Tourniquets have a checkered history past and current combat in the SW Asian theaters has drawn new attention to them.

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Femur fractures are serious injuries that usually occur as the result of significant forces. A full assessment, focusing on critical system problems and their stabilization is the crucial first step.

Effective stabilization of femur injuries will help alleviate pain and decrease the possibility of complications. I believe that either a vacuum splint or good padding in a stable carrying device does a good job of providing both.

Although there is no literature supporting their efficacy in the prehospital setting, a commercial traction splint can be a useful tool when applied by a skilled practitioner who receives periodic training on a particular device and/or uses it during rescues or EMS calls. They should not be left on for a prolonged period of time (e.g., greater than 2 hours) unless limb neurovascular integrity and splint tension can be monitored properly and regularly.

Regardless, these are painful injuries. All require the administration of analgesics.

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If you heard about the man who survived a cardiac arrest by receiving 96 minutes of cardiopulmonary resuscitation (CPR), you might be wondering how I feel now about our position on when to discontinue CPR.

We have steered away from silver sulfadiazine (e.g., Silvadene) at work for years. We have found that products like a vasoline-type gauze, e.g., Xeroform, is more comfortable and easier to maintain requiring fewer banadage changes.

If the stuff works, it seems it may reduce possible contact with blood borne pathogens to staff.

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It is difficult to know how to respond to H1N1.  Last spring schools were closing with the first whiff of a possible infection.  Now, kids who are sick are segregated until they can be sent home.  Schools are unlikely to be closed unless the numbers of absentees are large enough to prevent normal function or…