WMT’s Medical Director Dr Harvey Pynn, A&E consultant at the BRI, is pleased to share this exciting job notice. The closing date is 17 February.
The CQC outstanding rated University Hospitals Bristol NHS Foundation Trust (UHBFT) seeks applicants for Clinical Fellow posts in Emergency Medicine at SHO/ST 1 – 2 Level, to commence August 2020. The posts are ideally for a period of twelve months however applicants wishing to take a 6 month post will also be considered. Successful applicants will have the option to take a full time, or less than full time, 100% Emergency Medicine post or a hybrid post as described below (subject to availability).
As well as Emergency Medicine clinical posts, there is an exciting option of combining clinical Emergency Department work with developing an area of specialist interest.
This would be on the basis of 80:20 Emergency Medicine: Specialist interest and is paid on the same basis as the full time ED rota.
Currently active areas of specialist interest include Expedition Medicine, Global Health Medicine, Simulation, Intensive Care Medicine, Wellbeing, Research and Broadcasting. We would, however, be happy to consider any other suggestions from suitable candidates as long as they are justifiable from the perspective of contributing to the wider field of medicine.
Following quickly on from last week’s MBD No 15 (Is it time to ditch the Lake Louise Score?), in this Medical Director’s Bulletin No 16, Dr Harvey Pynn highlights important medicine issues involving recalls of the EMERADE ADRENALINE PEN and RANITIDINE TABLETS. There is also a temporary delay with Nomad Pharmacy being able to supply POMs.
High altitude medicine is of interest to many readers and most mountain travellers will be familiar with the Lake Louise Score for assessing acute mountain sickness. In this MDB, Dr Harvey Pynn asks the provocative question: Is it time to ditch the Lake Louise Score? Read the full bulletin here.
“…I can’t think of a course I’ve attended where I have taken away so much training output in so little time.” wrote delegate Ben Conway after attending Advanced Medicine at Glenmore Lodge recently.
Ben continues: Let me thank you again for the course delivery. I can’t express how important it is for me personally to have been shown techniques to sustain myself and those around me in situations we train to never be in, but may face nonetheless. I’ve been a first aider my whole life, and an instructor for a few years. It’s only now that I can say unequivocally that I would be confident and assertive when approaching an emergency situation. I think you’ve struck upon a seam of value in the training landscape and I can’t think of a course I’ve attended where I have taken away so much training output in so little time.
The next Advanced Medicine course runs 9-12 May. The mind maps below give some idea as to the broad scope of expedition medical planning and what WMT training equips delegates to consider and deal with.
Dr Harvey Pynn reflects on the news story today about Briton Audrey Schoeman who was revived after six-hours in cardiac arrest.
Chain of survival
Harvey writes:
Audrey Schoeman became unconscious when she was caught in a snowstorm while hiking in Spain. This is a remarkable story of survival.
Audrey Schoeman
There are similar cases in the press every year such as the Polish toddler story. Other more ‘famous’ stories that have been published are the Danish Fjordland boating accident where many children became severely hypothermic (see this paper Praesto fjord accident) or about Dr Anna Bagenholm who became trapped under the ice skiing off piste in Norway and was the subject of this short BBC horizon documentary by Dr Kevin Fong.
Getting very cold very quickly conveys a distinct advantage when it comes to survival from a cardiac arrest. Our core temperature is 37°C. As we get cold, our brain requires less oxygen to survive – for every degree the brain cools, its oxygen requirements decrease by 5%. Audrey’s body temperature went down to <18°C so the oxygen requirements of her brain would have been negligible. However, her heart would have stopped beating as she cooled through about 25°C. Therefore she would not have survived unless blood (and therefore oxygen) had been supplied to the brain. CPR was critical here.
In fact the whole chain of survival was still critical and all the links were in place even if the timelines were drawn out. And the only link that wouldn’t have been hugely important in Audrey’s case was defibrillation which wouldn’t have been attempted until after she had been re-warmed significantly (to approx 30°C.)
Audrey received CPR throughout her long phase of cardiac arrest and was taken to a hospital that has the ability to put patients on VA ECMO (veno-arterial extracorporeal membrane oxygenation) which is where cold blood is taken out of the body, put through a filter, oxygenator and warmer, and then pumped back into the body. With VA ECMO, the machinery takes over the role of the heart and the lungs and allows the patient to be warmed quickly (at between 6°-9°C per hour).
