C-MAC Self-laryngoscopy

Today, we acquired a new toy… uh, I mean tool on loan at work.  It’s a Storz C-MAC video laryngoscope.  (If that doesn’t mean anything to you, you’re allowed not be be excited and stop reading now.  Still here?  OK – it’s a thingymegummy for looking down the throat for putting in a breathing tube in patients under anaesthesia, with a video camera built in so that you can see better.  Practical AND technogeeky… who could ask for more?)

We’ve had a GlideScope on loan for quite some time, but it regularly gets withdrawn from theatre for training, so we obviously want our own.  There is of course a lot of competition in the video laryngoscope market, with many different devices and philosophies behind their construction.  I’ve really enjoyed the GlideScope, which (after you’ve ascended the learning curve) is a wonderful device, but it is good to play…uh, I mean work with as many different tools as possible.  Hence, it’s the C-MAC’s turn.

Typically, when the device arrived we had no suitable patients on which to use it, so I had to improvise:  10% lignocaine spray in my own oropharynx eased the process.  The C-MAC has an SD card slot and records photos and video at the touch of a button, so I was able to take a nice picture of my own vocal cords (that’s a Cormack-Lehane grade 2 view for those studying airways) and a video of the process:

If the video is not working you can watch it on YouTube (a goldmine for medical training, by the way):  C-MAC Self-Laryngoscopy

Powered Hang Gliding

Let me see, the short story:  Even though I have been paragliding for quite some time, I did a hang-gliding course back in 2009 because, well, it looked like fun and I had always wanted to try it.  This year my instructor posted some pictures of his newest creation – a super-light-weight powered hang-glider (PHG) trike.  It looked like fun… so I had to try it.  Here are some shots from my conversion course in Wilderness last weekend – click on the image for a larger view.  Aerial photos by me on my cellphone (don’t ask!) and the rest by my increasingly talented brother Stephen.my brother, Stephen.

Thick sea mist limited morning flying activity but was beautiful to behold.

Preflight checks on Kleinkrantz beach

“Magneto’s on… Clear Prop!”

First take-off!

Cruising along Paradise Ridge

Sedgefield from above Gericke’s Point

Enjoying the high life.

Kleinkrantz dune, setting off on an XC flight.

First solo out-landing

Gorgeous machine in a gorgeous spot… deserted beach for kilometers in either direction, dolphins playing in the surf, smooth firm sand to land on…

The sky is the limit…

1000ft ASL, heading back towards Wilderness.

Sure blows your hair back, baby.  Cockpits are for sissies.

Coming in to land on the Wilderness Green.

Successful short-field landing.

Marvelous machine.

The wing is a normal Will’s Wing Falcon tandem hang-glider, with no special modifications other than a ring on the keel to prevent the pylon tube for the power unit from slipping.  The power unit has a three-wheel undercarriage, making take-offs and landings much easier and safer than the traditional prone PHG designs.  Motor, undercarriage and airframe weighs in under 50kg fully fueled, falling easily within the weight range of the wing.  Another advantage of the supine design is that the flying characteristics of the wing with and without power are very similar, making it more pleasant for the pilot.  I enjoyed turning the engine off in flight and transitioning to soaring, then switching power on again and flying off to the next spot great view.

See www.hangcheck.co.za for more information about the aircraft and learning to fly it…

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 😉

First 9/11… now 8/22?

Demonstrating (what counts for me as) great personal restraint, I have held back the obvious Lord of the Rings puns all day as we bid farewell to the two Athlone Cooling Towers… but I can’t help note the allegory to the more unfortunate US event fading rapidly into our combined histories.  Ours, of course, came as less of a surprise – but still somewhat unexpected.

The cooling towers have been a feature in my landscape for as long as I’ve lived in Cape Town: my whole life.  I still recall driving past them as a child every time we set off to Betty’s Bay for a weekend.  The coal power station was still operational then, and one could see the cascades of water through the air intake fins at the bottom of the tower: a living example of the principles of physics that I was foggily beginning to grasp at the beginning of the long process to creating light pour from handy switches around the house.  My father could explain the entire process all the way to Somerset West, and I was enthralled.

