Download - Travel Medicine for Physicians
![Page 1: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/1.jpg)
John Sinnott, MD, FACPJohn Sinnott, MD, FACPAssociate Dean, International AffairsAssociate Dean, International Affairs
Director, Division of Infectious DiseaseDirector, Division of Infectious DiseaseUniversity of South Florida University of South Florida
College of MedicineCollege of Medicine
Travel Medicine for PhysiciansTravel Medicine for Physicians
![Page 2: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/2.jpg)
Let’s Look at Travel
![Page 3: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/3.jpg)
![Page 4: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/4.jpg)
![Page 5: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/5.jpg)
Research Before Traveling:•Europe: www.ricksteves.com •Elsewhere: Lonely Planet Guide•CIA World Fact Book
– www.cia.gov/cia/publications/factbook •US Department of State
– http://travel.state.gov/travel/cis_pa_tw/tw/tw_1764.html •Tourism information
– www.towd.com •Medical kits and other travel products
– http://www.adventuremedicalkits.com/ – http://www.travmed.com/
Do not leave the US without reading about your destination!
![Page 6: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/6.jpg)
Online Resources for the Traveler• Travel Gear: www.magellans.com
• Passports: http://travel.state.gov/passport/passport_1738.html
• Visas: http://travel.state.gov/visa/visa_1750.html
• Tourism info: www.towd.com
• Airports/flights:– http://www.flytecomm.com/cgi-bin/trackflight – www.quickaid.com – general airport info
• Weather: www.worldclimate.com – www.weather.com – www.accuweather.com
![Page 7: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/7.jpg)
Online Resources for the Traveler• Money: www.x-rates.com • Communications: http://www.countrycallingcodes.com/ -
International calling code directory– North America: www.allareacodes.com – www.frequentflyer.oag.com – toll-free number site with
hotels, car-rentals, airlines, etc.– Phone cards: www.nobel.com
• Electrical systems: www.kropia.com/electric.htm • Foreign languages: www.babelfish.altavista.com • Metric conversions: www.sciencemadesimple.com • On the Ground: www.amtrak.com
– www.aaa.com – http://subway.umka.org/
![Page 8: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/8.jpg)
IN GENERAL:
• Trauma - Cars, falls, swimming
• Social - Sex, drugs = hazards
• General - Label meds, travel light
• ID - Malaria, zoonoses
• Eating - Hot food served hot, CO H2O
• Wildlife - Avoid animals, insects
![Page 9: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/9.jpg)
![Page 10: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/10.jpg)
![Page 11: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/11.jpg)
![Page 12: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/12.jpg)
SCOPE OF PROBLEM - Yearly• 24M travel to developed areas
– 6M ill (25%)• 6M travel to developing countries
– 3M ill (50%)– 2M exposed to malaria
• Mortality: 3000 (.0015%) – 2000 MVA– 600 Falls– 200 ID– 100 Misc (CDC, 2008)
![Page 13: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/13.jpg)
BEFORE TRAVELING:“Think the trip through”
• Place– Developing vs. industrialized
– Hotels vs. “roughing it”
– Season: weather, vectors
– Air: jet lag, URI
– Ship: LRI, diarrhea
– Altitude: HAPE, HACE
![Page 14: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/14.jpg)
“Bucket Shops”• Global Touch - http://www.globaltouch.net/ - Offers consolidator tickets
to travel agents and the public.
• Justfares.com - http://www.justfares.com - Offers flights online or via live agents.
• OZ Flights - http://www.ozflights.co.uk/ - Offers flights from UK to Australia and New Zealand.
• Corporate Flyer - http://www.flyfirstclass.com/ - Discounted business and first class international airline tickets.
• Flight Coordinators - http://www.flightcoordinators.com/ - Offers international flights from the US.
• Executive Class Travel - http://www.executivetravelservice.com - Offers discounts on first class and business class tickets.
![Page 15: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/15.jpg)
• Travel Club International - http://www.unpublishedairfare.com Specializing in unpublished airfare to Europe, South America & Asia.
• IBN United - http://www.ibnunited.com/ Air consolidator to selected European and Middle East destinations.
• Holiday Deal Finder - http://www.holidaydealfinder.co.uk Offers both scheduled air and charter flights from UK airports.
• AirFareOutlet.ca - http://www.AirfareOutlet.ca Offers Air from major Canadian gateways, to destinations around the world. Compares consolidator fares against published fares.
• BizTravelDeals.com - http://www.biztraveldeals.com Offers First class, and Business class, consolidator airfares to all global destinations.
