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Travel and Adventure Medicine, An Issue of Medical Clinics of North America, E-Book

Travel and Adventure Medicine, An Issue of Medical Clinics of North America, E-Book

Paul S. Pottinger | Christopher A. Sanford

(2016)

Additional Information

Book Details

Abstract

This issue of Medical Clinics of North America, guest edited by Paul S. Pottinger and Christopher A. Sanford, is devoted to Travel and Adventure Medicine. Articles in this issue include: Immunizations; Malaria; Personal Protection Measures; Traveler’s Diarrhea; Urban Medicine and Trauma; Care of the Healthcare Provider; Evaluation of the Ill Returned Traveler; The Ethics of Medical Volunteerism; High-Altitude Medicine; Dive Medicine; Wilderness Medicine, Including First Aid & Hypo/Hyperthermia; The Medical Kit; Adventure Sports: Spelunking, water exposures; and Resources for the Provider and Opportunities in Further Training in Travel and Adventure Medicine.

Table of Contents

Section Title Page Action Price
Front Cover Cover
Travel and Adventure Medicine \r i
Copyright\r ii
PROGRAM OBJECTIVE iii
TARGET AUDIENCE iii
LEARNING OBJECTIVES iii
ACCREDITATION iii
DISCLOSURE OF CONFLICTS OF INTEREST iii
UNAPPROVED/OFF-LABEL USE DISCLOSURE iii
TO ENROLL iv
METHOD OF PARTICIPATION iv
CME INQUIRIES/SPECIAL NEEDS iv
MEDICAL CLINICS OF NORTH AMERICA\r v
FORTHCOMING ISSUES v
May 2016 v
July 2016 v
September 2016 v
RECENT ISSUES v
January 2016 v
November 2015 v
September 2015 v
Contributors vii
CONSULTING EDITORS vii
EDITORS vii
AUTHORS vii
Contents xi
Foreword: Travel and Adventure Medicine\r xi
Preface: Travel and Adventure Medicine\r xi
The Ethics of Medical Volunteerism\r xi
Immunizations\r xi
Travel Medical Kit\r xi
Care for the Health Care Provider\r xii
Malaria in the Traveler: How to Manage Before Departure and Evaluate Upon Return\r xii
Personal Protection Measures Against Mosquitoes, Ticks, and Other Arthropods\r xii
Traveler’s Diarrhea\r xii
Road Traffic and Other Unintentional Injuries Among Travelers to Developing Countries\r xiii
Wilderness Medicine\r xiii
High-Altitude Medicine\r xiii
Adventure and Extreme Sports\r xiii
Illness in the Returned International Traveler\r xiv
Travel and Adventure Medicine Resources\r xiv
Foreword:Travel and \rAdventure Medicine xv
Preface:Travel and \rAdventure Medicine xvii
The Ethics of Medical Volunteerism 237
Key points 237
BACKGROUND 237
ETHICAL CHALLENGES IN MEDICAL VOLUNTEER WORK 238
Context 238
Limited Time and Resources 239
Cultural and Language Barriers 239
LESSONS FROM INTERNATIONAL RESEARCH 240
PRINCIPLES FOR MEDICAL VOLUNTEERISM 240
Mission 241
Partnership 241
Preparation 241
Reflection 241
Support 242
Sustainability 242
Evaluation 242
SUMMARY 242
REFERENCES 243
Immunizations 247
Key points 247
ROUTINE VACCINES 248
Tetanus, Diphtheria, Pertussis 248
Measles, Mumps, Rubella 249
Rotavirus 249
Polio 249
Hepatitis A 250
Hepatitis B 250
Haemophilus Influenzae Type b 250
Human Papillomavirus 250
Influenza 251
Meningococcal Disease 251
Pneumococcal Disease 252
Varicella (Chickenpox) 253
Zoster (Shingles) 253
TRAVEL VACCINES 253
Typhoid Fever 253
Japanese Encephalitis 254
Rabies 254
Yellow Fever 255
VACCINES THAT ARE NOT ROUTINELY ADMINISTERED IN THE UNITED STATES 256
Tick-borne Encephalitis 256
Tuberculosis 256
Cholera 256
Oral Polio Virus 256
Smallpox 256
ADDITIONAL CLINICAL CONSIDERATIONS 257
Live Vaccines 257
Vaccine Interactions 257
Vaccine Hesitancy 257
