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Recruiting a doctor for the Lifeline Clinic in Namibia

This is a fantastic remote medicine job opportunity to work with the remarkable San Bushmen in our well-resourced Lifeline clinic in rural Namibia. We are looking for a doctor to start in May 2012 for 1 year or longer.

The clinic was set up in 2003 and is based in Epukiro, approximately 120km North of Gobabis and 400km East of Windhoek. It’s a small community made up of mainly Herero, cattle rearing people, and a small group of San Bushman who are traditionally nomadic hunter gatherers that live in small family groups.Remote Medicine jobs in Namibia

Sadly, San are treated as second or even third class citizens in Namibia and providing free and accessible primary healthcare to this community really is a lifeline to many. People walk hundreds of kilometres to receive medical care when they are sick and unfit to travel these distances. The clinic was set up to provide free medical care to the San Bushmen community. The majority of our patients are San who receive all their treatment free at the clinic (84% of consultations). The rest of the consultations are for fee paying locals, mainly Herero (16%).

The doctor’s role is extensive in nature but is extremely satisfying. The clinic is primarily open Monday- Friday, 8am- 5pm with a lunch break from 1pm-2:30pm. Patients are seen on an open access basis. We also provide an outreach clinic to a large primary school with 150 San pupils and to a village 40 kilometres away. We also run a community program which is in its infancy and consists of training and supporting community health workers in several San Bushman settlements in the area.

Many of the San come from the surrounding regions and may travel several hours to reach us. 40% of the patients we see are children. We see a lot of TB, respiratory infections and diarrhoea. We also see trauma, domestic violence, alcoholism and malnutrition. Patients who need to be admitted to hospital are transferred via our clinic car/ambulance to Gobabis Hospital, 120 km away, mainly on gravel roads. On some occasions they need to be taken straight to Windhoek which is a 4 hour drive away.

Facilities in the clinic are very good and include a microscope, ultrasound machine, computer facilities and the internet. We have a good relationship with the state clinic and mutually support each other.   The Lifeline clinic is entirely funded by charitable donations. It is part of the N/a’an ku se foundation which also has a wildlife and conservation sanctuary just outside of Windhoek. The farm is 320 km away from the clinic, mainly on tarmac roads.

The doctor is responsible for the clinic staff, currently consisting of a nurse, receptionist, translator, cleaner and gardener. The doctor works with Anna Daries, our wonderful Namibian nurse who has been with the clinic for approximately eight years. She has good local knowledge of the San community and is well respected by them. The doctor also looks after the medical volunteers who come from all over the world and stay for a period of two weeks upwards, provides teaching & projects for them to undertake and ensures they are looked after. They are vital to the financial aspect of the project. The doctor/ partner picks the volunteers up from the farm and then drops them back at regular two weekly intervals. This also allows for a few days leave from the clinic itself.

Accommodation is attached to the clinic and is shared with the nurse and medical volunteers so there is not a lot of privacy. The accommodation is comfortable with a fully equipped kitchen, electricity, solar heated water, a television, a garden and two small affectionate dogs. Regular visits to Gobabis are undertaken to pick up food and provisions.

Other responsibilities include keeping regular updates for the management team, writing reports to obtain further funding (working with the fundraising manager), ordering the medications for the pharmacy and generally maintaining patient records.

There is often a lot of driving involved, some of it on gravel roads, but the clinic car is a Nissan X-Trail in good condition and reliable and safe to drive. You do need to be able to change a tyre as punctures will occur!

Namibia is one of the safest African countries to visit; the main nuisance is petty crime. Driving around Namibia is quite safe as long as you keep to a sensible speed and avoid driving in the dark. The roads are not busy.

It must be stressed that this is a remote area of Namibia in a small but friendly community. There are frequent power and water cuts particularly in the rainy season. Accommodation and food are all provided. There is also a small monetary remuneration of N$5000/ month (about £400/ month). The job would be suitable for a single doctor or a couple (not necessarily two medics).

This very rewarding role would suit a doctor with a passion for people, who would be prepared for the remoteness and heat of Eastern Namibia and who can be flexible and embrace all aspects of the role.

For more information about N/a’an ku sê please visit www.naankuse.com and/or contact sarahfrance10@hotmail.com

N/a’an ku sê Foundation, P.O. Box 99292, Windhoek, Namibia.

T: +264 (0) 817 438 505

Of  interest;

EWM founder Mark Hannaford on the iconic Desert & Wilderness Medicine course

Desert & Wilderness Medicine CME accredited medical training course in Namibia

Sheltering the shadow of Brandberg Mountain, Namibia’s highest, EWM’s Desert & Wilderness Medicine course really is something different as Mark Hannaford explains

Developed for medical professionals and advanced medics working in hot or arid climates, the Desert and Wilderness Medicine medical training course aims to introduce participants to the skills required for working in hot, arid and sub Saharan areas, and to care for and treat injuries and illness likely to occur in this fascinating environment.