The Athlone Power Station shut down years ago, and since then the towers have gradually declined.  I once missed a chance to abseil from them during a rescue practice because of an ophthalmology tut I was too scared to bunk: what a waste 😉  The city council announcement that they had become structurally unsound and would be demolished didn’t come as much of a surprise, but it certainly jerked a few Capetownian tears.

Despite the girl and I both being badly post-call, neither of us was at all willing to miss something being blown up almost in our back garden.  I had done some reccie work on my trusty Dakar (LOTR reference coming:  it’s name is Hasufel) and selected a spot along the river just across the highway from the towers.  We arrived with dog in tow about 90 minutes early, picnic in hand, and selected a prime piece of river frontage replete with uninterrupted view for my cameras (HD video and DSLR).  As the time passed if became more and more festive, with people from all walks (and limps) of life filling the bank.  Everyone was delightfully polite and careful not to obstruct each other’s views; children played together and Kaptein earned much attention and praise.

With about 30 minutes before the 12h00 detonation time I settled in behind my tripod and did a full systems check: ready.  My watch had been zeroed to SA Standard Time before leaving home.  Occasionally we’d catch a waft of sound from the press tent on the golf-course across the river.  Time passed slowly but lazily, with a festival air.  At T-minus 5 minutes I decided to start my video camera rolling at T-3 just in case of an early detonation, and was shielding it from a short rain shower when we heard a sound drifting across the river…. “…. 3…. 2….. 1….”

AAAARGH!  Just over 4 minutes early!  Everyone scrabbled.  I hit record and yanked my SLR out of my jacket as the explosions zipped across the face of the tower and was shooting within seconds, but the more distant tower was already consumed in dust and smoke.  An unwelcome stranger charged in front of all of us, blocking the video camera, and earning a bout of curses from the petite aunty next to me…. then everyone was whooping and cheering and asking “Did you get it?”

Well, sorta.  Enjoy, the end of the Athlone Ladies.  Click on the images for an enlargement – the second in the series is a beaut to check out the bending and fault lines.

Damn the b@st@rds who hit the button early: I hear the Argus didn’t get a single good photo from their guys on scene and the E-TV reporter looked more shocked that the gulls perched on top when the bang went off 😉

The new view:

Random Photo – Welcome to South Georgia

Right Whale Bay on South Georgia - diversity, desolation, life and death

South Georgia is without doubt one of the most beautiful places I have ever visited.  I first set foot there in Right Whale Bay, late one summer evening, and was confronted with pandemonium – more seals than I had ever seen before, mixed with more penguins than I could comprehend, surrounded by other birds on the ground and the wing combining to create a cacophony amidst a visually overwhelming background of sheer splendour:  beauty, terrifying austerity, diversity, desolation,death, and life in abundance.

What my real job is like…

This is doing the rounds, and has us all in stitches (especially in the anaesthesia department, of course).  No orthopods were harmed in the making… but my head does hurt.  Click the image or link to play.

Anaesthesia vs Othopaedics

To be entirely fair, I thoroughly enjoy doping ortho cases, as I have an interest in regional blocks.  However, this conversation bears such striking resemblance to conversations that I’ve had with previous ortho’s that it can’t be allowed to go unknown 🙂  Each to his own, I suppose: when all you have is a hammer…

Random Photo – Ice in Cierva Cove

It’s not only the wildlife in Antarctica that is photogenic: the landscapes, sea and ice combine in innumerable ways to create awesome beauty.  While slowly cruising around Cierva Cove on the western side of the Antarctic Peninsula, the groups was captivated by a pair of crab-eater seals.  Turning around, I shot the sculpted ‘bergs beneath a brooding sky instead.  I don’t shoot in black-and-white often, but the emotion was unmistakable unavoidable.

Cierva Cove under a brooding sky in black and white

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