9789172059290 by Smakprov Media AB

9 789172 059290

ISBN 978-91-7205-929-0

Author Rickard Ånell is an orthopedic surgeon, flight surgeon, and specialist in hyperbarmedicine, and has worked for organisations such as the Swedish Armed Forces, the Swedish Polar Research Secretariat and the Centre for Teaching & Research in Disaster Medicine and Traumatology. He is also trained in tropical diseases and has worked as an accident and emergency doctor and surgeon. He helps both private individuals and companies with advice and medical knowledge during trips and expeditions.

The Travel Medicine Handbook

Rickard Ånell

The author, Rickard Ånell, is a licensed physician with great experience in travel medicine. As an orthopedic surgeon, flight surgeon, and specialist in hyperbarmedicine, he has worked for organisations such as the Swedish Armed Forces, the Swedish Polar Research Secretariat, and the Centre for Teaching & Research in Disaster Medicine and Traumatology.

RICKARD ÅNELL

Rickard Ånell on a mission in Afghanistan.

The Travel Medicine Handbook is a safe and indispensable companion on all trips and expeditions where direct access to medical care is lacking, regardless of whether the destination is a summer cottage or the South Pole. This book provides the knowledge needed to assess, and to some extent also treat, many different diseases and conditions. The first part of the book deals with important preparations before the journey, such as various risk situations, suitable medical equipment and vaccinations. The second part contains a comprehensive treatment guide with first aid, accidents, diseases and conditions – from respiratory distress and amoebic infection to ear injuries. This book is useful both for persons with medical training and for those who primarily want an introduction to the field.

RICKARD ÅNELL

Table of contents Foreword 10

The

Travel Medicine Handbook

FACTS

ADVICE

TREATMENT

Part 1. Before travelling 13 1. Planning and preparation 15 2. Risks during travel 19 3. Travel safety in high-risk environments 31 4. Dangerous animals 41 5. Vaccinations 49 6. Medical equipment on your journey 51 Part 2. Treatment guide 61 7. About first aid 63 8. Trauma treatment 67 9. Injuries and accidents 85 10. Diseases and infections 99 11. Symptoms and conditions 123 12. More advanced medical care 153 13. Communication and reporting 157 Explanations 164

ÂŠ 2014 The author and Gothia Fortbildning AB ISBN 978-91-7205-929-0 Prohibition against copying! Duplication of the contents of this book, in whole or in part, is prohibited under the Act on Copyright in Literary and Artistic Works without permission from the publisher Gothia Fortbildning AB, Stockholm. The prohibition applies to both text and illustration and is valid for all forms of duplication. Editor: Ingrid Sundqvist Cover and graphic design: Tomas RudstrĂśm Illustrations: Jeanette Engqvist Translation and adaptation: Space 360 AB First edition, first imprint Printing: Ednas Print, Slovenia 2014 Printed on environmentally friendly paper. Gothia Fortbildning Box 22543, 104 22 Stockholm, Sweden Customer service +46 (0) 8-462 26 70 Fax +46 (0) 8-644 46 67 www.gothiafortbildning.se The section on security was edited in corporation with SAAB Group.

Table of contents Foreword..........................................................10 Part 1. Before travelling..................................13 1. Planning and preparation ..........................15 Knowledge about the destination.......................15 Insurance and support........................................16 Nearest medical care facility...............................17 Your and your fellow travellersâ&#x20AC;&#x2122; health..............17 Emergency telephone numbers...........................18 2. Risks during travel......................................19 Traffic accidents.................................................19 Food and drink..................................................21 Age and pregnancy.............................................22 Diving and water sports.....................................23 Blood clots.........................................................23 Venereal disease.................................................24 Tattoos...............................................................24 Behaviour at the destination...............................24 Weather and geography......................................27 Dress..................................................................27 High altitude......................................................29

3. Travel safety in high-risk environments....31 Armed threats and robbery................................31 Under fire...........................................................32 Landmines..........................................................33 Survival..............................................................35 4. Dangerous animals.....................................41 Alligator and crocodile.......................................41 Bear....................................................................41 Dog....................................................................42 Elephant.............................................................43 Elk/moose..........................................................43 Hippopotamus...................................................43 Jellyfish..............................................................43 Large cats...........................................................44 Mosquito...........................................................44 Parasites.............................................................45 Scorpion.............................................................46 Snake.................................................................46 Tick....................................................................46 Wolf...................................................................47 5. Vaccinations.................................................49 6. Medical equipment on your journey..........51 Small medical kit................................................51 Advanced medical kit.........................................54

