Travel sickness Flashcards
What are the risks of illnesses for travellers?
- Food or water born pathogens
- Systemic febrile illness e.g. malaria, typhoid
- dermatological problems caused by insects
What are the main risks of death for travellers?
- Lack of medical expertise
- poor road conditions
- swimming in unfamiliar waters
- extreme environmental conditions
- Men are 4 times more likely to die from trauma
What is the ABCD guide to malaria?
A= Awareness of risk- area of travel, activities, duration of stay
B= Bite Prevention
C= Chemoprophylaxis- Take antimalarial medication
D= Diagnosis- if high temperature of 38 or higher or develop symptoms seek medical attention
What causes traveller’s diarrhoea?
Many different bacteria, viruses and parasites worldwide.
What is the most common illness in those travelling from resource-rich to resource-poor countries?
Traveller’s diarrhoea (20-50% of travellers)
How can you contract traveller’s diarrhoea?
- Eating contaminated food or liquids. Mostly if foods have not been heated properly or left out at room temperature (pathogens are inactivated above 60 degrees).
Who is more at risk of diarrhoea?
- The very young
- the elderly
- those with special needs
- people adventurous with eating
Symptoms of traveller’s diarrhoea:
- Passage of 3 or more unfound stools in a 24-hour period.
- Often accompanied by abdominal pain, fever, nausea, vomitting
How long does travellers diarrhoea usually last?
3-4 days
When should an individual seek medical advice for a traveller’s diarrhoea?
- If symptoms don’t improve within a few days
- If passing blood or mucus
- Developing a fever
- Dehydration
What is the most important aspect of managing travellers’ diarrhoea?
Maintaining adequate fluids.
Can give oral rehydration powders such as Dioralyte or Electolade.
Or can give normal fluids with a sugar solution of 8 teaspoons of sugar and 1/2 teaspoon of salt to 1L of water.
When is Loperamide used for traveller’s diarrhoea?
if frequent diarrhoea is inconvenient e.g. long bus rides or meetings
When can Loperamide not be used for traveller’s diarrhoea?
-If the patient has ulcerative colitis
- If they have a fever
- If they have bloody diarrhoea
What age can you give Loperamide?
Should be used with caution and under specialist supervision in those under 12.
When would antibiotics be considered for traveller’s diarrhoea?
- If they gave a serious underlying medical condition or would seriously disrupt travel plans.
Which antibiotics are generally used for traveller’s diarrhoea?
Ciprofloxacin- generally the drug of choice as one dose of 500mg.
May use azithromycin
What is prickly heat?
Occurs when swear glands become blocked
What is the usual treatment for prickly heat?
A first-generation anti-histamine such as Diphenhydramine.
What are the symptoms of heat exhaustion?
Heavy sweating
Tiredness
headaches
nausea
vomitting
fainting
When can heat exhaustion develop into heat stroke?
When fluids are NOT replaced and if the core body temperature is reduced.
What advice should be given on sunscreens?
- Broad spectrum protection against UVB and UVA
- Minimum SPF of 15
- Four-star rating
- If swimming or sweating should chose a water-resistant preparation
What advice should be given about sun exposure?
- sun screeen!!
- Avoid peak radiation levels (between 11-3 in the UK)
- Apply sunscreen 30 minutes before exposure and continue to reapply
What is deep vein thrombosis (DVT)?
A blood clot in one of the body’s deep veins, often in the lower leg. This can be fatal if it travels to the lungs.
What can cause DVT?
A period of inactivity e.g. after operations or long travel.
What is ‘economy class syndrome’?
- DVT caused after long journeys via planes, trains or road. Also known as ‘travel-related DVT’.
What are the symptoms of DVT?
- Pain
- Swelling and heavy feeling in legs
- Red and painful to touch
- may become dark and swollen if vein is completely blocked.
What is the serious complication of DVT?
A pulmonary embolism- is when part of the clot breaks off and travels to the lungs.
Most common symptom is difficulty breathing and shortness of breath.
What are the symptoms of a pulmonary embolism?
- shortness of breath
- chest pain
- coughing up blood
- sudden collapse
How can you reduce the risk of developing DVT?
- Stop smoking
- maintain a healthy weight
During travel:
- Stay hydrated
- Wear loose-fitting clothing
- Properly fitted compression socks
- Regularly flex and extend ankles
- reduce luggage in footwells to maximise leg room
- walk around as much as possible
When can the vaccine guidelines be contraindicated?
- Confirmed anaphylactic reaction to a previous dose of the same vaccine
- If anaphylactic to egg protein, should not be given influenza or yellow fever vaccines
- Pregnant or immunosuppressed- need specialist advice first
- Acutely unwell patients
What vaccines should those with an allergy to egg protein avoid?
- influenza
- yellow fever
What precautions should travellers with pre-existing conditions take?
- Tell their travel insurer
- Talk to their doctor
- Carry a doctors letter and copy of prescription
- Learn key words in the local language to do with their condition.
- Take enough medication
Points of interest when travelling with diabetes:
- No greater risk of contracting malaria- however, an infection may cause hypoglycaemia
- Travelling to a different location will change day length so carbohydrate and insulin intake may need to be modified ( east= shorten and reduce, west= longer and increase)
- Adjustment of medication only necessary of travelling through 5 or more time zones
Points of interest when travelling with
splenectomy:
- Avoid malaria epidemic countries
would suffer more if infected with malaria
Points of interest when travelling with Epilepsy:
- Should be okay if well-controlled
- Limitations in malaria chemoprophylaxis as chloroquine and mefloquine exacerbate the condition
Points of interest when travelling with a psychiatric illness:
- Travel may trigger stress and anxiety
- Mefloquine is contraindicated in those with. history of depression and anxiety
Points of interest when travelling if immunocompromised:
Refer to GP for advice on appropriate chemoprophylaxis and immunization options.
Points of interest when travelling pregnant or breastfeeding:
- Pregnancy increases the risk of malaria- increase in maternal and neonatal death
- refer to GP
- Can be given chloroquine and proguanil (need a 5mg folic acid supplement) and mefloquine if 2nd or 3rt trimester
- if baby is less than 7kg, mefloquine should not be taken by them or the mother
If taking proguanil when pregnant, what other medication is required?
A daily 5mg Folic acid supplement
Points of interest when travelling with cardiovascular disease:
If requiring anticoagulants, these should be started up to 3 weeks before departure to stabilise INR readings (international normalised readings).
advice should be given on reducing the chance of DVT
Who should avoid taking mefloquine?
Those with:
- Cardiac arrhythmias
- taking anti-arrhythmic drugs
- taking beta-blockers
Points of interest when travelling with respiratory diseases:
- Travel can exacerbate symptoms
-May increase secondary chest infections in COPD patients - have up to date influenza and pneumonia immunisation
What groups are more likely to get motion sickness?
- Women- especially if pregnant or menstruating
- Those who experience migraines
- Children aged 3-12 years
What are the symptoms of motion sickness?
- Drowsiness
- Cold sweats
- Nausea and vomiting
- Pallor and fainting
How can you prevent motion sickness?
- Lying horizontally
- Keeping the head fixed with the eyes on the horizon
- Avoid reading while travelling
- Try distraction (e.g. games, toys, music)
- Avoid a stuffy or smoky atmosphere and the smell of food