Medical Assistant Exam: Clinical Procedures - Emergencies and First Aid

Emergencies
Most emergencies in the medical office are minor and include such events as a patient arriving unexpectedly with a nosebleed or fractured arm. However, emergencies of all types can and do occur in the medical office. Therefore, the professional medical office team must always be ready for any emergency, small or large.

Policies and Procedures
Medical offices establish protocols that outline instructions on how to proceed in case of medical emergencies.

Such a protocol might include supplies and equipment needed, the roles for each staff member, and the step-by-step procedure for responding to that particular emergency.
All members of the healthcare team should know where the emergency equipment is located and obtain proper training in its use. In some cases, a team captain is designated to guide members of the team throughout the emergency.
An important, but sometimes overlooked, part of emergency preparedness is the designation of a team member to document the emergency. This person should assume his or her role from the beginning of the emergency so he or she can accurately record the events in a chronological fashion. Otherwise, reconstructing events after the fact will be difficult, especially in a complex medical emergency.
During a medical emergency, the medical assistant is responsible for identifying the presence of serious conditions that threaten the patient’s life. The medical assistant should take the appropriate actions that are within a medical assistant’s scope of practice. The emergency must be documented in the patient’s chart along with the patient’s assessment.

Controlled Substance Schedule
Schedule - Description - Examples

I
- no currently accepted medical use in the U.S.
- high potential for abuse

heroin
lysergic acid diethylamide (LSD)
MDMA (ecstasy)
marijuana
mescaline
peyote

II
- currently accepted medical use in the U.S. with severe restrictions
- high potential for abuse
- written prescription must be provided to pharmacist within seven days
- no refills allowed for prescription

cocaine
hydromorphone (Dialaudid)
meperidine (Demerol)
methylphenidate (Ritalin)
morphine (MS Contin)
oxycodone (OxyContin)

III
- currently accepted medical use in the U.S.
- potential for abuse is less than for schedules I and II
- telephone orders allowed
- can be refilled five times within six months of prescription date

acetaminophen (Tylenol and codeine)
acetaminophen and hydrocodone (Vicodin)
anabolic steroids, such as oxandrolone (Oxandrin)

IV
- potential for abuse is less than for schedule III
- telephone orders allowed
- can be refilled five times within six months of prescription date

diazepam (Valium)
alprazolam (Xanax)
zolpidem (Ambien)
phentermine (Fastin)

V
- potential for abuse is less than schedule IV
- telephone orders allowed
- number of refills determined by physician

cough suppressants with restricted amounts of codeine
diphenoxylate and atropine (Lomotil)

The full schedule of controlled substances in the Controlled Substances Act of 1990 describes the medical uses, potential abuse level, prescription requirements, and safety of each group of drugs. The table shown here lists each schedule number along with a description of the drugs’ uses and potential for abuse, and examples of the drugs included in that schedule.
 

Good Samaritan Principle and Laws
The Good Samaritan principle prevents a rescuer who has voluntarily helped a stranger in need of medical assistance from being sued for wrongdoing. In most of North America, one has no legal obligation to help a person in need. However, since governments want to encourage people to help others, they often pass Good Samaritan laws (or apply the principle to common laws). The person who offers medical assistance to a stranger in need is generally protected from liability as long as:
- he or she is reasonably careful
- he or she acts in 'good faith' (not for a reward)
- he or she does not provide care beyond his or her skill level
If a medical assistant decides to help in an emergency, the medical assistant must not leave the injured person until someone who has the same or more skill and training in medical emergencies can take over.

Consent
A patient requiring first aid must give his or her consent, or permission, to receive treatment. This can come in two forms:
- Expressed consent: With patients who are responsive adults, caregivers should identify themselves, explain their level of training, and ask the patient for his or her permission to help.
- Implied consent: With unresponsive or unconscious patients, the permission to provide first aid treatment is implied, or assumed, since a reasonable person would be willing to be treated in emergency situations.

Common Emergency and First-Aid Supplies and Equipment
Not all medical offices keep emergency equipment on hand; however, many do. If an office does stock emergency equipment and medication, the medical assistant and other staff members must be familiar with its use.

