Category Archives: Wilderness medicine

Locum MO position on Tristan da Cunha

An interesting position has emerged – Tristan da Cunha Island is looking for a locum medical officer for a limited period of time. See the info below:

“The usual contract is 12-24 months. There is however now an unusual
opportunity. They are struggling to find a replacement doctor. So
much so that they may be willing to break it up in periods of a few
months each (depending on the schedule of the supply ship – see
attached schedule) till the end of September. At the moment there are
two windows of opportunity: 26 May to 18 July and 18 July to 2
October. Perhaps the latter may still be broken up as well but the
ship’s schedule is not known yet.

There are some interesting You Tube video clips here.

As can be expected there will be the occasional medical emergency
(MI, heart failure, etc). Obstetrics is also a required skill – a
baby will be due in June. However, on the rare occasion you need to
be able and willing to give an anaesthetic / spinal and then do the
surgery yourself (eg c-section, appendectomy etc). There are 5 nurses
that can give a hand.”

You’d need to be at least and MO with relevant qualifications and experience – contact me if genuinely interested.

Good overview on field management of femur fracture

The Expedition Medicine team (www.expeditionmedicine.co.uk) have put together a nice review of field management of femur fracture, written by their medical director, Dr Amy Hughes.  In particular, it has a good step-by-step pictorial guide for applying the Kendrick Traction Device (KTD), one of my favourite pieces of kit.

The degree of haemorrhagic compromise caused by even a simple closed femur fracture shouldn’t be understated:  Expecting 1500ml of loss into the compartment, this by definition puts the patient into at least Class 2 shock.  While it is good to see wilderness/expedition medics au fair with hypotensive resuscitation,  we must not lose sight of the fact that maintaining adequate perfusion trumps the fear of dilutional coagulopathy and ‘clot-popping’, especially in the face of delayed/lengthy evacuation.  It’s a fine balance, especially in the wilderness.

I’d also ike to see the analgesia section expanded a little – in particular, the use of femoral block and the addition of ketamine to the armamentarium – but as that’s one of my personal soap boxes and fields of interest I’ll cut them a little slack 😉

The other great things to see in print are the promotion of simple cephalosporin antibiotic prophylaxis (not the shocking top-end drugs being advised from our US tactical compatriots) and encouragement to use adequate irrigation (utilising Wilderness And Tactical Environmental Rinse, aka WATER, *grin*).  Cue one of my favourite quotes:  “The solution to the pollution is dilution!”

Kudo’s on a good blog, folks.

WildMedix course getting a daily detailed review…

It is to be assume d that I believe that WildMedix is providing unique, challenging and useful training.  However, it is very good to get an unbiased view from the outside looking in!  Gaynor Schoeman – aka “Flygirl” – won a free course as a sponsored prize in the last Overberg Paragliding Club “Gatskop” competition, and when she expressed an interest in the Wilderness First Aid course we decided to upgrade her prize.  She seems to be loving it, even if it involves being at the sharp end.  Read her ongoing review here, complete with pictures of some of the action.  I have cuts and bruises 😉

Wilderness medicine reading for today – Salt-water Aspiration Syndrome

I have resigned myself to the fact that I will never be a world-famous blogger.  This is not due to a lack of the ability to write (well, ‘document’, perhaps, as true writing implies artistry) nor a dearth of material (the world around us is just full of quirky stuff) but rather my utter laziness.  It takes a serious effort and some time out of the day to place posterior on pew and pen to paper… metaphorically speaking.  In any case, with that admission out of the way, I have decided that for as long as the gumption lasts I will try to post a very brief blurb on whatever wilderness medicine literature or related information I happen to be reading.  Even if it’s just a link or two, this will hopefully be a small contribution to the field, rather than just my meandering musings.

Hence, here is ‘What I’m Reading in Wilderness Medicine Today’:  Salt-Water Aspiration Syndrome.

SWAS (I’ve just decided that is the acronym from now on) is reasonably well documented in the literature and should be familiar from any talk or chapter on drowning/near-drowning.  You will likely recall that two different clinical pictures emerge dependant on whether a patient has aspirated fresh or salt water; major concern in the former is the loss of surfactant and resultant atelectasis and lung damage, while the latter is characterised by pulmonary oedema, fluid shifts, metabolic acidosis and later hypoxia, depending on the inhaled volumes.  The original paper describing the phenomenon is attributed to a Dr Edmonds in 1970 (see Edmonds C, A salt water aspiration syndrome, Mil Med 1970 Sep;135(9):779-850; I have not yet been able to acquire the article).

Why am I suddenly interested in this?  Well, yesterday we were geocaching out along the coast.  There was a big sea running, and the onshore wind had piled sea foam in great masses along the shore.  We suddenly realised that the Labrador had gone missing, and after 15 minutes of running around calling (there were ostriches nearby, and I thought he might be chasing them) we realised that he had possible tried to run ‘over’ the foam and was now ‘submerged’ amongst the rocks… or had gone into the wild sea and was almost certainly already dead.

We both plunged into the foam, wading and feeling with our feet.  The foam was discoloured from particulate matter and very salty, and new ‘waves’ threatened to swamp us as the wind brought more from the adjacent sea.  You will imagine my relief when I felt a furry body beneath foam which was up to my neck, and the furry body turned out to be a live but very sick dog.  He had been trapped under the surface for 20 minutes.

Initial symptoms were bloodshot eyes, coughing, tachypnoeic with a very wet chest with ronchi/rales and hypersecretion.  He was still able to ambulate, however, and so we hoofed it to the car and sped off back to Cape Town and the veterinary hospital.  By the time we arrived an hour later the cough had settled but he had developed a harsh wheeze throughout the respiratory cycle.  He was admitted on IV fluids and prophylactic antibiotics for monitoring, and 24 hours later is gradually improving.

Mild cases of SWAS (not uncommon in divers) generally resolve with rest within a few days, while more severe cases require positive pressure ventilation (a very good response to CPAP/PEEP has been observed).  Expert opinion and the literature I’ve been able to track down concur that there is no role in for corticosteroids.

Resources to have a look at:

This is by no means an exhaustive review, but please drop me feedback if you find it informative and/or useful.  I have not yet been able to find a case report of aspiration/pneumonitis from sea foam in either human or canine in the literature yet, so if you are familiar with such a case please let me know.

Last (happier) picture – the dog and I after we found him.