagine," O’Brien wrote. "My forearm developed some dusky discoloration, but more alarming was the numbness. I could not feel my forearm!"
In cases like these, doctors recommend an emergency fasciotomy to relieve the pressure, cutting away the fascia and relieving the pressure on the muscle and nerves to "let them breathe," according to Vanderbilt’s Jahanhir, who just this morning successfully operated on a Tennessee logger whose leg had been crushed in an accident.