Crash Cart
Many supplies are stored in a portable, wheeled supply cabinet, called a crash cart or code cart, which is specifically used for emergencies. The crash cart (or sometimes just a tray) contains basic drugs, supplies, and equipment for medical emergencies. Most crash carts also contain a first-aid kit with supplies for managing minor injuries and ailments. Specific equipment stored on the cart varies, depending on the type of patients seen by the doctor. The most common drugs included in a crash cart are as follows.
- Epinephrine has multiple uses in emergency situations. As a vasoconstrictor, it controls hemorrhage, relaxes the bronchioles to relieve acute asthma attacks, and is an emergency heart stimulant used to treat shock. Epinephrine should be in ready-to-use cartridge syringe and needle units. These are supplied in 1 mL cartridges.
- Atropine decreases secretions, increases respiration and heart rate, and is a smooth-muscle relaxant. It is administered in a cardiac emergency for asystole or can be used to treat bradycardia.
- Digoxin is a cardiac drug that treats arrhythmias and congestive heart failure (CHF) and is good for emergency use because it has a relatively rapid action.
- Nitroglycerin is a vasodilator that is given to relieve angina. It acts by dilating the coronary arteries so an increased volume of oxygenated blood can reach the myocardium.
- Lidocaine is used intravenously to treat a cardiac arrhythmia and is used locally as an anesthetic.
- Sodium bicarbonate corrects metabolic acidosis that typically occurs after a cardiac arrest.
- An emetic causes vomiting soon after swallowing.
- Activated charcoal is an antidote that is swallowed to absorb ingested poisons.
- Naloxone (Narcan) is a narcotic antidote that is administered intravenously for drug overdoses and acts to raise blood pressure and increase respiratory rate.
- Antihistamines for the treatment of allergic reactions and anaphylaxis should be available to treat potential allergic responses to medication administered in the facility. These can include diphenhydramine (Benadryl) for minor reactions and a corticosteroid (e.g., Solumedrol), for severe anaphylactic responses.

Other medications that may be found on a crash cart are:
- isoproterenol (for example, Isuprel, Medihaler-Iso, or Norisodrine), an antispasmodic that is used to treat bronchospasms (such as those experienced during an asthma attack) and is also effective as a cardiac stimulant
- metaraminol (Aramine) (50%, in a prefilled syringe) for severe shock
- phenobarbital, amobarbital sodium (Amytal), and diazepam (Valium) for convulsions and/or sedative effects
- furosemide (Lasix) for CHF
- glucagons, primarily used to counteract severe hypoglycemic reactions in diabetic patients taking insulin

Defibrillator
One item almost always present on a crash cart is defibrillator. This specialized device is used to deliver an electrical shock to a patient suffering from a life-threatening cardiac arrhythmia, such as ventricular fibrillation or ventricular tachycardia. During such arrhythmias, some or all heart muscle fibers contract in a disorganized fashion. Delivery of an electrical shock causes all cardiac muscle fibers to contract in unison, which sometimes stimulates the heart to convert back to normal sinus rhythm. Because some risk is associated with operating this device, all staff members who use it must be properly trained.

MOCK EMERGENCY DRILLS
Many facilities routinely run mock drills, which allow all members of the healthcare team to practice and develop their skills in responding to medical emergencies. Such drills rehearse the staff’s response to bomb scares, fires, infant or child abduction, a threat of violence and, most commonly, a patient experiencing cardiac or respiratory failure.
After each mock drill, members of the team should debrief. This includes a discussion of the event among all team members to determine what worked during the event and what did not, so that appropriate changes can be made in the response plan.

Automated external defibrillators: Automated external defibrillators (AEDs) make operation of this type of emergency equipment relatively easy. The AED’s manufacturers have programmed the devices to give automatic, step-by-step instructions—through both voice and visual prompts—for their use. They are smaller and more portable than older defibrillators.
Healthcare providers, first responders, and other professional rescuers should practice cardiopulmonary resuscitation (CPR) and AED. 