“Bucket Shops”
![Page 16: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/16.jpg)
• Sky Bird Travel and Tours - http://www.skybirdtravel.com/ Consolidators that supplies international airfares to travel agents.
• Airline Tickets Direct - http://www.airlineticketsdirect.com Books flights to or from Canada with major Canadian airlines.
• DiscoveryWorld.com - http://www.discoveryworld.com/ Offering airfares to Europe, Asia, Australia, Africa, South and Central America leaving from all major US gateways.
• Airtravel Network - http://www.airtravel.net Provides airfare to several international destinations
“Bucket Shops”
![Page 17: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/17.jpg)
flyfirstclass.com
• How to get a good seat!! Double secret information• Sign up for airline FF program• Go to seatguru.com• Pick three choices then call airline and negotiate
![Page 18: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/18.jpg)
Seatguru.com
![Page 19: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/19.jpg)
Books for the Traveler
• 300 Incredible Things for Travelers on the Internet, Ken Leebow $8.95
• The Rough Guide to Travel Online (Rough Guides $11.99)
![Page 20: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/20.jpg)
Trauma
![Page 21: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/21.jpg)
Medical student, Dominican Republic
![Page 22: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/22.jpg)
![Page 23: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/23.jpg)
![Page 24: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/24.jpg)
SOS Card
![Page 25: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/25.jpg)
CHECKLIST:• Labeled meds _______• Liquid meds and pastes in baggie _______• Xerox passport ( 6 mos) _______• Get Visa _______• RX eyeglasses _______• MD, phone # _______• MED evac insurance _______• Trip Insurance _______• Vaccine Card _______• Int’l Drivers License _______• Eyeshades ______________
![Page 26: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/26.jpg)
CHECKLIST:• Neck cushion _______
• Ear plugs _______
• Carry-on with UW and coat _______
• Hat _______
• Sunglasses _______
• Label outside of passport withpassport # _______
• Magnifying glass and sterile needle _______
• Leave irreplaceable valuables at home _______
• VISA Photos _______
• Snacks _______
• Travel adapters __________________
![Page 27: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/27.jpg)
Put all liquids and pastes in a clear bag for Transportation Security
Administration. Label all medicines.
![Page 28: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/28.jpg)
Consider a travel vest
![Page 29: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/29.jpg)
Don’t bring medications without a label!
![Page 30: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/30.jpg)
Bring a color copy of your passport. Label the outside of your passport
with your passport number
![Page 31: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/31.jpg)
Invest in a passport holder
![Page 32: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/32.jpg)
Traveling essentials
![Page 33: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/33.jpg)
Splinter removal and foot protection
![Page 34: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/34.jpg)
Sexually Transmitted Diseases
• Sense of anonymity
• Less inhibited
• Condoms often unused
• “Hooking up”
![Page 35: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/35.jpg)
Take enough medicine not just to treat yourself, but to treat fellow travelers
![Page 36: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/36.jpg)
Doctor’s Meds: I• A-B
– Ampicillin-sulbactam– Quinolone: Lo + Hi dose, Xifaxan– Neosporin/cortisone otic qtts– Quinolone eye qtts– Z-Pak – 2– Tamiflu – course for each traveler
• Supplies– Suture – 4-0/nylon– Paper tape, 4x4’s– Ace wrap
![Page 37: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/37.jpg)
Doctor’s Meds: II• Analgesia
– Oxycontin or Hydrocodone– Compazine Spansules– Cox-2 [NSAID]
• G-I:– Metoclopramide– Anti-motility
• Skin:– Steroids: topical and oral– Misc: Long acting injectable steroid
• Meds for Jet Lag: – armodefinil / zolpidem / melatonin debate
![Page 38: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/38.jpg)
Doctor’s Meds: III
• Motion: Isoptohyascine .025% qtts SL or scop patches, ? methylphenidate
• Chronic meds: Put in 2 places for complete trip
• Sleep meds: zolpidem
![Page 39: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/39.jpg)
Neck cushion, eye mask, headset, ipod, earplugs
![Page 40: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/40.jpg)
General Security& Safety Concerns
![Page 41: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/41.jpg)
U.S. Department of State
http://travel.state.gov/
![Page 42: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/42.jpg)
