Archive for the ‘Dr Amy Hughes’ Category

EWM Medical Director Dr Amy Hughes featured in the BMA news

When adventure comes before ambition

28 February 2013

SpR Amy Hughes is happy to forego the chance of becoming a consultant so she can pursue her passion for expedition medicine  expedition medicine course

In many ways, the pictures tell the story. There are snow-capped mountains and lush rainforests, kayaks full of adventurers and smiling groups under makeshift shelters.  And there are images that only a particular type of audience could find enthralling — close-ups of frostbite, tropical skin disease and ghastly intestinal parasites.  All of these and more were exhibited by speakers at a recent London conference on opportunities in expedition medicine.  They illustrate the obvious appeal for doctors of accompanying groups of travellers to remote regions: a chance to visit beautiful places while honing your medical skills and clinical judgement.  Dozens of medics attended the event, organised by the trainees committee of the Royal Society of Medicine, and more watched from Aberdeen via a live link.  There was plenty of advice for all doctors about the possibilities of combining expedition medicine with conventional postgraduate training and NHS commitments.

Stirring words

But there were also stirring words from one young doctor whose passion for expedition medicine and humanitarian work has prompted her to step off the traditional medical career ladder entirely — at least for the time being.  SpR in pre-hospital medicine Amy Hughes graduated from Nottingham University medical school in 2003. At that stage, she had no interest in expedition medicine; in fact, she had barely travelled outside the UK.  But as she progressed through her house officer jobs (now foundation years one and two), she began to wonder what the future held.

‘I was getting itchy feet, thinking: “What do I want to do? I don’t want to stay in hospital training”,’ she says.

All around her, fellow medics were studying hard for exams.

‘I wasn’t the slightest bit interested in doing exams at that time,’ she says.

Dire warnings

So she decided to take a year out. It was not a move that attracted universal support; in fact, she faced dire warnings about how hard it would be for her to re-enter training, given the imminent introduction of ST (specialty training). Undaunted, she began researching opportunities in expedition medicine.  Her first foray was with a social enterprise called Blue Ventures, which leads marine conservation projects in Madagascar and Belize.  It was one of the few outfits willing to take on a doctor with no previous experience of expedition medicine. And it was to prove a valuable — and unforgettable — launch pad.

‘As an expedition medic … you have this incredible link with the community,’ Dr Hughes says. ‘You get to go to places that no tourist will ever go. You work with the locals, you are welcomed into their community and learn the importance of respecting cultures both professionally and personally. You teach public health education and basic health education.’

During her year out, she also gained a diploma in tropical medicine and hygiene from Liverpool University. That stood her in good stead when she applied to return to training at Addenbrooke’s Hospital.  Despite competing against people with more exam qualifications, Dr Hughes was able to convince the selectors that she was the best candidate.

Transferrable skills

She says: ‘I talked about the skills I’d learned from the expedition world, the medical skills I’d improved on, how I’d had to become not just a medic but a multi-tasking individual — involved in logistics, decision making, team management, communication skill development, teaching and training.’  Dr Hughes believes her experience proves criteria have changed for those assessing trainee applicants. ‘They want an interesting, dynamic individual who’s going to be good at the job and work well with their peers,’ she says.   While at Addenbrooke’s, she used her annual leave to join short Across the Divide expeditions to places including Namibia, and took a European masters in disaster medicine.   By the time she was appointed to an ST2 post in the Severn Deanery in August 2007, her career was potentially mapped out: she could have stayed in emergency medicine training all the way to ST6.

But within a couple of years — during which she completed six months in anaesthetics and six months in ICU as well as stints in acute orthopaedics and emergency paediatric medicine — she was dreaming of escape again.   At a conference in Birmingham, she picked up a flyer advertising opportunities with one of Australia’s ‘flying doctor’ services. She negotiated an out-of-programme experience, which enabled the deanery to keep her training number open for a year, and headed off down under.

Make or break

That was in 2009. So far, she has not returned to training. The make-or-break moment came during her stint in Australia, when she successfully applied — via an email and a long-distance telephone interview — for a job with Kent’s HEMS (helicopter emergency medical service).  After a ‘fantastic’ year in that role, she made the momentous decision to resign her run-through training number and follow her interest in humanitarian medicine.  Dr Hughes has since spent seven months working with relief organisation Médecins Sans Frontières in the aftermath of civil strife in Sri Lanka, and now has a post with the London HEMS.

