Returning Travellers and Altitude Medicine Flashcards
What are the crucial pillars of a Travel Hx?
Where - travelled, exact locations
When - helps to understand incubation
Why - work vs leisure
What
Which - vaccines, previous exposure
What is the most common presenting complaint in the the returning traveller?
Diarrhoea (± febrile illness, derm complaint, respiratory illness)
Which database is used to monitor illnesses in the retruning traveller?
Geosentinel database https://www.istm.org/geosentinel
What are the most common causes of fever in the returning traveller?
Malaria
Dengue
What is the incubation of dengue?
4-7 days
What mosquito causes dengue?
Aedes
What are the symptoms of leptospirosisi ?
Flu like illess, conjunctival haemorrhage, Fever with a break in it, hepatomegaly,
How does HIV seroconversion present?
Incubation: Up to 3 month s
Pharyngitis, lymphadenopathy, oral thrush
±meningoencephalitis (rare)
Which cause of pneumonia has significant resistance to beta-lactams gloablly (i.e dont respond to penicillins)
Pneumococcal pneumonia
Which resp. illness is assocaited with caving?
Histoplasmosis
How do you diagnose Legionnaires?
Urinary Ag
What is Katayma Syndrome?
Acute schisto –> headache, cough, wheeze, fever, fatigue Urticaria, Eosinophilia, Hepatosplenomegaly
Rx: Praziqnatal + Steroids + antihistamines
Chronic Diarrhoea definitiion
Adults: >28 Days
HIV > 14 days
Kids >14 days
How does Tick typhus present?
Fever, headache, dry cough, ESCHARS
How do you manage cutaenous Leish?
SSG
l-AMB
Miltefisone
How do HIV and secondary syphillis present?
Widespread macuopapular rash
What is the presentation of Acute Mountain Sickness?
high altitude headache (>80% of people climbing >5000 metres)
What are the risk factors for AMS
**Previous hx of AMS
Genetics
Usual living altitiude level
At which Core Body temperature are you likely to go into Cardiac Arrest
<24C
What are the symptmos of HAPE?
Dyspnoea on exertion, cough, sensation of chest pressure –> severe cough, white to reddish frothy sputum, dyspnoea, syanoss, tachypooea, crackles
High mortality if untreated, 24%
How do you treated HAPE?
Descend
O2
Nifedipine 20mg TDS
Dexamethasone
NB: diuretics do not work as the person is usually pretty dry
How does HACE present?
Ataxic gait !!!
±high altitude retinopathy
±impaired LOC
± neausea and vomiting
±vertigo
± any other generalised neurological symptoms
*** not HACE if no impreovement with descent, no headache, symptoms started >3 days after going to altitude
WHat is the mortality of HACE?
40% –> every unclear health disorder should be treated as HACE until proven otherwise
How do you manage HACE?
Dexamethasone 8mg STAT –> 4mg PO Dex. 6 hourly
What are the 4 stages of Frostbite?
- Pre=freezing phase
- Freezing and thawing
- Vascular stasis stages
- Late ischaemic Stage
How do you manage Frostbite?
Rewarm
Analgesia
Vasodilators
Thombolytics
Surgery –> only done after final demarcation can take several weeks