![Page 43: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/43.jpg)
![Page 44: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/44.jpg)
![Page 45: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/45.jpg)
![Page 46: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/46.jpg)
![Page 47: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/47.jpg)
![Page 48: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/48.jpg)
VACCINES: HD• YF
• Cholera
• Typhoid
• MMR
• Polio
• Rabies
• Hep B, A
• Plague• Meningococcus• HIB• Influenza• Pneumococcal• Japanese B
encephalitis• Gamma globulin
http://wwwnc.cdc.gov/travel/content/vaccinations.aspx
![Page 49: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/49.jpg)
CDC Vaccination Recommendations
http://wwwnc.cdc.gov/travel/content/vaccinations.aspx
![Page 50: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/50.jpg)
MEDS: MEDICAL PROPHYLAXIS
• Location?• Malaria – Malarone
[atovaquone + proguanil], Mefloquine, Doxy
• GI – Quinolone vs. Xifaxan• Misc - Doxy
![Page 51: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/51.jpg)
MALARIA PROPHYLAXIS: 1o
• Bed nets
• Repellents
• Clothing
• Meds
![Page 52: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/52.jpg)
![Page 53: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/53.jpg)
Chemoprophylaxis
• www.who.int/ith/
• www.CDC.gov
• CDC: 877-394-8747
• Acute Dx/TX: 770-488-7100
![Page 54: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/54.jpg)
Traveler’s Diarrhea
• 50% of travelers affected in some areas
![Page 55: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/55.jpg)
Travelers Diarrhea• 80% bacterial, 15% viral, 5% other• Bacterial
– Enterotoxogenic E. coli – gastro enteritis– Salmonella – gastro enteritis– Shigella – dysentery, small volume muco
purulent– Camplyobacter – dysentery– S. aureus – acute vomiting
• Viruses– Norovirus
• Parasitic ?
Current Medical Diagnosis and Treatment, 2007.
![Page 56: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/56.jpg)
General Features
• Benign, self-limited disease• One week into travel• Prophylaxis recommended
– For inflammatory bowel Dz, HIV, IBS, immunosuppression: give prophylaxis
• In others: treat symptomatically
Current Medical Diagnosis and Treatment, 2007.
![Page 57: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/57.jpg)
Gastroenteritis [NVD] for Dummies
• Cause: E. coli, salmonella, shigella, campylobacter, norovirus
• Transmission: fecal oral• Incubation: 1 hr or 3 d• SSx: NVD• Dx: clinical• TX: metaclopramide, quinolone ;;;zithro in
Asia
![Page 58: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/58.jpg)
Dysentery
• Small volume muco-purulent stoolsShigella, Campylobacter
![Page 59: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/59.jpg)
Acute vomiting
• S. aureus
![Page 60: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/60.jpg)
Acute Diarrhea w/ no lab
T > 101, abdominal pain, Bloody diarrhea
HIV, IC >65
Rehydration +
Rifaxin 3D orQuinolone 5D
Zithromax X 3D
Rehydration
Adapted from: Figure 14-1 and 14-6, 559. Current Medical Diagnosis and Treatment, 2008
NO YES
![Page 61: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/61.jpg)
CDC Health Information for International Travel 2008. Found at http://wwwn.cdc.gov/travel/YellowBookListofMaps.aspx.
![Page 62: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/62.jpg)
Self-Rehydration Therapy for Diarrhea
• With sugar and salt (raw sugar or molasses can be used instead of sugar)– 1 liter (.3 gallon) of clean water
– 1/2 tsp SALT
– 8 level tsps sugar or substituteNeed 3 L/ D, drink q5 min
Werner D. Where There is No Doctor: A Village Healthcare Handbook for
Africa, p161.
![Page 63: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/63.jpg)
Safe Eating:• Clean rims
• Bottled water
• Carbonated drinks
• Black coffee
• Hot foods served hot
• Look at the kitchen
• Go local
![Page 64: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/64.jpg)
![Page 65: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/65.jpg)
UNSAFE:“We speak English! Credit Cards Accepted!”
• Ice
• Vendors
• Raw food
• Pastries
• Unpeeled fruit
• Dairy- Milk, Ice cream
![Page 66: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/66.jpg)
Exotic and Trendy Cuisine• Raw fish, seafood and worms in the time of cholera…..
– Anisakiasis:* caused by larval stages of marine nematodes, or “herring worms”• Hallmark: sudden abdominal pain, 1 to 24 hr after consumption of raw fish
• Nausea, vomiting, fever, often with worm regurgitated
– Pseudoterranova decipiens: pathogen of seals, sea lions, walruses
– Anisakis simplex: pathogen of porpoises, whales• 1- to 4-cm-long larval worm in 50% of cases
– Pacific > Atlantic
• Raw Beef, Raw Pork, and Dysentery • Steak Tartare and Toxoplasmosis and salmonella
*Hawkes S, Hart GJ, et al. 1995. Risk behavior and STD acquisition in geniourinary clinic attenders who have travelled. Genitourin. Med. 71:351-354.