In addition, she is medical director of remote medical training organisation Expedition & Wilderness Medicine. She says there is a huge amount to be learned from expedition medicine, but warns that no one should contemplate it unless they have a certain amount of postgraduate training under their belt.

‘When you’re in a hospital and you’ve got an ICU consultant, a paediatric consultant, an anaesthetist, an emergency doctor and an orthopaedics consultant next to you, fine; you can help treat the multiply injured patient as an F1 [foundation doctor 1].

‘If you go to somewhere like the depths of the jungle in Costa Rica, and you have a significant head injury or a pelvic injury, or a fall from height, or anaphylaxis, you cannot competently deal with that well as an F1 because you just don’t have the experience.’

Uncertain future

Dr Hughes is uncertain what her future holds. But she knows that stepping out of training was the right think to do.

‘I took that risk and I have never looked back,’ she says.

‘I want to hold on to the immense passion I have for my work, which I think is often lost during standard training.

‘And I think the process of learning and the experiences I’m gaining are more important than the “end point” [of becoming a consultant] in making me a better doctor.

‘In four years I might go back to ST4. I’ll see.

‘I have to accept that I may never be a consultant, but if that is the case, I will never have any regret about the decisions I have made.’

To infinity, and beyond…

Source – British Medical Association News

 

Of interest

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London’s Air Ambulance Clinical Governance Day

Humanitarian & Disaster  Medicine, September 6th

SPEAKERS:

Experiences from the field: Medecins Sans Frontier (MSF)
Experiences from the field: Pakistan Earthquake
Pathways into humanitarian medicine

Thursday September 6, 2012 10:00-17:00
Holiday Inn, 261-267 Commercial Road
Whitechapel E1 2BT
Contact: amyhughes@doctors.org.uk

London HEMS Clinical Governance Day – Sept 6 (PDF)

Of interest ( also taught by Dr Amy Hughes)

Pre Hospital Trauma and Management of Medical Emergencies in Remote Settings

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EWM Medical Director Dr Amy Hughes appointed to London HEM’s Team

Massive congratulations and respect for our medical director Dr Amy Hughes for her graduation on the London HEM’s Team… we are very proud of her!

London’s Air Ambulance is the charity which runs London’s Helicopter Emergency Medical Service. The service provides pre-hospital medical care to victims of serious injury, at the scene of the incident, throughout London – serving the 10 million people who live, work and commute within the M25.

Based at the Royal London Hospital and founded in 1989, the service is unique in that it operates 24/7, with the helicopter running in daylight hours and rapid response cars taking over at night.

The Team, which at all times includes a Senior Trauma Doctor and a specially trained Paramedic, perform advanced medical interventions, normally only found in the Hospital Emergency Department, in time critical, life threatening situations. Missions commonly involve serious road traffic collisions, falls from height, industrial accidents, assaults and injuries on the rail network.

London’s Air Ambulance has an international reputation for clinical excellence and delivers pioneering procedures which have been adopted across the world.

London’s Air Ambulance was the first air ambulance service in the UK:

  • with a doctor and paramedic team;
  • to deliver high standard pre-hospital anaesthesia;
  • to have a clinical governance programme;
  • to perform a thoracotomy (open heart surgery) at the roadside;
  • to perform thoracostomy (to drain collapsed lungs);
  • to use check lists to improve patient safety;
  • with air & land based response; and to provide 24 hour cover.

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The EWM story you have the book now watch the film!

We have written the book and now we have made the film…

Expedition & Wilderness Medicine and their inspirational CME and FAWM accredited medical training courses ‘taking medicine to the edge’

 

Share this video via our Facebook Group to be entered into a draw to win the Expedition & Wilderness HandbookEWM handbook

https://www.facebook.com/ExpeditionMedicine

Expedition & Wilderness Medicine facebook page

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Remote Medicine posts and latest course news

Expedition & Wilderness Medicine course in the Lake District, Mountain Medicine in Nepal and Remote Medicine Jobs
Keswick Expedition & Wilderness Medicine Course05 March 2012 to 08 March 2012

We are starting to get geared up here at EWM for the first of our Expedition & Wilderness Medicine courses in the Lake District. It is always particularly stunning at this time of year, even worth staying on after the course to enjoy.

We are also looking forward to welcoming back our peripatetic medical directors old and new. During the course Drs Sean Hudson and Caroline Knox are going to be sharing their experience of working as ski field medics on New Zealand’s South Island and working at Union Glacier in Antarctica, whilst our incumbent director Dr Amy Hughes has just returned from an intensive six month stint with MSF in the northern part of Sri Lanka – (formerly held by Tamil Tigers) – and she will using the Rupert Bennett Memorial Lecture slot to tell the story of her journey.