There are many different brands of AEDs, but the same basic steps apply to all of them:
- Turn on the AED, and the voice prompts will be activated.
- Bare the patient’s chest.
- Follow the voice and visual prompts.
- Remove the disposable electrode pads from the package. Look at the graphic images on each electrode as a guide for proper pad placement.
- Attach the electrodes to the patient’s chest, after removing the adhesive backing.
- Most AEDs will automatically begin to analyze a patient’s heart rhythm when the electrodes are fully attached. Some will prompt you to push a button to start the analysis; no one should be touching the patient while the AED is conducting its analysis of the heart rhythm.
- Once everyone is clear of the patient, the shock button can be pushed; and chest compressions can be resumed; see the section on Cardiac and Respiratory Arrest/CPR for guidance on chest compressions.
- Perform five cycles of 30 compressions and two breaths and then very briefly reassess the rhythm. Continue as directed by the AED.
A ventricular fibrillation victim who gets his or her heart pattern restored immediately following a sudden cardiac arrest has about a two-thirds chance of recovery. Every minute that revival is delayed, the chances drop until there is little hope after ten minutes.

Triage
In the medical setting, triage involves making a quick determination about the nature of the patient’s emergency, the type of immediate care needed, and the most appropriate response. If more than one patient is involved, triage involves determining which patient should be treated first. In many settings, a registered nurse performs triage; however, other staff members may perform this task, depending on their qualifications.
In some cases, medical assistants must perform triage. Most offices have written guidelines in place that guide the process. Even so, no guidelines are as valuable as experience and practice. Therefore, the person assigned triage duties should be an experienced healthcare provider.

Emergency Preparedness
All healthcare facilities must make an effort to create an environment that is safe for patients and staff alike. Workplace safety programs provide instruction in CPR, standard precautions, proper body mechanics, and other safety issues. New employees undergo safety training upon hire and are required to update their knowledge and regularly demonstrate competence (usually annually) on specific skills, such as CPR.
The appropriate response to an emergency depends on the nature of the emergency, the patient population being served, and the proximity of other medical facilities. Steps and principles to follow include:
- The physician or most highly trained clinician in the office should be summoned for immediate help.
- If the office has staff trained in advanced cardiac life support (ACLS) and the needed equipment is on hand, the staff can provide ACLS measures at the office.
- In the case of life-threatening emergencies, the staff should institute basic cardiac life support (BCLS) measures while summoning emergency medical service (EMS) personnel.
- EMS staff include experts experienced in evaluation, treatment, and transport of persons experiencing a medical emergency.

First Aid
First aid is treatment of individuals in emergency situations before professional medical care can be, or is, administered. In the medical office, the staff must be understand and be prepared to apply first-aid techniques for a range of conditions.
In all cases, the medical assistant should remember to identify him or herself as a medical assistant.
The first step in applying first aid is assessing the patient. The most basic assessment tool is the ABCs.
A—airway: Check for an open airway using the head-tilt/chin-lift method or the jaw thrust method (for suspected neck injuries).
B—breathing: Make sure the patient is breathing by looking for chest movement.
C—circulation: Check the patient’s pulse.

In many emergency cases, the medical assistant, after assessing the patient, should follow the emergency preparedness guidelines discussed earlier in this section, including the activation of the office’s emergency medical system.
Identification and the ABCs, along with activating the EMS when necessary, should be part of the medical assistant’s response to all emergencies. The following sections describe the specific first-aid techniques for specific conditions.
In treating many of these conditions, the use of personal protective equipment is necessary. See the first section of this chapter, under Infection Control, for information on PPE and other precautions medical staff should take when in danger of exposure to potentially biohazardous material.

Severe Bleeding
Severe or excessive bleeding (hemorrhage) can result from a range of injuries and conditions. In all cases, it is important to locate the source of the bleeding.
- Clear away clothing from the area of the wound.
- Place an absorbent pad directly over the wound.
- Apply firm pressure on the wound, using a sterile gauze pad to absorb the blood.
- Wrap an elastic bandage over the gauze pad to keep it in place.
- If possible, position the part of the body containing the wound above the level of the heart.
- If needed—if blood soaks through the gauze pad—more should be applied.
- Pressure should be kept on the wound.

Applying pressure to pressure points, specific points on the body at which blood vessels are located close to the surface, can be helpful in reducing blood flow to a wound. Common pressure points are:
- brachial artery: located on the arm between shoulder and elbow
- femoral artery: located in the upper thigh, at the intersection with the groin area
- popliteal artery: located in the crease behind the knee
When using pressure points, the medical assistant should make sure he or she is pressing on a point closer to the heart than the wound. Pressing on a blood vessel further from the heart than the wound is will have no effect on the bleeding.

