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

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Section VI: Backcountry Medicine

is advised. Persistent pain unrelieved by this procedure should be considered an emergency. Persistent pain following trauma is also of con- cern, especially if swelling is severe. Immediate evacuation to surgical care is indicated.

persistent pain is not normal. If infection is sus- pected, evacuation for testing and diagnosis before treatment is ideal. In the remote setting, treatment with antibiotics under medical advice may be necessary before any testing can be accomplished. The risk of complications increases substantially with time. In any case, sexually transmitted dis- ease should be suspected and medical follow up sought as soon as practical. A patient with kidney stones will need hydration and pain management. Ibuprofen may help but this is not going to be an easy problem to deal with in the field. Even if the diagnosis is certain and the risk of complications is low, evacuation is warranted.

Bladder infection in men is uncommon because of the length of the urethra. Infection and swelling of the prostate with severe pain and obstruction is possible. Infection of the testes or epididymis is more common than torsion, but still unusual. It is extremely uncomfortable and potentially serious. Persistent testicular pain with or without swell- ing should motivate an early medical evaluation. Antibiotics can be used if evacuation is delayed or impossible. Epididymitis can be difficult to A mild UTI or vaginitis can often be treated in the field as a low-risk problem in cases where the woman has a previous history of similar symp- toms and is confident in her diagnosis. You should see rapid response to medication and return to normal function within two days, or evacuation should be considered. The male urinary tract can become mildly irritated by dehydration or sexual activity, but distinguish from testicular torsion. Risk Versus Benefit