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

Wilderness and Rescue Medicine 224

or crackles are detected on auscultation of the lungs. If you are authorized to use these drugs, the patient can safely be treated in the field if he or she is doing well otherwise. The availability of antibiotics should not cause you to delay the evacuation of a patient in respiratory distress. Risk Versus Benefit It is unusual for an otherwise healthy individual to develop a serious respiratory infection. Most cases are just annoying viral syndromes that do not respond to antibiotics. However, certain patients are at increased risk for complications in viral infections and more likely to develop seri- ous bacterial infections. These include infants, the elderly, asthmatics, recently hospitalized patients, and people with impaired immunity. Respiratory viruses and some bacteria are spread when mucous from an infected person contacts the next host’s mucous membranes. This can occur by contact with mucous left on surfaces or by inhaling aerosolized droplets generated by sneezing and coughing. Public health warnings during epidemics call for the use of conscientious hand washing, having coughing and sneezing people wear face masks, and isolating infected people from food preparation and other common areas as much as practical. These are good ways to reduce the risk of spreading any respiratory infection to other members of an expedition whether you are dealing with the common cold or an outbreak of influenza. Simple hand washing and the use of a mask on the patient can greatly reduce the spread of respiratory infection even in the confined space of a voyaging sailboat or group tent.

Respiratory Infection

General Principles

2

Serious (Red Flags): • Respiratory distress • Significant difficulty swallowing secretions

• Persistent fever • Bloody sputum • Tachycardia • Persistent chest pain

*

©2018WMA

Treatment of Respiratory Infection

Although antiviral drugs may be effective in the early stages of a cold or flu, eradication of the virus usually depends on the body’s immune system. A patient with a constellation of mild symptoms suggestive of viral infection should be made more comfortable while the body works to defeat the virus. Use whatever over-the-counter medications are available to make the patient feel better while not interfering with his or her ability to function. Local decongestants such as nasal sprays, systemic decongestants, and nonopioid cough medications can be very helpful at alleviating symptoms, as can anti-inflammatory medications like ibuprofen. Equally important is maintaining fluid balance, eating well, staying warm, and getting enough rest. This reduces the number of stressors that the body must deal with.

Respiratory Infection

General Principles

4

Treatment: • OTC NSAIDs and cough medication • Maintain hydration and calories • Bronchodilators for wheezing (Rx) • Antibiotics for infection (Rx) • PROP and evacuation for serious s/sx

*

“The availability of antibiotics should not cause you to delay the evacuation of a patient in respiratory distress.”

©2018WMA

A patient with symptoms of bacterial infec- tion may need antibiotics, especially if wheezing