Good overview on field management of femur fracture

The Expedition Medicine team ( 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 😉