![Page 67: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/67.jpg)
![Page 68: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/68.jpg)
![Page 69: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/69.jpg)
![Page 70: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/70.jpg)
Disinfecting H2O
• Boil – five minutes
• Bleach – 1 drop/1 glass
• CL tablets
![Page 71: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/71.jpg)
Environment
• Air travel ⇨ walk vs rest
• Jacket
• Medical alert bracelet
• Heat exhaustion, stroke
• Hat
• Sunglasses
• Hydration
![Page 72: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/72.jpg)
On the Plane: Level 2 Anesthesia
• No caffeine• Window/Bulkhead/Emergency exit• Eat at once or before travel• Sleep med (?) – short acting/long acting• Neck pillow• Sleep mask• Ear plugs• Pillows, blankets• Tell flight attendant• Stay hydrated, if awake, walk
![Page 73: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/73.jpg)
![Page 74: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/74.jpg)
On Arrival:
• Set watch to local time on landing
• DO NOT SLEEP! DO NOT SLEEP!
• Go to sleep at your normal time in new place!
• Use a sleeping aid and? Provigil• ?? melatonin
![Page 75: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/75.jpg)
At the Shore…
![Page 76: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/76.jpg)
![Page 77: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/77.jpg)
![Page 78: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/78.jpg)
Motion Sickness
• Cephalic and gastric phase
• 85% gastric
• Anticipatory motion sickness
• General concept is to learn to like motion1] Isopto- hyascine qtts
2] ephedrine or CNS stimulant
3] corticosteroids
![Page 79: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/79.jpg)
SALTWATER: Sea Lice
• Path: Lanuche trapped under suit ⇨ severe itching
• DX: Papules/pustules under suit
• Rx: Vinegar/Urine stat
Steroids laterWash clothes
(Sinnott J, S Med J 14,44,1996)
![Page 80: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/80.jpg)
![Page 81: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/81.jpg)
SALTWATER: Jellyfish
• Path: Nematocyst allergy• DX: See jellyfish or feel
sting• 6 Hr: Vinegar (?Urine, NH3,
Baking Soda) Not ETOH• Late: Topical steroid
Oral steroids
![Page 82: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/82.jpg)
![Page 83: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/83.jpg)
![Page 84: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/84.jpg)
SALTWATER: Sea Urchin Puncture
• Path: Venomous spines ⇨ FB
inflammation
• Rx: Hot H20 110-113o
Pain meds
Remove spines
• Caveat: Near joint/tendon
Infection
![Page 85: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/85.jpg)
![Page 86: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/86.jpg)
![Page 87: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/87.jpg)
SALTWATER: Sting Ray
• Path: Venomous Puncture
• Rx: Hot water
Scrub
Antibiotics
Pain meds
• Prevent: Shuffle feet
![Page 88: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/88.jpg)
![Page 89: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/89.jpg)
![Page 90: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/90.jpg)
SUNBURN: SEVERE
• Cool shower
• NSAID and steroid topical
• Steroid oral, hydration
![Page 91: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/91.jpg)
![Page 92: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/92.jpg)
Freshwater: Swimmer’s Ear
![Page 93: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/93.jpg)
![Page 94: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/94.jpg)
•ENDThank you very much.
![Page 95: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/95.jpg)
![Page 96: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/96.jpg)
Doctor’s Meds: IV
• HIV Test Kit
• Ace Bandage
• Band Aids
• Paper Tape
![Page 97: Travel Medicine for Physicians](https://reader037.vdocuments.mx/reader037/viewer/2022110210/56812b4c550346895d8f705c/html5/thumbnails/97.jpg)
Colloquialisms for Travelers Diarrhea
• Cypress Rush• Egypt Tummy• Casablanca Crud• Basra Belly• Karachi Crouch• Delhi Belly • Montezuma’s Revenge • Thai-dal Wave • Turista• Backdoor Sprint• Aztec Two-step
• Greek Gallop• Hong Kong Dog• Aden Gut• Malta Dog• Rangoon Runs• Tokyo Trots• Tourist Trot• Trotsky’s Revenge • Turkey Trots• Maladie de la Mer Rouge