We are also really pleased to be welcoming back Professor Chris Imray to talk about his involvement in the Caudwell Xtreme Everest Expedition and his recent climb up Denali in Alaska, and Dr Rob Conway, founder of the award winning marine conservation charity Blue Ventures. This is, of course, as well as our regular team of eclectic medics.

We were fortunate to be visited by ITV’s John Bevir during last September’s course and his report makes interesting viewing. Watch it here.

Find out more here | Email Expedition & Wilderness Medicine for more details

Mountain Medicine Course.

The Mountain Medicine in Nepal with EverestER founder Dr Luanne Freer is departing in April and has a few places left. on this iconic learning experience trekking to Base Camp.

To find out more about this iconic learning experience trekking to base camp follow this link. EverestER and Luanne are featured in a BBC documentary which also makes very interesting watching.See EverestER in action here

Announcing a new course.

A Pre-hospital trauma and medical emergency 2 day course for medical practitioners who may not have regular exposure to acute emergencies and trauma care, but who are interested in improving and refining their skill base for expeditions, humanitarian relief missions or everyday practice. The course will be CME accredited. Email Expedition & Wilderness Medicine to pre-register your interest

Jobs

There are some great jobs out there at the moment, make sure you ‘like’ our Facebook page to hear about them first FACEBOOK PAGE or keep a regular eye on our home page.

Volunteer Doctor for International Porter Protection Group

Work on the most remote inhabited island in the world…

Recruiting a doctor for our Lifeline Clinic Doctor in Namibia

We have some other great courses coming up this year, led by inspiring medics, topped off by the Antarctic Wilderness medical Conference with National Geographic, at the end of the year.

Why not do something different with your medical degree this year??

Why not join us at Extreme Medicine Conference at the Royal Society of Medicine? We have just made the speakers’ page live and it’s a pretty impressive array – but don’t take our word for it, visit the website to see for yourself. www.ExtremeMedicineExpo.com.

Reserve your place on Extreme Medicine now.

PolarExpeditionNepal

Nepal

Nepal

International World Extreme Medicine Conference & EXPOExpedition & Wilderness Medicine would like to introduce a major new International World Extreme Medicine Conference and EXPO series starting in 2012. Find out more >>
CLICK TO VIEW THE EXPEDITION & WILDERNESS MEDICINE COURSESQuote ‘Expedition Medicine’ to receive very special RSM membership discounts.
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Trauma Jungle Wild
Desert Polar Antarctic
www.expeditionmedicine.co.uk © Expedition & Wilderness Medicine 2011
admin@expeditionmedicine.co.uk Tel: +44 (0) 1476 879 013
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A journey to Palau – swimming across one of the deepest trenches in the world, media medical work with the BBC

Watch BBC Big Splash tomorrow, 20th June, at 4.30 BBC2 to see Dr Amy Hughes supporting Blue Peters two world records for swimming in one of the deepest stretches of water on the planet.

As often is the case, many of the media operations requiring a medic often do so at the very last minute. This in no way reflects badly on the programme or producers themselves, it is often just the case that many don’t think about the requirement of medical cover for a shoot until highlighted by either the insurance documents or, with final plans in place, the realization of quite how remote the shoot is! The benefits of this for the medic is that it adds a whole new dimension to the event, as limited preparation time only adds to the wonderfully enjoyable challenge of working with the media.

Media medical support for the BBC

In this case, I had a couple of days to prepare for an overseas shoot with the BBC (Blue Peter). The main challenge for this project arose with the planning of medical kit to take. I needed enough for a 10 strong boat crew, an endurance swim and a country with a scarcely resourced hospital. Once on the boat, the minimal casevac time was thought to be around 24 hours from the time taken to sail from the depths of the pacific ocean to an air strip or helicopter pick up point. And so began my 48 hour almost sleepless venture of composing, ordering and searching for various drugs and bits of kit I may need for any possible medical or traumatic eventuality. In planning it can often be easy to focus on the activity at hand and what injuries could result from that, and overlook the more common likely events that may happen amongst the crew – for example someone slipping on a wet deck and banging their head resulting in a extradural or subdural bleed (time critical) or a myocardial infarction (pretty time critical). Everything needs to be considered, including quantities sufficient to treat one or more individuals who may suffer a similar illness at the furthest possible casevac point – for example a severe bout of food poisoning requiring intravenous fluids and antiemetics 23 hours 59 minutes from aeromedical retrieval! Something to be aware of is that ordering drugs, especially opiates and controlled drugs, takes at least 24 hours and that can be delayed due to stock levels. Also, various forms of signed official paperwork are required prior to online pharmacies dispensing opiates which is time consuming (those who are hospital doctors will find this is the best way to source drugs such as morphine and fentanyl. GPs often have access to a controlled drug prescription pad).

