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epinephrine include difficulty swallowing or speaking and large
areas of swelling. In addition to this medication, a person who
suffers respiratory distress due to anaphylaxis should also take
an antihistamine such as Benadryl.
For any individual not breathing adequately on his own,
oxygen is recommended. People who are not breathing at
all should be given rescue breaths, either by mouth, bag
valve mask or manually triggered ventilator followed by
immediate evacuation for emergency medical care. Prompt
evacuation for a medical exam is recommended after any
respiratory distress, even if it resolves.
AbdominAl EmErgEnciEs
Gastrointestinal problems are very common among travelers.
Even in locales where the water is safe to drink, changes in
activity, schedule and diet can be sufficient to cause discomfort
or diarrhea. The important thing is to be able to determine
whether abdominal distress warrants a medical evaluation or
whether it’s just gas or some other transient phenomenon. Any
abdominal pain that’s accompanied by a fever of more than
102 degrees or lasts for more than 12 hours should prompt
evaluation, as should pain localized to a very specific area
or accompanied by signs such as dizziness, rapid breathing,
lightheadedness, sweating or anxiety — signs that might indicate
shock. Blood in the urine, stool or vomit; unusual hardness or
softness of the abdomen or resistance to touch are also grounds
for seeking medical care. A woman for whom pregnancy cannot
be ruled out should also be evaluated promptly. Finally, anyone
who is nauseated and vomiting or has diarrhea for more than
24 hours should consult a physician; such a person would likely
become too dehydrated to manage effectively in the field.
In the absence of any of these red flags, it is appropriate
to monitor a patient and encourage him to eat a bland diet
consisting of foods such as bananas, rice, applesauce and toast
until symptoms resolve. An anti-diarrheal medication such
as Imodium may be helpful for short-term management of
diarrhea, but it does not address the cause and should not be
used for extended periods. For people who are constipated,
caffeine and/or alternating hot and cold liquids (ice water in one
hand and a cup of coffee in the other, for example) may help.
nEurologicAl EmErgEnciEs
Many factors can cause neurological impairment: temperature
extremes, decompression illness, head injuries, intoxication
and others. But when confusion, disorientation, seizures or
personality changes occur in the absence of any such causative
factors, an underlying medical issue might be to blame.
A cerebrovascular accident, or stroke, is an interruption in
the flow of oxygenated blood to a part of the brain. Facial droop,
weakness or paralysis on one side of the body or impaired
speech, memory or cognition may be apparent. There is little
that can be done for a stroke patient in a remote setting, but
providing oxygen, evacuating quickly and lying the patient on
the affected side (to protect the airway) are recommended.
Continue to interact with the individual as you did before the
stroke, even if he can’t participate in the conversation or seems
unable to understand you.
A seizure is the result of disorganized electrical
activity in the brain. Seizures can manifest as a period of
unresponsiveness or dramatic, uncontrolled physical activity.
The best thing a rescuer can do for a person experiencing
a seizure is to pad the environment. Do not restrain the
individual or put anything in his mouth, but protect him
(especially his head) from any hard or sharp objects. After the
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SPRING 2012
RESEARCH, EDUCATION & MEDICINE
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