Shock
Shock can result from a range of conditions, such as severe bleeding, a severe allergic reaction (anaphylactic shock), hypoglycemia in diabetics (insulin shock), or massive internal infection (septic shock). Signs of shock include:
- skin that is cold and clammy to the touch
- drop in blood pressure
- weakened pulse, but elevated pulse rate
- elevated respiration rate
- sometimes behavioral changes, such as heightened anxiety or confusion
Guidelines to help manage shock include:
- Make sure an open airway exists for an adequate air supply.
- Keep the patient from becoming chilled or overheated.
- Administer oxygen, if you have the appropriate training.
In addition, the medical assistant staff should attempt to address the underlying cause of the shock. For instance, in the case of insulin shock, sugar should be administered, and in the case of anaphylactic shock, the allergen should be removed from touching, or any other interaction with, the patient.

Burns
Burns involve injury to the tissue caused not just by heat, but by chemicals, electricity, or radiation. Burns can cause massive injury to the body, and must be carefully handled.
The extent of a person’s burns is estimated and reported by with the rule of nines: Each body part is considered 9% of the entire body, and individual percentages are added to arrive at a total percentage. For instance, in an adult, one arm is considered 9%, the chest is considered 9%, the abdomen is considered 9%, and so forth; if these parts were all burned, the total would be 27%.

Third-Degree Burn
The most severe burn, a third-degree burn, involves the layers of the skin—including the epidermis and dermis—and often underlying tissues. Signs include white, leathery, or blackened, charred skin.
Guidelines to handle third-degree burns:
- Clear away clothing covering the burned area; do not remove clothing that is stuck to the burned area.
- If clothing is stuck to the burn, do not remove it.
- Cover the burn area with clean moist sterile bandage, cloth, or towel.
- If possible, elevate the burned area above heart level.

Second-Degree Burn
A second-degree burn involves the epidermis and part of the dermis. Signs include pain, redness, blisters, and/or swelling.
Guidelines to handle second-degree burns include:
- Cool the burn with cool, running water or cold compresses.
- After cooling, use a sterile bandage or a clean dressing to cover the burned area and protect it.
- Wrap the bandage or dressing loosely but avoid putting pressure on the burned area.

First-Degree Burn
A first-degree burn involves the epidermis. Signs include redness, swelling, pain, and peeling of skin. First-degree burns should be treated by immersion in cool water or covering with cold compresses.

Cardiac and Respiratory Arrest/CPR
Cardiopulmonary resuscitation is an emergency treatment applied to individuals who are in cardiac arrest. It combines breathing into the victim’s lungs and compressing the victim’s chest. Its object is to 'buy some time,' by getting some blood flowing to the heart and brain, after which restoration of full heart function can be achieved.

Steps for performing CPR on an adult are:

1. Try to rouse the victim.

2. Check for breathing: Open the victim’s air passage by tilting the head back and lifting the chin; with your ear to the patient’s mouth, listen for breathing, and with your cheek to the patient’s mouth, feel for his or her breath.

3. Perform rescue breathing, if the victim is not breathing: Pinch the person’s nose shut and cover his or her mouth completely with yours; breath fully into the mouth, watching for the chest to rise. Perform this rescue breathing twice.

4. Start chest compressions: Place the heel of your hand at the center of the patient’s chest, with the other hand covering it; press down deeply—about two inches—and release, letting the chest fully relax before repeating the compression; the compressions should be done firmly and quickly, at a rate of about 100 times per minute, for a total of 30 compressions.

5. Perform rescue breathing again, followed by 30 chest compressions.

6. Continue this pattern until patient begins to breathe on his or her own, or until EMS providers arrive.

Choking
Choking—the blocking of the primary air passage from the mouth—happens in variety of situations. Small children often put small objects such as coins, toys, and candy in their mouth and then aspirate them. Adults sometimes aspirate food they are eating. In some cases, the obstruction of air flow is just partial, but in other cases, the blockage is complete, cutting off the supply of oxygen to the blood vessels, and therefore is life threatening.
Signs for choking include the inability to talk and labored, noisy, wheezing breathing. In severe cases, when oxygen supply is drastically reduced or cut off, the patient’s lips and skin, including the skin under the nails, may take on a bluish cast.
Guidelines for handling choking in an adult include:
- First, encourage the patient to cough, since this may clear out the air passage.
- Perform back blows: Forcefully hit the patient’s back with the heel of your hand, between the shoulder blades; this should be done five times.
- Perform abdominal thrusts, sometimes called the Heimlich maneuver, if choking has not cleared: Standing behind the patient with arms wrapped around him or her and hands clasped together in a fist, push in and up forcefully at the base of the diaphragm, just above the navel; perform five thrusts.
- Perform the five back blows and five abdominal thrusts continuously until the blockage clears or until EMS help arrives.
- With pregnant or obese patients, the Heimlich maneuver should be performed in the same way, except that the placement of the clenched fists is higher, just below the sternum, the point at which the lower ribs join.