Palau, Latitude 70 30’00″ North, longitude 1340 30’00” east; is an island of approximately 459 square kilometers and with a population of 20000, sitting about 500 miles east of the Philippines forming part of the Micronesian state. The island hosts a beautiful outcrop of rock islands as well as probably the most beautiful coves of sand and gardens of coral. It is a truly stunning island, slowly becoming popular with divers although the dive sites are still relatively untouched.

Palau was to be the island from which Blue Peter presenter Andy Akinwolere started his journey of swimming 8km across one of the worlds deepest trenches. For someone with a fear of deep water and having only learnt to swim ten weeks prior, it was an incredible achievement.

Fortunately the only medical emergency that I was required for was the delivery of an intramuscular injection of Stemetil in a futile attempt to cease the vomiting of a sea sickness victim. The rest of the trip was uneventful and an absolute delight to be part of. In a way though, there is always that slight disappointment that my 26kg of medical kit wasn’t put to use……….!

Dr Amy Hughes, Medical Director Expedition and Wilderness Medicine

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Expedition Medicine course in Plas Y Brenin kicks off

The Expedition and Wilderness Medicine course at the Plas y Brenin convenes today. An eclectic mix of delegates and faculty gather today at the National Mountain Centre in North Wales for what promises to be an amazing week. Kicking off the talks are Dr Amy Hughes HEMS medic for Kent Air Ambulance, Steve Jones polar base camp manager for Patriot Hills and now the new Antarctic Camp at Grand Union Glacier and veteran of large scale expeditions to Nicaragua, Chile, Costa Rica, Zimbabwe and Borneo to name but a few and Dr Martin Rhodes medic for Antarctic Logistics operations at the South Pole, resident of the Pyrennes and medic for numerous Bond movies.

Expedition Medicine logo

Expedition Medicine logo

Dr Amy Hughes, Wilderness Medicine and Pre Hospital Care Expert | Wilderness Remote Medical training course.

Steve Jones, Polar Logisitics and Expedition Expert | Polar and Cold Weather Wilderness Medicine CME training course.

Dr Martin Rhodes, Wilderness Medicine and Cold Weather Medicine Expert | Remote Medicine Training Courses.

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Dr Amy Hughes, Medical Director of Expedition Medicine gives her view on the recent Keswick Expedition Medicine course

Dr Amy Hughes, Expedition Medicine

Dr Amy Hughes, Expedition Medicine

Write up UK Keswick Course March 2011

Blue sky. Stunning landscape and 63 medics. The first of the 2011 UK Expedition medicine courses encompassed all of these during its four day run in March two weeks ago. It was an absolutely beautiful setting in BarrowHouse Youth Hostel overlooking Derwent Water and surrounded by enticing Lake District scenery.

With a combination of lecture based and outdoor practical sessions, the course covered an array of all possible expedition medicine topics one could want, and the team ensured each day started with the development of a very new – albeit pretty useless  – lifeskill – whether this be the art of balloon racing, the speed of penguin racing or the logistics of passing the hand squeeze……!

Expedition Medicine had the  wonderful Chris Imray (of Extreme Everest fame) joining the faculty for three of the days , imparting artfully his knowledge and immense skill base in cold weather medicine  – be it altitude, frostbite, blood gases on top of Everest or HAPE. As one of the participants summarised perfectly in his feedback form when asked to list his three favourite lectures of the course  …’’anything involving Chris Imray’’ ……

The four days aimed to have a balance of both the academic nature of expedition medicine  – be it diving physiology, tropical medicine, legal aspects, heat  – and the practicalities of expedition medicine – be it lateral thinking , communication skills, rope skills, improvised stretchers, pre- hospital wilderness resuscitation, radio use,  voice procedure, extricating a casualty from a vehicle or search and rescue techniques –  which it seemed to achieve successfully aided by a wonderfully diverse and experienced faculty. Plus some great socialising and networking over a beer in the shadowed hills of the Lakes.

So a great course, one we hope was  inspiring , and the start for many of a journey into a fantastically challenging, diverse and thoroughly exciting world of expedition medicine…..