 

Book your place on Desert Medicine now …..www.expeditionmedicine.co.uk

Of interest - Conservation ‘Wild Medicine’ in Namibia

Dr Rob Conway writes about his time working in rural Kwa-Zulu Natal

Dr Rob Conway, one our regular lecturers on our famous Maldives based Diving & Marine Medicine course  flew directly from Male to Johannesberg last year take up a post in  South Africa at the rurally located Ngwelezane Hospital.   The position was organised through African Health Placements .

Life without pre op.

Anaesthesia in a rural Hospital in Kwa-Zulu Natal

It struck me as I was watching my wife hold a beating heart in one hand and stitching it up with the other that this was one thing that every newly wed couple should do. We have been working in

image (c) Dr Rob Conway

image (c) Dr Rob Conway

Northern Kwa-Zulu Natal, South Africa, in a busy district general hospital called Ngwelezane.

I was desperate to get back to Africa and I thought that South Africa might offer both the experience with some form of supervision that I desired. I was keen to do anaesthetics and not a more generalist role that many of the more rural and remote hospitals require doctors to perform. The planning took 12 months and was helped by a charity called African Health Placements (AHP) who facilitates doctors placements in rural South Africa.

Ngwelezane has approximately 500 acute beds and 8 ICU beds. The catchment area covers a population of 4 million people in an area the size of England, and contains 22 referring hospitals. This means that the workload at Ngwelezane is incredibly demanding, with a high emphasis on trauma, emergencies and paediatrics. There is also a nearby maternity hospital where I do mainly regionals for caesareans and crash GA’s are not uncommon.

As it turned out Ngwelezane was struggling. The anaesthetic consultant I had liaised with had left, as had two of the four surgical consultants and all of the medical consultants. There was chaos in the department, which was staffing two sites with 8 staff, many of whom had done under 6 months of anaesthetics.

After a month of plotting how to escape early, I began to enjoy the job. The work is varied and interesting, making for an amazing experience. The nurses sing the day in and their voices drift across the hospital as you check your machine and draw up emergency drugs for the day ahead. There are general, orthopaedic, eye and ENT lists. We deal with emergencies or urgent cases and there is little planned work. Workload is high, hours are long and lists are generally overbooked, as there is a huge volume of work to be done here. As an example, this weekend I have anaesthetised 2 gunshot abdomens, 2 perforated duodenal ulcers, 3 children under the age of 5 and been involved in the triage of a mass casualty motor vehicle accident. I helped with the treatment of an organophosphate overdose, not to forget the numerous other surgical and orthopaedic patients.

There is currently no pre-operative assessment, we just do not have the resources and lists for the following day are not released until late afternoon making organising difficult. Although the cohort of patients are generally much younger and fitter than those that I saw in the UK, the majority have underlying HIV infection and TB. There are also the high risk patients who turn up to theatre without the relevant investigations and it is down to us to make the decision to postpone these patients for further investigations.

Anaesthetists here do not have the extended role that I experienced in the UK. You rarely step outside of theatre and are not involved in either acute trauma in the emergency department or critical

image (c) Dr Rob Conway

image (c) Dr Rob Conway

care in intensive care. Sometimes, however, we get the opportunity to help, such as when two packed buses collided and around 40 people arrived at the hospital, many of them children. I was involved in the care of a young girl, age unknown probably 4, who had bilateral open tibia and fibula fractures and a head injury. Her mother had died in the crash and we had no way of contacting a guardian. It was the weekend, no one was around to ask for advice, and I had to make a decision to wait to see the outcome of her head injury prior to rushing to theatre. I still feel that I was not in the right position to do this but I had no one to ask. After two successful trips to theatre we located an aunt to look after her. Her story is not uncommon.

