Pre Travel Consultation

Question 1

What preventable measures we can do to avoid snake bites?

Answer 1

• leave them alone
• wear heavy, ankle high or higher boots, long pants
• they are mostly active at night & during warm weather

Question 2

What are the recommended management after a snake bite?

Answer 2

• seek immediate medical attention
• immobilization of the limb
• application of a pressure bandage ( not restrict blood flow)

Contraindicated: incision at the bite or tourniquets

Try toidentify the species of snake

Question 3

What are the prevention measures to avoid injuries from marine fish?

Answer 3

• avoid contact
• do not feed
• wear protective clothing
• research which animal you could encounter during your activity

Question 4

Where in the world do snake bites occur?

Answer 4

Southeast Asia
Sub-saharan africa
Tropical areas in americas

Question 5

Describe The brown recluse (feedleback-loxos eles) bite reaction? And treatment?

Lives indoor

Answer 5

• no pain
• classic: hemorrhagic vesicle surround by white ischemic zone
• can become necrotic
  Tx: local wound care. Ice pack, dapsone if G6PD neg.

Question 6

The centruroides scorpion is potentially lethal in US. It’s found in Southwest arizona. Children and elderly more at risk. Most bites are not dangerous. Scorpion are non aggressive, nocturnal

What are the signs, treatment , prevention?

Answer 6

Sings: painful sting, more localise, reaction with centruroides sting more sensitive zone, area is sensitive numb, hypertention, vision changes

Tx: apply ice , clean, dressing, supportive care

Question 7

Describe jelly fish sting and tx?

Answer 7

Symptoms: namatocyst fire , punctures & envenomates, local pain,

Box jellyfish- worst:

Tx: 1. Vinegar ( 5% acetic acid)
2. Remove nematocyst: gloves or forceps

• rinse with salt water, immerse in hot water 45•C

Question 8

Tarantula: australian type very dangerous, males bite, no webs= not aggressive. Describe bite and treatment?

Answer 8

Bites with small teeth, flicks urticarial hairs, occular irritation

Tx: ice/ anti-inflammation

Question 9

Herpes B transmitted by bite, scratch, splashes of infected tissue by macaques monkey. Asia and N. Africa ( temples: Nepal & India). Describe symptom, post exposure tx and prevention?

Answer 9

• 1 wk to a month
• neurologic sx develop as virus infects CNS with ascending paralysis ( resp. Failure)

Tx: first aid, post exposure with acyclovir/ antiviral

Prevention: don’t feed, pet, handle

Question 10

What can you do to minimize respiratory infections?

Answer 10

1. Minimize close contact
2. Frequent handwashing
3. Vasoconstricting nadal spray

Influenza & routine immunization should be up to date

Respiratory disease include: influenza, pneumoniae, influ type b, pertussis, diphtheria, varicella, measles

Question 11

What are the prevention high altitude sickness?

Answer 11

1. Gradual ascent: first camp 2400m (8000ft) increase no more than 1000 to 2000ft (300-600m) per night climb high sleep low
2. High carb diet ( appetite is suppressed)
3. Appropriate exercise level avoid dyspnea fatigue
4. Hydration
5. Drug prophylaxis
   Acetazolamide: effective AMS, forced rapid ascent, hx AMS,
   250mg bid start day before ascent for children- 4mg/kg a day
   Side effects; paresthesia, alt taste
   Contraindicated: pregnancy, allergy to sulfa

Dexamethasone: AMS or very forced ascent rescue
4 mg q6hrs. Start 2-4 hrs before ascent
Side effects: dyspnea, bizarre dreams, euphoria

Ginko bilo a: uncertain

Nifedipine: prevent HAPE
30-60 mg daily during ascent & 3 days at altitude
Side effects: hypotension

Inhaled salmeterol: prevent HAPE
125mcg bidclear fluids in alveoli

Sedstive $ hypnotics

Question 12

Assessment & tx

Answer 12

Descent tx for HAPE & HACE

AMS: h/a + anorexia or nausea, vomitting, dizziness, lightheaded, disturbed sleep,lassitude
Tx: descent or stop ascent, oxygen 90%, acetazolide 250mg daily or dexamethasone 4mg q 6 hrs

HAPE: decrease exercise performance, fatigue, dyspnea on exertion, dry cough, crackles on inspiration