REFERENCES 257
Travel Medical Kit 261
Key points 261
INTRODUCTION 261
Personal Health 261
Prescriptions 262
ALLERGIC REACTION 262
High-Altitude Medicine 263
EYE CARE 263
FIRST AID 263
GASTROINTESTINAL DISORDERS 269
Traveler’s Diarrhea Treatment 270
Other Gastrointestinal Symptoms 270
Nausea 270
Gastroesophageal Reflux Disease 270
Constipation 270
ARTHROPOD AVOIDANCE 271
Permethrin (0.5% Solution) 271
MOTION SICKNESS 272
MALARIA PREVENTION 272
RESPIRATORY ILLNESS 273
SLEEP DISRUPTION/JET LAG 273
SKIN CONCERNS 273
Zanfel 274
Sunscreen 274
SEXUAL HEALTH 274
WOMEN’S HEALTH 274
Vaginitis 275
Contraception 275
Emergency Contraception 275
Urinary Tract Infection Treatment 275
REFERENCES 276
Care for the Health Care Provider 279
Key points 279
INTRODUCTION 279
PREVENTING MORBIDITY AND MORTALITY 280
PRECOUNTRY PLANNING/ADVICE 282
Health Care Provider Kit and Packing List 284
IN COUNTRY CARE 284
Food and Water Precautions 284
Water Disinfection 284
Needle Sticks and PostExposure Prophylaxis 284
Special Conditions 286
FUTURE CONSIDERATIONS/SUMMARY 287
REFERENCES 287
Malaria in the Traveler 289
Key points 289
OVERVIEW 289
MALARIA 290
PREVENTION: 4 STEPS TO SUCCESS 291
Step 1: Determine Whether a Patient Is at Risk of Malaria 291
Geographic risk assessment 291
Host risk assessment 291
Step 2: Counsel on Mosquito Avoidance Techniques 292
Step 3: Prescribe Chemoprophylaxis 293
Geographic considerations: new world versus old world 293
Chloroquine 293
Mefloquine 295
Atovaquone/proguanil 296
Doxycycline 296
Step 4: Educate on Warning Signs of Malaria 296
CLINICAL PRESENTATION: ALWAYS SUSPECT MALARIA IN AN ILL RETURNING TRAVELER 297
DIAGNOSIS 298
Smear 298
Rapid Diagnostic Tests 299
Species Difference: Clinical Considerations 300
TREATMENT 300
REFERENCES 301
Personal Protection Measures Against Mosquitoes, Ticks, and Other Arthropods 303
Key points 303
INTRODUCTION 304
DESTINATION AND VECTOR CONSIDERATIONS 304
TRAVELER CONSIDERATIONS 305
General Protective Measures 305
Traveler’s Diarrhea 317
Key points 317
INTRODUCTION 317
Definition, Incidence, and Risk Factors 317
Cause 318
Impact on the Traveler 318
PRETRAVEL PREPARATION 318
Prevention 318
Impact of food and water hygiene measures 318
Vaccines 319
Probiotics 319
Bismuth subsalicylate 320
Antibiotic chemoprophylaxis 320
Traveler-Initiated Symptomatic Treatment 321
Oral rehydration 321
Antidiarrheal medication 321
Early antibiotic self-treatment 322
When to seek medical care 323
SPECIAL POPULATIONS 323
Pregnant Women 323
Children 324
Immunocompromised Host 324
Comorbid Disease 324
POSTTRAVEL MANAGEMENT 324
Persistent Diarrhea After Travel 324
Evaluation 325
Postinfectious Sequelae 325
Postinfectious irritable bowel syndrome 325
Reactive arthritis 326
Guillain-Barré syndrome 327
SUMMARY 327
ACKNOWLEDGMENTS 327
REFERENCES 327
Road Traffic and Other Unintentional Injuries Among Travelers to Developing Countries 331
Key points 331
INTRODUCTION 332
ROAD TRAFFIC INJURIES 333
Epidemiology 333
Differences in Road Traffic Injuries Between High-income and Low- and Middle-income Countries 333
Road Safety in Low- and Middle-income Countries 334
Road Traffic Injury Risk Among Travelers 334
Pretravel Advice on Road Traffic Injuries 335
DROWNING 336
Epidemiology 336
Drowning Risk Among Travelers 336
Pretravel Advice on Drowning 337
OTHER UNINTENTIONAL CAUSES OF TRAVELER INJURY 337
OPPORTUNITY FOR ADVOCACY 337
REFERENCES 340
Wilderness Medicine 345
Key points 345
INTRODUCTION 345
PLANNING AND PREPARATION 346
