The incidence of pelvic fractures with traumatic lower limb amputation in modern warfare due to improvised explosive devices.

AIMS: A frequently-seen injury pattern in current military experience is traumatic lower limb amputation as a result of improvised explosive devices (IEDs). This injury can coexist with fractures involving the pelvic ring. This study aims to assess the frequency of concomitant pelvic fracture in IED-related lower limb amputation. METHODS: A retrospective analysis of the trauma charts, medical notes, and digital imaging was undertaken for all patients arriving at the Emergency Department at the UK military field hospital in Camp Bastion, Afghanistan, with a traumatic lower limb amputation in the six months between September 2009 and April 2010, in order to determine the incidence of associated pelvic ring fractures. RESULTS: Of 77 consecutive patients with traumatic lower limb amputations, 17 (22%) had an associated pelvic fracture (eleven with displaced pelvic ring fractures, five undisplaced fractures and one acetabular fracture). Unilateral amputees (n = 31) had a 10% incidence of associated pelvic fracture, whilst 30 % of bilateral amputees (n = 46) had a concurrent pelvic fracture. However, in bilateral, trans-femoral amputations (n = 28) the incidence of pelvic fracture was 39%. CONCLUSIONS: The study demonstrates a high incidence of pelvic fractures in patients with traumatic lower limb amputations, supporting the routine pre-hospital application of pelvic binders in this patient group.

The early detection and management of neuropathic pain following combat injury.

The mechanism of injury on the modern battlefield results in a pattern of wounding which is associated with both nociceptive and neuropathic pain. Nociceptive pain is managed using the WHO Analgesic Ladder but neuropathic pain requires the use of co-analgesic drugs, e.g. antidepressants and anticonvulsants. This study was designed to determine the incidence of neuropathic pain within military casualties with limb injuries. From May to November 2007, 50 casualties were interviewed and assessed using the Leeds Assessment of Neuropathic Symptoms and Signs Scale (LANSS) over consecutive weeks. During the first week post injury, 30% of casualties had a LANSS pain score > 12, suggesting a neuropathic element to their pain. The early detection (using LANSS) and management of neuropathic pain using robust protocols represent the most effective strategy to address this significant problem.

Battlefield analgesia: an advanced approach.

We present an advanced battlefield analgesia protocol that is designed to provide the maximum benefit for the greatest number of patients using the minimum of resources. During the development we considered logistics, drug pharmacology and safety, aetiology of the pain and the experience of the expected administrator. Analgesia is only considered after the "ABCD" criteria of the Primary Survey have been satisfied. The analgesics administered range from enteral nonopioids through to intravenous opioids based dynamically upon the Visual Analogue Score (VAS). We suggest this protocol could be used by healthcare workers who may not have been trained in acute pain management but are called to administer analgesia to the serviceman in pain.

Management of chest injuries--a 5 year retrospective survey.

One hundred and eighty one patients with chest injuries (145 with blunt injuries and 36 with penetrating injuries) were managed using a standardized protocol at the JIPMER Hospital between 1990 and 1995. The insertion of an intercostal tube drain, provision of analgesia and oxygen was sufficient in 80 per cent of patients. An operation was required in 30 per cent of those with penetrating injuries but in only 6.2 per cent of those with blunt injuries. Most patients with chest injuries do not require an operation and can be treated adequately at District General Hospitals. Those with penetrating injuries are more likely to need surgery than those with blunt injuries.

Battlefield analgesia--a basic approach.

There is a requirement for a basic approach to the provision of analgesia on the battlefield using the morphine autojet. Assuming there is cardiorespiratory stability and no contraindications to opioid therapy, morphine can be administered intramuscularly to a serviceman in pain on a 2 hourly basis provided that there are no adverse effects on the respiratory rate and degree of sedation. This proven simple approach in civilian practice has the potential to be incorporated into Battlefield Advanced Trauma Life Support (BATLS) and Combat Training Regimens (CTR).

Recommended reading for the FRCA diploma. Fellow of the Royal College of Anaesthetists.

Anaesthetists in training have access to a bewildering array of journals and textbooks from which to acquire information for the FRCA diploma. From the results of a questionnaire sent to 60 senior registrars, we have produced a core selection of journals and textbooks to guide the trainee preparing for all three parts of the diploma.