Part 2. Treatment guide...................................61 7. About first aid..............................................63 8. Trauma treatment........................................67 Always raise an alarm if you can! ......................67 L: Life-threatening surroundings, Life-threatening bleeding..............................................................67 A: Airway and C-spine control/ stabilising the neck.............................................69 B: Breathing.......................................................72 C: Circulation....................................................76 D: Disability/degree of consciousness and neurological injuries....................................................79 E: Exposure and environment............................79 Debriefing..........................................................83 9. Injuries and accidents.................................85 Bite injuries........................................................85 Blue nails............................................................86 Burns..................................................................86 Dental injuries....................................................89 Ear injuries.........................................................89 Eye injuries.........................................................89 Fracture..............................................................90 Internal bleeding................................................93 Luxation, dislocation.........................................94 Pneumothorax....................................................95 Tension pneumothorax......................................96 Wound...............................................................96

10. Diseases and infections............................99 Amoebic infection............................................100 Athleteâ&#x20AC;&#x2122;s foot....................................................100 Blood poisoning (sepsis)...................................100 Borrelia............................................................101 Chickenpox......................................................101 Cholera............................................................102 Cryptosporidium..............................................102 Dengue fever/breakbone fever..........................102 Diabetes...........................................................103 Diabetic coma, hyperglycaemia........................104 Diabetic with hypoglycaemia/coma .................105 Ear infection in the auditory meatus/ external otitis...................................................105 Ear inflammation/acute media otitis.................105 EHEC/ETEC....................................................106 Epilepsy............................................................106 Giardia.............................................................107 Haemophilus influenzae typ B (HIB)................107 Hepatitis A ......................................................107 Hepatitis B.......................................................108 Hepatitis C, D, E..............................................109 HIV..................................................................109 Influenza..........................................................110 Japanese encephalitis........................................110 Leishmaniasis...................................................111 Malaria............................................................111 Measles, mumps, rubella..................................112 Meningococcal meningitis................................113 6

MERS-CoV......................................................114 Pneumococcal/streptococcal pneumonia...........114 Pneumonia.......................................................115 Polio................................................................115 Rabies..............................................................115 Schistosomiasis/bilharzia..................................116 Sepsis...............................................................117 Sinusitis............................................................117 TBE (Tick borne encephalitis)..........................118 Tetanus and diphtheria.....................................118 Tuberculosis.....................................................119 Typhoid fever...................................................120 Urinary tract infection......................................120 Whooping cough .............................................120 Yellow fever.....................................................121 11. Symptoms and conditions......................123 Abdominal pain...............................................124 Acute airway blockage, choking.......................126 Allergic shock/anaphylactic shock....................128 Allergic reaction...............................................129 Blister...............................................................129 Blood clot/deep vein thrombosis, DVT.............130 Cramps............................................................130 Cold.................................................................130 Constipation....................................................131 Cough..............................................................131 Diarrhoea.........................................................131 Fainting............................................................132

Fever................................................................132 Frostbite...........................................................133 Gynaecological pain.........................................134 Haemorrhoids..................................................135 Head cold.........................................................135 Heart attack.....................................................135 Heat stroke/sun stroke (hyperthermia).............135 Hyperventilation..............................................136 Hypothermia....................................................137 Infected wound................................................139 Ingrown toenail................................................139 Insect bite.........................................................140 Jellyfish sting....................................................140 Jet-lag...............................................................141 Lumbago..........................................................141 Mountain sickness: HAI, AMS, HACE, HAPE.142 Muscular pain..................................................144 Nausea.............................................................144 Nosebleed........................................................144 Pain..................................................................145 Parasites...........................................................145 Poisoning.........................................................146 Prostatitis.........................................................147 Reflux..............................................................147 Scorpion sting..................................................147 Seasickness.......................................................148 Slipped disc......................................................148 Snake bite.........................................................149 Snow blindness.................................................150 8

Sore throat.......................................................150 Stroke...............................................................151 Sun stroke........................................................151 Tick..................................................................151 Travel sickness.................................................151 Unconsciousness...............................................152 12. More advanced medical care.................153 Inserting a needle intravenously or intraosseously...................................................153 Suturing techniques..........................................154 Linear anaesthesia............................................155 13. Communication and reporting...............157 Injury journal...................................................157 Report template...............................................157 Prioritising injured persons...............................161 Helicopter landing site.....................................162 Radio communication, spelling out..................163 Examples of emergency calls............................163 Explanations....................................................164 References........................................................168 Index................................................................169 Notes...............................................................173