Christmas was insane. My wife and I were working a 24 hour on call every third day. It was relentless, each one consisting of at least four penetrating trauma laparotomies and a number of stabbed hearts. The Zulu’s are tough, stoical and very appreciative of treatment and it amazes me that they can survive to hospital with a stabbed ventricle. I had never really contemplated the anaesthetic considerations for someone with a stabbed heart beyond fixing the defect. After inducing him I turned to the machine and then back to the patient. The next thing I know the surgeon is cracking open his sternum, grabs his beating heart in his hand, looks at me and says “He’s not going to like this”. Mental! He was right, the capnography disappeared and he went into some strange rhythm that I’m pretty sure is not compatible with life. The surgery was quick, the access was large and we filled him with lots of fluid as no blood was available. He went home four days later.

image (c) Dr Rob Conway

image (c) Dr Rob Conway

I have seen many weird and wonderful things that are too numerous to include here. The 30cm worm crawling out of someone’s abdomen intra-operatively, the hippo attack, the major trauma, the snake bites, the rare tropical diseases, the use of halothane, ketamine and the fact that I am left to anaesthetise children on my own. A lot of the time I am unsure if I’m doing the right thing and at times it has helped to debrief on doctors.net to ask advice from others who may know better. There are also many non-clinical roles that need to be filled and I have responsibility for the out of hours rota and annual leave as well as looking after the interns.

If there is one thing that would keep me here it is life outside of work. Kwa-Zulu Natal is a gem. We work long hours but are paid well and you can live a fabulous life, if you overlook the lack of security. We have a beautiful home overlooking the Zulu hills minutes from the beach in a small village called Mtunzini. Within two hours there are world class game reserves, two of the worlds top 10 dive sites and surf. A little further away are the Drakensburg or Mozambique and you are only a short flight to Cape Town.

Having had some time to reflect I realise that I have certainly had my ups and downs. The experience, especially the exposure to trauma and paediatrics, has been amazing. This environment has highlighted the value of training as I am out of my depth every day. I want to be both confident and competent in my work and proud of why and how I do it. Would I recommended Ngwelezane, well it depends on what you want out of your time here. If you are after training then not currently, but that may change. If you require a hands on, raw, frightening and yet exhilarating African experience then I don’t think I could recommend anywhere better.

Of interest

 

 

Nepal Mountain Medicine leader featured in Smithsonian article

Dr Luanne Freer, leader of this years Nepal CME accredited Wilderness Mountain Medicine course in Nepal, has been written up in a brillant article on the illustrouis Smithsonian website in an article entitled ‘Inside the ER at Mt. Everest’ by Molly Loomis.

A middle-aged woman squats motionless on the side of the trail, sheltering her head from the falling snow with a tattered grain sack.

Wilderness Medicine

Find out more about Mountain Medicine in Nepal

Luanne Freer, an emergency room doctor from Bozeman, Montana, whose athletic build and energetic demeanor belie her 53 years, sets down her backpack and places her hand on the woman’s shoulder. “Sanche cha?” she asks. Are you OK?

The woman motions to her head, then her belly and points up-valley. Ashish Lohani, a Nepali doctor studying high-altitude medicine, translates.

“She has a terrible headache and is feeling nauseous,” he says. The woman, from the Rai lowlands south of the Khumbu Valley, was herding her yaks on the popular Island Peak (20,305 feet), and had been running ragged for days. Her headache and nausea indicate the onset of Acute Mountain Sickness, a mild form of altitude illness that can progress to High Altitude Cerebral Edema (HACE), a swelling of the brain that can turn deadly if left untreated. After assessing her for HACE by having her walk in a straight line and testing her oxygen saturation levels, the doctors instruct her to continue descending to the nearest town, Namche Bazaar, less than two miles away.

Freer, Lohani and I are trekking through Nepal’s Khumbu Valley, home to several of the world’s highest peaks, including Mount Everest. We are still days from our destination of Mount Everest Base Camp and Everest ER, the medical clinic that Freer established nine years ago, but already Freer’s work has begun. More than once as she has hiked up to the base camp, Freer has encountered a lowland Nepali, such as the Rai woman, on the side of the trail ill from altitude. Thankfully, this yak herder is in better condition than most. A few weeks earlier, just before any of the clinics had opened for the spring season, two porters had succumbed to altitude-related illnesses.

Each year over 30,000 people visit the Khumbu to gaze upon the icy slopes of its famed peaks, traverse its magical rhododendron forests and experience Sherpa hospitality by the warmth of a yak dung stove. Some visitors trek between teahouses, traveling with just a light backpack while a porter carries their overnight belongings. Others are climbers, traveling with a support staff that will aid them as they attempt famous peaks such as Everest (29,029 feet), Lhotse (27,940 feet) and Nuptse (25,790 feet). Many of these climbers, trekkers and even their support staff will fall ill to altitude-induced ailments, such as the famed Khumbu cough, or gastro-intestinal bugs that are compounded by altitude.

A short trip with a group of fellow doctors to the Khumbu in 1999 left Freer desperate for the chance to return to the area and learn more from the local people she had met. So in 2002 Freer volunteered for the Himalayan Rescue Association’s Periche clinic—a remote stone outpost accessed by a five-day hike up to 14,600 feet. Established in 1973, Periche is located at an elevation where, historically, altitude-related problems begin to manifest in travelers who have come up too far too fast.