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Dr Amy Hughes talks about Expedition Medicine

Medical Director at Expedition and Wilderness Medicine and Pre Hospital Care Registrar with Kent HEMS talks about the benefits and opportunities in pursuing a line of training with the sub medical speciality of Expedition Medicine.

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Pre-hospital Expedition Medicine Series – Pelvic Injury

Pre-hospital Expedition Medicine Series

Dr Amy Hughes, Medical Director of Expedition Medicine and Pre-Hospital Emergency Medicine Registrar and HEMS paramedic Dave Marshall, both part of the Kent Helicopter Emergency Medical Team, continue their series examining pre-hospital expedition trauma care and associated kit.

In the second article in the series, Dave Marshall gives an overview of managing pelvic fractures pre-hospitally and in an expedition environment, and introduces the use of the pelvic splint.

Edited by Dr Amy Hughes.

Pre hospital and Expedition management of pelvic trauma and use of the pelvic splint

Expeditions have become more and more adventurous over the past years, both in destination and the participants involved. As a result, the frequency and pattern of injury is changing and the demand on the medical team thus increased. Having a broad knowledge of fracture management, including mechanism of injury, clinical findings, reduction techniques and splinting is essential. Although one of the most enjoyable challenges of being a medic on an expedition team is improvisation regarding kit used to manage various ailments and injuries, practice and competence in the use of non-improvised kit such as the Pelvic Sam Splint is essential.

Mechanism of Injury

Pelvic fractures often result in extensive disruption of the bony structures and associated ligaments of the pelvis and are potentially life-threatening injuries. The fractures associated with the greatest morbidity and mortality involve significant forces such as motor vehicle crashes, motorcyclist crash, pedestrian versus car, falls from height and crush injuries. Early suspicion, identification and management of a pelvic fracture at the prehospital stage is essential to reduce the risk of death as a result of hypovolaemia, (1). It is especially important to be able to identify, treat and minimize risk of further damage when in a remote area miles from the nearest medical facility.

Understanding the mechanism of injury is vital in being able to predict the potential for significant injury to the pelvis and its underlying structures, even in the absence of clinical signs. It is, therefore, essential that time is taken to evaluate the mechanisms involved in any accident resulting from significant force or where there is pain or injury to the spine, abdomen, pelvis or femurs.

In motor vehicle accidents – a not uncommon event on expeditions – learning how to ‘read’ the wreckage to help identify possible pelvic injury, in conjunction with clinical suspicion, can significantly aid diagnoses.

The intrusion into the passenger and drivers door is likely to result in massive lateral injury to the pelvis

The intrusion into the passenger and drivers door is likely to result in massive lateral injury to the pelvis

  

The intrusion into fuel tank shows the imprint of the riders pelvis. This would often result in significant fracture to the pelvis – often multiple, often ‘’open book’’ pelvis

  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Anatomy of the pelvis

Anatomical structure of the pelvis (2)

The pelvic ring is often likened to a polo mint in that it is almost impossible to have a significant break in one place and not another. The most common area to be damaged in trauma is the pubic rami, acetabulum and the sacroiliac joint. There is extensive vasculature through and around the pelvic ring, most notably the iliac vessels. For imagery see http://visualsunlimited.photoshelter.com/image/I0000kUOn3NJHcZU.

The greatest risk of a pelvic fracture is catastrophic haemorrhage and gentle handling of the patient in the initial and subsequent stages could literally be the difference between life and death. Whole blood clotting time is approximately 10 minutes, (depending on the environment). Expedition medics should be familiar with the ‘first clot best clot’ theory. In other words, a patient sustaining a traumatic injury resulting in haemorrhage will begin to form a clot using their own clotting factors. If this clot is disrupted they could easily bleed to death. A full fluid resuscitation will not be practical in the field as most expeditions carry a maximum of 2 litres of crystaloid. However it should be noted that overloading the patient with fluid can be equally harmful, and small boluses should be given to maintain a central pulse and cerebral perfusion. This is known as permissive hypotension and will be discussed in more detail in a future article. Disruption of this first clot in the prehospital setting could be fatal, and without access to blood and clotting agents the patient may die. Trauma will result in the patient becoming acidotic, hypothermic, and coagulopathic. (3)

This coagulopathy cannot be easily reversed pre-hospitally, each factor contributes to the decline in the others. (see above diagram). Any disruption to the first clot will have devastating consequences. Ultimately, the patient requires definitive haemorrhage control, (surgery, angiography and embolisation), and replacement of blood and clotting agents.