It is notable that the ability to perform this intervention in the UK is severely limited (there are only 5-6 hospitals in the UK with the ability to do VA ECMO though there are others who can put patients on cardiac bypass with similar effects).
The most remarkable aspect of this story was that Audrey was discharged from hospital after only 12 days and seems to close to making a full recovery in only a few weeks. This is a wonderful story of survival and a testament to every person involved in the resuscitation, from those who did CPR at the scene, all the way to the intensive care staff who commenced VA ECMO.
Dr HJ Pynn FRCEM
Medical Director
Wilderness Medical Training
Consultant in Emergency Medicine
University Hospitals Bristol NHS Foundation Trust
Join Mountain Medicine on Skis, Chamonix 27-31 January. A cancellation has freed up 1 place. Raise your game on and off piste with guided instruction and learn the essentials about mountain medicine from WMT Medical Director Dr Harvey Pynn on this demanding course for a maximum of 10 strong red run skiers. Details and booking online here. Don’t forget, there’s also the Expedition Medicine course in Chamonix 2-6 March that allows free time to ski.
A doctor is needed for an Atlantic crossing to the Bahamas on a tall ship.
Adventure Under Sail Operations Manager Kellie Grice provided these details. Contact Kellie directly for more info.
We are looking for a qualified doctor to do an Atlantic crossing onboard the tall ship Pelican of London as part of the voyage “Ocean College”.
This would mean sailing with us from the 19th of February in the Caicos Islands, till the 5th of April in Vigo. We may be able to let them join in Bermuda on the 7th of March if they could not come for the whole time.
Ocean College is a programme with 31 young people aged 15 to 18 onboard. They are schooled by 4 teachers whilst sailing a loop of the Atlantic over a 6 month period. There will be 7 permanent ship’s crew aboard. Full details of the programme can be found at www.oceancollege.eu.
The doctor should be confident with issuing prescription drug from the medical kit, and happy to deal with any accidents which occur onboard. We do have satellite communications that can be used to contact shore based medical support if they require it in the event of an emergency. We hope that their skills as a doctor will not be used on route, so anyone with some knowledge about sailing, or desire to learn would be ideal. Then they can also get involved with day to day life aboard the ship.
They will be in a shared cabin, with bunk beds. All food will be supplied onboard and the cost of their flights will be covered. Please pass on my details to anyone who may be interested. Thanks!
Kind regards,
Kellie Grice
Operations Manager
Adventure under Sail
T. 07743159967
E.
Introduction
This case is about a 21 year old male trekker who presented with a severe headache and fever on Mount Kilimanjaro in Tanzania.
Headache is common at altitude and is often a sympton of acute mountain sickness (AMS) or high altitude cerebral oedema (HACE). Many symtpoms of high altitude defined medical problems can be mimicked by conditions unrelated to being at altitude such as infection, dehydration, hypoglycaemia and hypothermia.
In a wilderness setting, it can be difficult to differentiate between varying causes of headache without recourse to investigations. It is therefore crucial for expedition medics to consider all possible differential diagnoses in order to safely and effectively manage participants.
WMT’s flagship international Expedition Medicine course, now later than normal 2-6 March 2020, has so far attracted delegates from New Zealand, America, Sweden, Canada, Ireland and across the UK including med students, nurses, GPs, junior doctors and surgeons. This truly is an inclusive and multi-disciplinary, multi-national event packed with thought leading medical content, career advice and inspiring faculty life stories. There’s a poster competition again and crucially, a good chunk of time is available for free skiing. Delegates are now busy arranging shared accommodation and finding ski lesson partners via the course WhatsApp group. Dr Lucy Obolensky Featured faculty: Hear from Dr Lucy Obolensky and her work as a global health advocate and TV doctor with Sir David Attenborough. WMT’s Ice Maiden – GP Nics Wetherill – knows a thing or two about extreme cold conditions as co-leader of the first all-female team to ski coast to coast cross Antarctica. Ice Maiden – Dr Nics Wetherill Daily themes (playfully cryptic this year) are:
Mountain medicine, safety and rescue
Get ready! (with a global health flavour)
Practical outdoor workshops
Hot and traumatic
Cold and poorly
See the web page for the full programme. Discounted places are still available (but limited) for nurses, paramedics and medical students. Join us! Book online.