For three months, Freer worked in Periche treating foreigners, locals and even animals in cases ranging from the simple—blisters and warts—to the serious, instructing another doctor in Kunde, a remote village a day’s walk away, via radio how to perform spinal anesthesia on a woman in labor. Both the woman and the baby survived.

Find out more about the  Nepal CME accredited Wilderness Mountain Medicine course in Nepal attendance of this course will count toward a FAWN degree.

Expedition Medicine’s UK Course welcomes their University Liaison

Dr Nick Knight - Expedition Medicine Facualty

Dr Nick Knight - Expedition Medicine University Liaison (c) Mark Hannaford FRGS

Expedition Medicine’s UK Course Welcomes their University Liaison

With the sunshine out and the rasping sounds of the Search and Rescue Teams over the two-way radios out on the Cumbria hills – you would have been easily mistaken in thinking you were in the middle of a real emergency. In fact, it was the final Search and Rescue exercise (with CASEVAC) of a fantastic 4 day Expedition Medicine Course in Keswick in Cumbria.

As the University Liaison for Expedition Medicine, it was the first course that I attended as a new member of the ‘EM faculty’ – and what a fantastic experience it was. Not only did I get to absorb the electric atmosphere of the 60+ delegates there alongside the seasoned expedition medics leading the course but it gave me ample opportunity to see how such courses can align themselves with my role as University Liaison and to stimulate a few more ideas.

(more…)

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.

Remote medicine job vancency in Northern Namibia

The role of the Doctor at the Lifeline Clinic has only developed over the past 18 months and is therefore still in its infancy. The clinic is based in Epukiro, Eastern Namibia and provides Primary Care Facilities for the local population. The majority of the patients are San Bushmen who receive all treatment free at the clinic (84% of consultations). The rest of the consultations are for fee paying locals, mainly Herero (16%).

Post is available in May 2011 for a one year duration.

To find out more about this vacency visit our ‘Expedition Medicine Jobs’ page here

Treatment of cholera in active malaria zone

The treatment of cholera in an active malaria zone is a difficult matter.  This is especially true with lessons being learned in Haiti and their recent cholera outbreak.  I am specifically referring to the combination of Chloroquine (antimalarial) and the antibiotic class Macrolides (used in treatment of cholera).  A post that I made back in 2009 has new recent relevance and I wanted to repost that here:

Azithromycin, Chloroquine and Arrythmias:

Travel medicine frequently uses medicines that are taken under special circumstances and for short periods of time, like a trip.  Many travelers carry an antidiarrheal antibiotic on their trip and a common choice is azithromycin.  This can potentially be a problem when they are also traveling in a malaria area and using chloroquine for prevention.  Two very commonly used medicines chloroquine (antimalarial) and azithromycin(macrolide antibiotic used for respiratory infections and diarrhea) both have wonderful safety profiles, individually.  However when taken together, there is discussion of the chance of a heart arrhythmia, specifically prolonging the QT interval.  In fact, my software I use for prescribing cites this as a combination to avoid. 

There are several important articles that can be used to look at this problem and evaluate the risks.  One very good paper looks at medications that prolong this QT interval:

These authors list azithromycin as a “very improbable” medication, although other macrolides are listed as higher risk.  Chloroquine is listed as an “Unknown” medication, with respect to prolongation of QT interval.  This article was based on expert opinions.

This study looked directly at this problem, in animal models.  Their research showed no increase in arrhythmia risk. 

A wonderful article that is actually helping to look at using this drug combination to treat resistant forms of malaria.  More about this combination and treating malaria here.  Their study did show an increase in the QT interval in both groups of those who received chloroquine alone and those who received the combination of chloroquine and azithromycin.  This QT interval increase was maximum on day number three and returned to baseline by the end of the study.

Most of the information I am finding looks reassuring for safely using this combination, in healthy individuals.  Those with a history of arrhythmia should use this combination with caution and discuss this problem with their doctor, before they take these two medicines within a close amount of time.

Contributer: Dr Erik McLaughlin |  www.adventuredoc.net

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

Expedition Medicine medics involved with UNICEF challenges

Having participated in an Expedition and Wilderness Medicine training course can open up a whole network of contacts and opportunities, not only do expedition, media and travel organisations look more favourably on EWM trained medics who have participated in one of our courses we a have  an incredible network of contacts who are constantly on adventures, working remotely and who need remote medical cover.

Recently expedition medics have been working with UNICEF  and with a well known charity challenge compamy to provide medical cover on thier fundraising adventures – they are off to Namibia next and you can find out more about UNICEF’s fundraising expeditions here.