Foreword Travelling beyond the familiar routesâ&#x20AC;&#x201C;whether to a cottage in the interior of Norrland, on an expedition to Namibia or on a ship in the Arctic Oceanâ&#x20AC;&#x201C;often means that you are far away from hospitals and medical care. What do you do when something happens, and there is no help to be had? This is what this book wishes to highlight. Some problems can be solved entirely on your own, others can be alleviated while waiting for medical care. In the event of trauma and emergency conditions, what the first person on location does often plays a greater role than what a doctor performs at a medical centre several hours later. The more medical knowledge people in the local environment have, the more lives can be saved. Apart from first aid, this book also deals with injuries and accidents, and diseases and infections, as well as symptoms and conditions. These are presented in alphabetic order, with suggestions for measures and treatments. The treatments consist both of things that anyone could do themselves and more advanced treatments that can be given by persons with some medical training. The book also deals with how to prepare ahead of travelling, and travel safety and survival in various types of threatening environments. The book is intended to increase the rewards of travelling and to reduce the risk of illness when access to medical care is limited. Knowledge may be the difference between a trip being cut short and being able to continue, regardless of whether you are on an expedi10

tion, a climber, a journalist on an assignment or an ordinary traveller who does not have a doctor in the car. The book is dedicated to my wife Tina: Thanks for the journey of my life! Without your single-minded support, these experiences would never have been learned, or this book produced. Rickard Ånell

Rickard Ånell is an orthopedic surgeon, occupational and environmental health specialist, flight surgeon, and specialist in hyperbarmedicine. He works as Global Medical Adviser for the SAAB Group. He has worked for the Swedish Special Forces, the Swedish Polar Research Secretariat and the Centre for Teaching & Research in Disaster Medicine and Traumatology, and for many years has run Adapted Medical Solutions AB, which conducts training for and gives advice to many Swedish security companies and international companies. Mr Ånell is also greatly interested in tropical medicine and trained in Swedish, Ethiopia, Tanzania and Zanzibar. He has worked as a surgeon, and an accident and emergency doctor. The technical content of the book was reviewed by Professor Tore Vikström, Centre for Teaching & Research in Disaster Medicine and Traumatology in Linköping; Per Loftås, Consultant at the Surgery Clinic, Norrköping; Dag Lemming, Docent, Aerospace Medical Centre, Linköping; Andreas Johansson, Surgery Clinic, Lidköping; Thomas Axelsson, Anaesthetics Clinic, Värnamo; and Mats Wizén, Medical Officer on the state icebreaker ODEN. The section on security was edited by Jens Berglund, Corporate Security SAAB AB, ahead of the English edition. More information about the author is available on www.medicalsolutions.se

Part 1.

Before travelling

1. Planning and preparation Regardless of whether you are travelling alone or in a group, there are some preparations you should make to make things easier if anything should happen. Of course, the risks are different depending on where you are going, and what your task and purpose of the journey is. Knowledge about the destination Being prepared is the best way to a good travel experience. Making time for the right preparations, and finding and taking in the right information is not always easy. Start by thinking about the challenges and uncertain factors that you feel comfortable with, such as primitive housing, limited opportunities for personal hygiene, or unreliable transport times. Adapt the planning to suit your and your fellow travellersâ&#x20AC;&#x2122; wishes, experiences and prerequisites. Never take a chance unless you are prepared for the consequences. This applies to all risksâ&#x20AC;&#x201C;financial, medical and security-related. During your planning, you will come across stories where people have made extraordinary journeys without the slightest mishap, but do consider whether this was due to luck or skill. Always start by finding out the facts, reading up on travel advice from

the website of your country’s foreign ministry. If you need an in-depth picture, the British Foreign & Commonwealth Office has a very high international standard of travel advice (www.gov.uk). Remember that if you do not follow the recommendations of the authorities and the insurance companies, your chances of getting help or compensation may be severely limited. Insurance and support The more distant and more exposed your journey, the better support you will need. A minimum is always ordinary travel insurance. Be sure to have the contact information for your insurance company or your administrator immediately available. Check that your insurance company is open round the clock. This service is known as 24/7 – 24 hours a day, 7 days a week. If you plan to travel alone to sparsely populated areas, you must have planned both for the need for emergency transport out in the event of injury, and how the link-up with the person collecting you is to be made. You should also add as a routine precaution: “If I have not been in contact within 48 hours, you should start searching for me via the following contact, where my travel plan is lodged.” Alternatively, email you travel plan to your employer or family. Today there are many technical solutions, such as GPS trackers, 16