Guidelines for handling choking in an infant include:
- Perform modified back blows: In a seated position, place the infant facedown on your forearm; push or thump the middle of the infant’s back with the heel of your hand; perform five times.
- Perform chest compressions: Turn the infant over, so that he or she is facing up; position the infant with the head lower than the rest of the body; with two fingers at the infant’s breastbone, push in quickly, delivering five chest compressions.
- Perform the five back blows and the five chest compressions continuously until the blockage clears or until EMS help arrives.

Emergencies for Diabetic Patients
Diabetes is a chronic disease characterized by the inability of the body to regulate the level of glucose in the blood. Two emergency situations can arise in patients with diabetes:
Insulin shock: Insulin shock is very severe hypoglycemia, in which a patient has too little glucose in the blood. Insulin shock occurs when insulin levels are so high that too much glucose is transported from the blood into the body’s cells.

Symptoms include:
- rapid pulse
- shallow respiration
- hunger
- profuse sweating
- pale, cool, clammy skin
- double vision
- tremors
- restlessness
- confusion
- possible fainting
Insulin shock can usually be corrected with administration of some form of sugar (candy, juice, or regular soda for a conscious patient or a sprinkle of table sugar on the tongue for an unconscious patient).
Diabetic coma: Diabetic coma is the final stage of severe hyperglycemia, in which a patient has too much glucose in the blood. It occurs when insulin levels are insufficient to transport blood glucose into the cells of the body.

Symptoms include:
- rapid, deep gulping breaths
- flushed, warm, dry skin
- extreme thirst
- sweet or fruity-smelling breath
- disorientation or confusion
The medical assistant should notify the doctor at once and expect to arrange transport to the hospital if a diabetic coma is suspected.
If the cause of a diabetic emergency is not known, sugar in any form possible should be given to the patient. Once sugar is given, the patient will improve shortly if the cause is insulin shock. No harm will be done by the intake of sugar if the cause of the emergency is diabetic coma.

Fractures
A fracture is a break in a bone. Treatment of fractures depends on the nature of the injury and the patient’s age and physical condition.
Types of fractures include:
- simple (closed) fracture: a fracture with no external wound caused by the bone
- compound (open) fracture: a fracture where the bone protrudes from the skin
- greenstick fracture: an incomplete break as when a fresh twig is bent; typical in children, whose bones are still relatively
- transverse fracture: a straight break straight across the bone
- spiral fracture: a break caused by a twisting force creating an 's' shaped fracture

Signs of fractures include tenderness, pain, swelling, and bruising. If the fracture is severe, deformity or external bleeding (in the case of a compound fracture) may occur.
The symptoms of other types of injuries to the musculoskeletal system, such as the following, might be confused with those of fractures.
- Dislocation: A bone is separated or displaced from its normal position at a joint.
- Sprain: Stretching or tearing of ligaments within a joint.
- Strain: Stretching or tearing of muscles or tendons.

Guidelines to handle open or closed fractures include:
- Apply ice to the area affected; this will reduce swelling, bleeding, and pain; use a cloth or thin towel between an ice pack and the skin to prevent frostbite.
- Elevate the affected limb, if possible.
- In the case of open, or compound, fracture, apply gentle pressure to control bleeding where the bone is protruding from the skin and use a sterile cloth or dressing to cover open wounds.
- Limit movement of the affected area; keep the patient from putting weight on the affected limb.
If a painful, deformed, or swollen limb is blue or extremely pale, EMS should be activated immediately.