The glass pelvisThink of the pelvis as being made of very fragile glass, and you can see the clot in the form of a cartoon jelly inside. The jelly is very delicate and unless movement is gentle and kept to a minimum, it will ‘wobble’ to the point of destruction very easily. The same applies to the blood clot! Early recognition of the potential for a pelvic injury, gentle handling and prompt stabilisation is vital to improve the outcome of a patient injured on an expedition.

Clinical Features of a pelvic injury: (4)

  • Asymmetry of the pelvis – do not spring the pelvis. Visual alignment and gentle palpation of the Anterior Superior Iliac Spine may help demonstrate pelvic injury, but often the pelvis visually appears normal, thus mechanism of injury is vital in determining injury
  • Shortening/rotation of the leg/s
  • Inguinal pain
  • Localised swelling/contusion
  • Hematuria/urinary incontinence
  • Bleeding PR/PV – PR examination not recommended to determine pelvic injury.
  • MECHANISM, MECHANISM, MECHANISM! (albeit not a clinical feature!) – there may be no obvious clinical abnormality despite significant injury. Thus clinical suspicion is essential.

Management of pelvic fractures and clot preservation:

As we have already discussed, a patient with a suspected pelvic fracture must be handled very carefully. Whether in a medical facility or the most extreme expedition environment, the same principles apply to prevent worsening the injury and preserving the clot.

Log rolling the patient should be avoided at all costs!

The medical kit available on expeditions will be minimal. Stretchers may have to be improvised and transportation limited. However, all medical kits should have some sort of pelvic binder which should be applied carefully and correctly at the earliest opportunity, (see images below).

 

 

 

Application of the pelvic SAM splint.

The casualty will inevitably have to be placed in the supine position, to evacuate them on whichever device is available. This can be achieved by a coordinated team approach utilising other members of the expedition.

One person should be at the head end of the patient maintaining in manual inline immobilisation, (MILS), and they will give clear commands to the team when moving the casualty, (“ready, brace, roll”). A pelvic binder such as the one shown can be applied using a minimal 10-15% roll, (enough to get a bum cheek off the ground!)

 

 

 

 

 

 

 

 

 

 

 

 

 

The most common problem associated with pelvic binders are incorrect positioning. Identify the greater trochanters and line up the binder. Ideally it should be applied over bare skin, though clearly this will depend on environmental factors.

  

Once in position the device can be tightened just enough to maintain anatomical alignment. Do not over tighten as this could cause significant further damage!

 

 

 

 

 

 

 

 

 

 

 

 

 

Log rolling patients, whilst sometimes useful in a controlled hospital environment following appropriate imaging, should be avoided in the pre hospital field. In simple risk versus benefit terms it could have catastrophic consequences. By using the hands available and correctly briefing the team about the amount of movement required (one cheek off!), it should be possible to optimise the care of the casualty prior to evacuating them to definitive care.

Improvised methods of pelvic splinting on expeditions

Much of the challenge of expedition medicine is improvisation. The medical kit you take out with you may not have SAM splints in them. Providing a support can be placed across the greater trochanter, then any sort of material could be used – for example clothing, a sheet, or a canvass of some kind.

Fluids

The approach to fluid management in trauma has changed. Two litres of fluid is not necessarily required for management of pelvic injury. Titrate fluid according to the presence of pulses or cerebration (alertness). The presence of a radial pulse, and even in certain circumstances (without associated head injury) presence of a femoral pulse signifies the blood pressure is sufficient to perfuse the necessary organs and promote clot preservation. Further details of permissive hypotension will follow in another article.

Analgesia

Essential – this depends on what is available. Intravenous opiates or a fentanyl lolly is ideal for analgesia, after the use of paracetamol or a NSAID.

Other injuries

Pelvic injuries are often present in conjunction with other significant injuries – spinal, femur, urological or abdominal as examples. Whether or not other injuries have been excluded, spinal precautions are essential in conjunction with good management of the pelvis.

References

  1. Lee C, Porter K. The prehospital management of pelvic fractures, Emergency Medical Journal 2007;24:130-133
  2. Image 1: Available at: http://home.comcast.net/~wnor/pelvis.htm
  3. Maya A, Matinowitz U, Kluger Y. Coagulopathy in the critically injured patient, Yearbook of Intensive Care and Emergency Medicine 2006, Part 5,232-243
  4. Crawford C, Pelvic Fracture in Emergency Medicine, available at: http://emedicine.medscape.com/article/825869-overview
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