that can show your position. However, you should never rely solely on electronic equipment. Nearest medical care facility If you are going to an area where medical care is not fully available, making personal contact with the nearest medical care facility is a good idea. There you can find out the various contact routes and transport facilities that exist. This should be done ahead of each journey, even if you have been to the destination before, as telephone numbers, contact persons and email addresses often change. Your and your fellow travellersâ&#x20AC;&#x2122; health It is important to ensure that the health of you and your fellow travellers is up to the challenges you will meet on your travel. During an ordinary trip, as well as on a two-person expedition, you may have to care for you and your fellow traveller yourself, so an in-depth discussion about allergies, previous injuries and illnesses is important. How do I take care of my fellow travellerâ&#x20AC;&#x2122;s diabetes or heart disease? How should I act, and what medications can I give? Talk about this before departure, and prepare yourselves so that you can best handle situations that arise. Once you are actually travelling, it may be very difficult, or even impossible, to resolve situations that could otherwise be handled easily with the right knowledge, 17

equipment and medications. For more demanding travel to places with weak infrastructure and limited access to care, it may be suitable to have a health check before departure, in particular if you belong to some medical risk group. Emergency telephone numbers Are telephone numbers and email addresses upto-date? What means of communication will I need? Do I have backup for my communication equipment? Mobile telephone, satellite telephone, radio? Save the telephone numbers of your immediate family on your mobile telephone.

2. Risks during travel Traffic accidents One of the most underestimated risks when travelling are traffic accidents, which are actually by far the most common cause of injury on most travel abroad. More travellers die from traffic injuries than from infectious diseases in many countries. Motorcycles and mopeds are felt by many to be a cheap and convenient way of getting around. But in several destinations, this is a totally unsuitable means of transport, as motorcycle accidents represent the majority of tourists injured in traffic. Remember the following: ·· Avoid travelling by car at night, as the risk of accidents is greater due to poor lighting, people on the road and risk of assault. ·· Never drive a vehicle when under the influence of alcohol or drugs. ·· Use a helmet (moped/motorcycle) and safety belt (car and bus). ·· Avoid driving vehicles that you are not used to. ·· Use a safety belt, even on a holiday trip. ·· Take the time to check the brakes, lights, wheels, fuel and range (i.e. how much fuel you have got in the tank) of your vehicle. ·· If the driver you have is careless, ask him to stop and leave the car.

Part 2.

Treatment guide

9. Injuries and accidents This section describes injuries and accidents that may occur, both on long-distance travel and at a holiday cottage or on a sailing trip. Many injuries and accidents require medical care and are marked “Seek medical care” or “Medical care may be needed”. Emergency conditions are marked “Emergency condition” and must be brought to a medical facility as soon as possible! The treatment advice also includes more advanced treatments and prescription medications (prescription medications are marked with a *) as a guide for those who have medical training and have brought such equipment along (see also Chapter 6). You should always raise an alarm and contact your 24/7 doctor before giving any prescription medication. However, first aid and treatment according to L-ABCDE (see Chapter 8) must always be started immediately.

All bite injuries must be considered as infected wounds and are often treated with antibiotics for preventative purposes. Cat bites (around 15 per cent of all bite injuries) often contain different bacteria (for example Pasteurella multicoda), which require broader spectrum treatment. For bite injuries from dogs (around 80 per cent of all bite injuries) and bats, consider the risk of rabies (see page 115). Bites from humans must also be considered as infected. Bite injuries are most common on knuckles, fingers and the head.

MEDICAL CARE MAY BE NEEDED

Bite injuries

Symptoms: Infection, pain, redness, increased heat, pus formation, reduced mobility. Cause: Bacterial infection. Treatment: Wash the wound very carefully mechanically with soap, if you have any with you, and plenty of water. Remove any dead tissue. Always leave infected wounds open, with a covering dressing. Seek medical care. If you are far from medical facilities, treat with amoxicillin* + clavulanic acid* (Spectramox速) 500 mg, 3 times daily for 10 days. For human bites, consider also the risk of hepatitis B and HIV infection. If the bite is located on the hand, extra careful checks must be made due to the great risk of infection close to the ligaments. In the event of reduced mobility, redness, pain in fingers on the palm side, seek medical care as soon as possible, as an operative intervention is often necessary.