Poisoning
Poisoning is the intake of toxic substances into the body. Poisons can be ingested, absorbed through the skin, or inhaled. Symptoms can be wide-ranging and can mimic many common illnesses.
One of the most important rules in dealing with cases of poisoning is to call the Poison Control Center to obtain instructions from an expert about the specific toxin the patient has encountered. Other guidelines to handle poisoning include:
- Put on PPE as soon as possible to protect from any toxin that is still present, and remove the toxin from the environment.
- Keep the containers holding the toxin with you and bring to the emergency room or give to EMS workers when they arrive; this is for the purpose of helping in the identification of the toxin if unknown.
- Do not administer water, milk, or antidote of any kind unless advised to do so by the poison control expert.
- Do not induce vomiting—with ipecac syrup, activated carbon, or another agent—unless advised to do so by the poison control expert.
- For toxins absorbed through the skin, thoroughly rinse the area of exposure with a large volume of water.

Seizures
A seizure is the sudden and abnormal incidence of involuntary muscle movements, which come in a series of contractions and relaxations. No matter what the underlying cause—which can include such factors as epilepsy, high fever, low sodium in the blood, head injury, and drug or alcohol abuse—the first aid used for individuals suffering from seizures is the same.
Guidelines for handling seizures in an adult include:
- Move objects—such as furniture—that the victim may hit.
- Do not insert anything in the victim’s mouth.
- Do not restrain the victim; allow the seizure to take its course.
- Loosen tight clothing, if possible.
- When the seizure is over, the victim should be placed in, or helped into, the recovery position, which is on his or her side, to ensure an open air passage and prevent aspirating any liquid secreted orally during the seizure.

Stroke
A stroke, also referred to as a cerebrovascular accident (CVA), is a disturbance in, and potential loss of, brain function resulting from a lessening of the blood supply to the brain. A bursting of or blockage in a blood vessel is the usual cause of the reduced blood flow. Symptoms can include:
- weakness, numbness, or paralysis of a specific area, frequently on just one side of the body
- confusion and/or inability to communicate
- sudden and severe headache
- loss of balance and/or coordination
- dizziness

First aid guidelines call for simple supportive care, including keeping the patient calm, until EMS staff arrive. In a medical office, the medical assistant might prepare to administer oxygen upon direction from a physician, if the medical assistant has the appropriate training.

Syncope
Syncope, or fainting, results from a decrease in the blood flow to the brain. A fainting spell is usually brief and may have no medical significance.
When a patient faints and quickly comes to, the patient may become embarrassed by the attention that follows. It is important in these situations that the patient is evaluated by the doctor before he or she is allowed to leave. Fainting should be considered a medical emergency until proven otherwise. When a person feels faint, the medical assistant should help the individual sit or lie down and position his or head between the knees.

When a person faints, first aid guidelines include:
- Check for clear air passages.
- Loosen clothing and belts.
- The patient should be positioned on his or her back, with feet above the level of the head.

Wounds
Simply put, a wound is a break in the skin or other body tissue. The term, however, covers a wide range of conditions—from bruises and abrasions to punctures and complete amputations. In all cases, the basic role of first aid is to stop the bleeding and reduce the chance of infection.

Bruise
A contusion, or bruise, is a wound in which the surface skin has not been broken, but the blood vessels under the skin have been torn, causing a leakage of blood into the surrounding tissue. First aid treatment is to apply ice in order to reduce the swelling of the tissue and bleeding.

Open Wounds
There are several types of open wounds.
- An abrasion is an open wound in which the skin has been scraped open.
- A laceration is a jagged cut into the skin and surrounding tissue.
- An avulsion is a type of open wound characterized by a ripping away of the skin from bone; often a flap of loose skin remains connected to the skin.
- A puncture is an open wound in which an object has pierced the skin.
- An amputation is the complete removal of a body part.

First aid guidelines include:
- cleansing of the wound with soap and water to remove particles or residue
- application of an antiseptic to reduce the threat of infection
- covering the wound in sterile cloth or gauze
- If a laceration is deep, it may need to be closed up with adhesive strips (Steri-Strips) or sutures (by a qualified medical professional).
- The skin flap resulting from an avulsion can be replaced over the wound.
- In a puncture wound, if the object protruding from the skin remains, the object should be left in place.

Amputation
When resulting from trauma—amputation may also be surgically performed in rare cases if medically necessary—the procedure for open wounds should be followed, with one crucial added step. The amputated part should be wrapped in a sterile moistened dressing and brought to the hospital, since the severed part can often be surgically reattached and will successfully reconnect to the rest of the body during the healing process.