Clothing 346
Medical Kit 346
Education and Training 346
PREVENTION 347
Waterborne Illness 347
Boiling 347
Halogens 347
Filtration 347
Ultraviolet radiation 347
Vector Control 348
Sunscreen 348
INJURY AND ILLNESS 349
Heat-Related Illness 349
Hypothermia 350
Allergic Reactions 351
Head Injuries 351
Spinal Injuries 352
Thoracic and Abdominal Injuries 352
Musculoskeletal Injuries 353
Fractures and sprains 353
Dislocations 353
Wounds 354
Burns 354
Blisters 354
EVACUATION 355
SUMMARY 355
REFERENCES 355
High-Altitude Medicine 357
Key points 357
INTRODUCTION 357
DEFINING “HIGH ALTITUDE” 358
THE ENVIRONMENT AT HIGH ALTITUDE 358
PHYSIOLOGIC RESPONSES TO HIGH ALTITUDE 358
ACUTE ALTITUDE ILLNESS 358
Acute Mountain Sickness and High-Altitude Cerebral Edema 358
Definitions and clinical features 358
Epidemiology and risk factors 360
Prevention 360
Treatment 360
High-Altitude Pulmonary Edema 360
Definition and clinical features 360
Epidemiology and risk factors 362
Prevention 362
Treatment 363
WHEN THE HIGH-ALTITUDE TRAVELER COMES TO CLINIC 363
The Altitude-Naïve Traveler 363
The Returning Traveler 363
The Potentially Risky Traveler 364
A framework for assessing risk 364
Question 1: Is the individual at risk for severe hypoxemia or impaired tissue oxygen delivery? 365
Question 2: Is the individual at risk for impaired ventilatory responses to hypoxia? 365
Question 3: Is the individual at risk from the expected pulmonary vascular responses to hypobaric hypoxia? 365
Question 4: Will environmental features of high altitude or the expected physiologic responses to hypobaric hypoxia worsen ... 365
Further evaluation 365
SUMMARY 367
REFERENCES 367
Adventure and Extreme Sports 371
Key points 371
INTRODUCTION 371
ALPINE SNOWBOARDING AND SKIING 372
Overall Epidemiology 372
Environment 372
Demographics 372
Injury 372
Ulnar collateral ligament injury in skiers 374
Upper extremity injuries in snowboarders 374
Anterior cruciate ligament injury 374
Fracture of the lateral process of the talus in snowboarders 375
Spinal injuries 375
Fatalities 375
Prevention 375
SKATEBOARDING 376
Overall Epidemiology 376
Environmental 376
Demographics 376
Injury 377
Head injury 378
Upper extremity injury 378
Lower extremity injury 378
Fatality 379
Prevention 379
SURFING 379
Overall Epidemiology 379
Demographics 379
Environment 379
Injury 379
Head injury 380
Ocular injury 380
Otologic injury 380
Extremity injury 381
Back injury and surfer’s myelopathy 381
Dermatopathology 381
Chronic injury 382
Prevention 382
BUNGEE JUMPING 383
Illness in the Returned International Traveler 393
Key points 393
INTRODUCTION 393
GASTROINTESTINAL DISORDERS IN THE RETURNING TRAVELER 394
Pathophysiology 394
Clinical Presentation 394
Patient History 394
Physical Examination 394
Diagnostic Testing 394
Management Goals 395
Self-management Strategies 395
Pharmacologic Strategies 395
FEVER 400
Work-up 403
DERMATOSES 403
Cutaneous Larva Migrans 403
Localized Cutaneous Leishmaniasis 407
Myiasis 407
OTHER CAUSES OF ILLNESS IN RETURNED INTERNATIONAL TRAVELERS 408
REFERENCES 408
Travel and Adventure Medicine Resources 411
Key points 411
PROFESSIONAL ASSOCIATIONS AND SOCIETIES 411
CONTINUING MEDICAL EDUCATION COURSES 412
ONLINE COURSES 412
PRINTED MANUALS AND TEXTBOOKS 413
COURSES IN TROPICAL MEDICINE 413
FELLOWSHIPS 414
E-MAIL LISTSERVS 414
CERTIFICATES OF EXPERTISE 414
INFORMATION ON CRIME, SECURITY, TERRORISM 415
SUBSCRIPTION SERVICE 415
APPLICATIONS 415
REFERENCES 415
Index 417