Travel Medicine Flashcards
Key factors in determining the health risks to which travelers may be exposed are?
6
- destinations
- duration of visit
- purpose of visit
- standards of accommodation and food
- hygiene
- behavior of the traveler
Pre-Trip Recommendations
14
- Basic medical kit
- Analgesics (acetaminophen, aspirin, ibuprofen)
- Antibiotic for self-treatment of diarrhea (ciprofloxacin, azithromycin)
- Anti-diarrheals…bismuth subsalicylate(Pepto Bismol), loperamide (Imodium)
- Antihistamines
- Antimalarials
- Antinausea/motion sickness (Bendadryl, Dramamine) meds
- Sleeping medication
- Insect repellent
- Water purifier or tablets
- Cold/sinus/cough medication
- Sunscreen
- Wound dressings
- Antiseptic
Risk Assessment looking at Itinerary?
7
- Regions visiting
- Urban v Rural
- Dates and lengths
- Purpose
- Modes of transportation
- Activities
- Accommodations
Traveler demographics
risk assessment?
5
- Health/medical history
- Vaccinations
- Medications/allergies
- Pregnancy
- Planned surgeries/medical care
Environmental Precautions
8
- Air Travel
- Jet Lag (Melatonin?)
- Sun Protection
- Extreme Heat and Cold
dehydration, heat stroke
hypothermia, frostbite - Altitude (Lake Titicaca 12,570 feet)
- Water recreation
- Drowning, boating & diving accidents
- Biological and chemical contamination
Food and Water Precautions
2
- Bottled water may be best
- Selection of foods
- -well-cooked and hot
What foods/things to avoid?
5
Avoid
- salads,
- raw vegetables
- unpasteurized dairy products
- street vendors
- ice
Determine If Pre-existing Health Status Precludes Travel:
Flying contraindications for Cardiovascular disease?
3
- Less than 3 weeks post MI
- Longer “wait” following complicated courses
- ~ 2 weeks post CABG
Determine If Pre-existing Health Status Precludes Travel:
Flying contraindications for Pulmonary disease?
3
- 2-3 weeks post chest tube removal
- Pao2
- See if patient can walk up flight of stairs or walk 50 yards as practical stress test
Determine If Pre-existing Health Status Precludes Travel:
Flying contraindications for Post-op?
3
- Increased risk of DVT, especially in “economy” class seats
- Recommended wait of 2 weeks
- Recommend frequent movement and walking through cabin
Determine If Pre-existing Health Status Precludes Travel:
Severe Anemia?
3
- Hgb
- Recommended wait of 2 weeks
- Recommend frequent movement and walking through cabin
What might flying after diving lead to?
What should we wait how long after diving before flying?
May lead to decompression illness
Should wait 12 hours after diving
General Recommendations for Travel Patients With Cardiopulmonary Disease
8
- Carry all medications on board
- Be aware of dose intervals while crossing time zones
- Carry a recent EKG
- Carry a pacemaker card with an EKG
- Use airline special services: wheelchairs, trolley service, special diet, oxygen, pre boarding
- Walk through the cabin frequently, perform in-seat range-of-motion exercises and deep breathing exercises
- Avoid alcohol and drink plenty of fluids
- Wear support hose
Vaccines up to date?
(which ones?)
11
Poliovirus Hep A Hep B Meningococcal Influenza Tetanus, Diptheria, Pertusis MMR Varicella HIB Influenza Pneumococcal
Vaccines you may need before you go?
7
Typhoid Yellow Fever Rabies Japanese Encephalitis Cholera Tick-borne Encephalitis Tuberculosis
Motion sickness prophylaxis?
3
What is the only one that works after symptoms are started?
Meclizine (OTC)
Promethazine (needs Rx)**
Transdermal scopolamine (needs Rx)
Promethazine works after symptoms started
What is Jet Lag?
What are the symptoms?
4
Disturbance of circadian rhythms due to crossing time barriers
Symptoms- fatigue, irritability, nausea, difficulty concentrating
Three helpful therapies for Jet Lag?
- Light therapy
- Diet therapy (Ehret-Scanlon’s Jet Lag Diet)
- -Alternate high and low food intake before travel and high protein and low carb lunches before and after travel - Melatonin therapy
Problems at Your Destination Altitude Sickness:
Symptoms include headache and one or more of the following? 5
What is the pathology of altitude sickness?
Nausea Vomiting Fatigue Malaise Insomnia
Due to relative hypoxemia and delay in development of compensatory erythrocytosis
Problems at Your Destination
Altitude Sickness:
Acute Mountain sickness usually acclimation occurs in how many days?
2-3 days