Blue nails Symptoms: Strong pain and discolouration of nails. Cause: Crushing injury with bleeding under the nails. Treatment: Heat one end of a paperclip in an open flame; once it is glowing, carefully push the tip through the nail where the blood layer is the thickest. Once the nail is perforated, the bleeding will empty and the pain reduce. If severe pain remains over the skeleton, suspect a fracture (see page 90); relieve pressure and seek medical care, in particular for pain from the joint.

Burns All burns apart from first degree burns (see next page) should be cooled as quickly as possible to halt the burning process. Remove any warm, soaked or melted clothes that are not stuck to the wound, cut off remaining textiles, but leave those stuck in the wound. Rinse off any remaining chemicals. Check

whether there is soot and redness around nose and throat, or if the injured person is hoarse or has difficulty breathing. If the injured person has inhaled heated gases, there is a risk the airway will swell shut, and the person should be taken to hospital as soon as possible. Be prepared to give breathing assistance or create an open airway with the equipment you have, for example a “mushroom” or oropharyngeal airway, see Chapter 8 (page 70). If you do not have access to medical care on location, contact the doctor on call (24/7 service). Persons with burns require a large amount of liquid due to leakage of body fluids from the damaged tissue as a result of the skin’s protective barrier being destroyed, and a pronounced evaporation takes place. Give conscious persons plenty of fluids. In order to calculate the fluid loss, you can use MUIR’s formula: (percent of a person’s surface that is burnt x weight in kilograms)/2 = fluid loss (ml). You can mix your own fluid replacement to give orally to conscious persons: 1 litre water, ½ tsp. salt, 1 tbsp. sugar, ½ tsp. baking powder. Unconscious persons must be given fluid straight into the blood flow via various types of needles; intravenous or intraosseous, administered by a person with medical training. Pain relief is always required for conscious patients, apart from isolated third degree burns, when the nerves are badly burnt and less pain is felt. Fentanyl* 400 mg lozenge (Actiq®) at the acute stage if the pain is very severe. For milder pain, use paracetamol 1 g x 4 (for example Panodil®) and Tramadol retard* 100 mg x 1–2 for severe pain (Tradolan retard®).

First-degree burns Symptoms: Red, painful skin. Damage to the outermost layer of skin. Cause: Sunburn, for example. Treatment: Cooling balm, avoid further exposure.

SEEK MEDICAL CARE

Second-degree burns

SEEK MEDICAL CARE

Third-degree burns

EMERGENCY CONDITION

Chemical burns

Symptoms: Redness, pain, blister formation. Cause: Scalding with hot water, for example. Treatment: Flush the damaged body part with cold water for at least 20 minutes, or until the pain reduces. Avoid flushing the whole body, as there is a risk of hypothermia (chilling). Avoid piercing blisters. Wash with soap and water as necessary. Apply protective burns bandage (such as Watergel速) or plastic film. Second degree burns on a surface larger than the palm of the injured person must be examined by medical personnel, as well as all burns to the face or the genitals.

Symptoms: White/yellow or charred skin. No feeling or bleeding. Whole skin damage that has affected all skin layers. Cause: Fire in clothes or electrical burn. Treatment: All third degree burns must be taken to medical care. Wash with soap and water as necessary. Cover the injury with a burns bandage or plastic film. Give plenty of fluids.

All chemical burns must be taken to medical care for assessment. Initial treatment according to L-ABCDE (Chapter 8). Flush the injured area with plenty of tepid water, but not over the entire body as there is a risk of hypothermia (chilling). Flush for at least 20 minutes if the injured person has been exposed to an acid or alkaline solution; for strong alkaline injuries, flush for 45 minutes. If the eye is damaged, maintain continuous flushing until contact with a doctor has been established. Remove any rings immediately, as well as any contaminated clothes.

First aid measures for chemical burns: ·· Inhalation: give fresh air and possibly oxygen. ·· Contact with skin: remove contaminated clothes, flush liberally with water. ·· Contact with eye: flush with large amounts of water until the injured person gets medical care. ·· Ingestion: give two glasses of water or milk to drink. Do not cause vomiting. Always contact a doctor in the event of a chemical burn. Note that the treatment of injuries caused by chemical substances may vary radically, depending on the substance in question. Some elements produce heat on contact with water.

Symptoms: Pain, missing section of tooth, shooting pain. Cause: Trauma. Treatment: Retain the loose tooth in the mouth or in a glass of milk; seek a dentist. If staying in an inaccessible environment: After cleaning, a temporary mend can be done, for example using Coltosol-F®*. For a whole tooth that has been pushed out, push the tooth back in carefully. Seek dental care!

