Wilderness and Rescue Medicine 7th Edition Jeffrey Isaac, PA-C and David E. Johnson, MD

Wilderness and Rescue Medicine 202

However, you must monitor for the development of severe infection where swelling of the tonsils, epiglottis, and uvula have the potential to cause airway obstruction. This will most often be the result of a bacterial infection such as strep throat or epiglottitis, but it can occur with viral mononucleosis. Bacterial infection is characterized by persistent pain, dif- ficulty swallowing, and obvious edema of pha- ryngeal structures. Pus is white patches on the throat and tonsils. Fever tends to be persistent. Suspected bacterial infection should be seen by a medical practitioner. Mild pharyngitis can be effectively treated with ibuprofen and acetamino- phen, cool liquids, and topical medication like throat lozenges or honey.

specific diagnosis is often unavailable or high-risk infection is an anticipated problem, the threshold for the use of antibiotics is lower. The primary goal is to reduce the need for a high-risk evacuation from a remote setting. The appropriate use of antibiotics by SAR per- sonnel, expedition medics, wilderness guides, voyaging sailors, and some rural EMS units should be considered part of the overall effort at risk reduction. The common bacterial infections contracted by otherwise healthy people generally respond to well-known oral and topical antibiot- ics with an acceptable side effects profile. Medical directors will need to provide instructions and precautions as well as authorization and protocol.

Throat Infection

General Principles

15

Serious (Red Flags): • Respiratory distress • Impaired food/fluid intake • Persistent fever • Persistent severe pain • Coughing blood • Getting worse

*

Strep pharyngitis

©2018WMA

Impending airway obstruction is suggested by the patient’s inability to swallow secretions or water. The patient may position himself or herself in a chin thrust to keep the airway open. Stridor may be noted. This is a medical emergency in which evacuation and advanced life support is indicated. In a desperate situation, inhaled epi- nephrine and steroids may be used by advanced providers to temporarily reduce swelling and keep the airway open. Risk Versus Benefit Antibiotics are listed as part of the temporary or definitive treatment for many illnesses but are controversial in others. The use of antibiotics to prevent wound infection is also controver- sial. However, in the wilderness setting where a