Symptoms: Severely swollen and discoloured ear cartilage. Cause: Bleeding between cartilage and skin. Treatment: Should be drained with a needle by an ear specialist due to the raised pressure which causes damage to the cartilage and cauliflower ear (shrunken outer ear).

For major penetrating injuries, do not remove the foreign body; cover the eye and seek an eye specialist as soon as possible.

MEDICAL CARE MAY BE NEEDED

Eye injuries

SEEK MEDICAL CARE

Ear injuries

SEEK MEDICAL CARE

Dental injuries

Symptoms: Grainy feeling, pain, impact on vision, reduced sharpness of vision, light sensitivity, tear flow. Cause: Injury to the cornea, foreign body, weld flash. Treatment: Flush liberally in the event of a foreign body or chemical substance, preferably with an eyebath under both eyelids, while the injured person looks in different directions. If necessary, turn the upper eyelid inside-out and flush liberally. If the pain is unbearable, you can anaesthetise using, for example, tetracaine* eye drops 1.0 per cent, 1â&#x20AC;&#x201C;2 drops in the eye as necessary. The eye should then be covered after anaesthesia so that no further damage is done due to the lack of pain. SEEK MEDICAL CARE

Fracture Symptoms: Pain, wrong position, swelling, discolouration. Cause: Direct or indirect violence. Treatment: There is rarely any acute hurry, with the exception of unstable pelvic fractures, where the minutes count.

An unstable pelvic fracture can cause severe and rapid internal bleeding, which leads to death unless it is treated surgically. Unstable pelvic fractures must be compressed immediately using a pelvic girdle, for example T-PODÂŽ. Feet and legs are intro-rotated, the toes should point towards each other and fixed in this position. This reduces the volume in the minor pelvis. You can also twist a wet sheet around the pelvis at the height of the ball of the hip. Twist the sheet hard; if necessary, you can thread through a handle to further increase compression (the same technique as a tourniquet; see page 68). The injured person needs to be taken to medical care immediately for an operation.

Pelvic girdle with sheet

Medical care should be sought for all fractures. If you are far from any medical facility, the fracture may be fixed Figur 7 on location. Check whether there is feeling, pulse and movement distal from (below) the injury. This is called the distal status. If these are present, fix the injury in its present position against the body or an external device, such as a Sager extreme splint速. Fractures must be fixed beyond both one joint above and one joint below the fracture. For example, to fix a break of the shin bone, both the foot joint and the knee joint need to be fixed to provide stability

around the fracture, while a thigh bone break must be fixed and braced from the lower leg across the hip joint. Finger fractures are most easily fixed to the neighbouring fingers using tape. The fingers should be slightly bent (see two finger fixation, page 95). If the distal status is poor, i.e. there is no feeling, pulse or movement below the injury, then nerves and blood vessels are impacted and the fracture needs to be put back into its original position. This applies in particular to unstable fractures, for example serious foot joint fractures that easily glide out of position. There is a great risk of vessel and nerve damage here.

Repositioning If possible the injured person should receive pain relief before you reset the fracture, for example fentanyl* lozenge 400 micrograms, where the effect is felt within 5 to 10 minutes. Repositioning is easiest done if two people are helping. One takes hold above the injury, as a counterweight, and the other slowly starts to pull in a distal direction, i.e. in the direction of the sole of the foot or the fingers. The more musculature around the break, the more force is needed. Once the length and angle have been reset (compare with the other side if possible), any rotation error can be corrected. This must never be done until the fracture ends have been pulled apart. Check the distal status again, as pulse and feeling should hopefully have returned. Maintain the pull and fix in existing position. Remember to check the distal status regularly.

Fracture reposition

Figur 8

This is an acute life-threatening condition!

EMERGENCY CONDITION

Internal bleeding Symptoms: Signs of bleeding, but no external bleeding found. High pulse, low blood pressure, cold sweat, nausea, paleness, confusion. Cause: Internal bleeding. Treatment: Operation at a medical facility. Internal bleeding cannot be compressed from the outside. 2 g tranexamic acid (Cyklokapron速) can be given intravenously if there are no contra-indications (according to the CRASH-II study).

9 789172 059290

ISBN 978-91-7205-929-0

The Travel Medicine Handbook

Rickard Ånell

RICKARD ÅNELL

Rickard Ånell on a mission in Afghanistan.

RICKARD ÅNELL

Table of contents Foreword 10

The

Travel Medicine Handbook

FACTS

ADVICE

TREATMENT