Wilderness and Travel Medicine: A Complete Wilderness Medicine and Travel Medicine Handbook (Escape, Evasion and Survival Series)

Animals: Terrestrial

General Prevention of Animal Attack

Leave animals alone.

Do not feed, antagonize or surprise them.

Don’t put your hands or feet in places you can’t see; use sticks to turn over logs, rocks etc.

Don’t try to take their food, block their escape or get in between a mother and child.

Most are afraid of fire, loud noises and humans in general.

They are most dangerous when threatened, wounded, hungry, dehydrated, bearing young etc.

If you encounter large animals:

Keep calm, freeze, then slowly back away.

Do not make any sudden movements.

If it charges, move out of the way.

If you need to run, zigzag.

Shouting and making a commotion may put off a predator.

Climbing a tree is a last resort as they may wait for you.

Ant Bites

Fire ants often attack in mass if their nest is disturbed.

Treatment for Ant Bites

Brush them away with your hand.

Move away from the nest.

Strip your clothes to ensure there are none inside them.

Elevate the bitten extremity.

Place a cool compress on the affected area.

If a blister develops, don’t pop it.

If a blister pops, wash it with soap and water then dress.

Pharmaceuticals:

Antihistamine.

Anti-inflammatory.

Bed Bugs

Bed Bugs feed on your blood while you sleep and are most active at night. The bites are usually painless, but the after effects vary.

Symptoms of Bed Bug Bites

Resemble mosquito bites, but often are multiple bites in a straight line.

Treatment for Bed Bug Bites

Eradication (see below).

Pharmaceuticals:

Antihistamine.

Anti-inflammatory.

Eradication of Bed Bugs

Find the nest; check mattress seams, linens, backpacks, wooden joints etc. Look for brown fecal markings and dried blood.

Once the nest has been found, there are a number of methods which can be used to eradicate bed bugs:

Ø Bedding covers to starve them out, although adult bed bugs can live for more than a year without a blood meal.

Ø Diatomaceous earth is a natural pesticide found at most organic gardening supply stores. Dust the seams of the mattress with it. It won’t kill the eggs.

Ø Extreme cold: 5 days of temperatures -15 °C (about 0 °F).

Ø Pesticides: cover all areas and repeat at least once 10 days after the initial treatment.

Ø Placing all bedding and clothes in a hot dryer (as hot as possible) for 90 minutes.

Ø Rubbing alcohol: apply and repeat for a week.

Ø Vacuum the flooring and upholstery: a stiff brush is helpful to scrub mattress seams before vacuuming.

Ø Washing in hot, soapy water over 50 °C (125 °F).

Bee/Wasp Sting

The sooner you treat a sting the better, but you should first leave the area to prevent further attack.

Treatment for Bee/Wasp Stings

Remove the bee stinger with tweezers or by scraping it with a credit card or your fingernail. Be careful not to squeeze the venom from the sack into your body.

Treat as Open Wound; Must Read - Open Wounds, Skin Infections and Sepsis - Open Wounds.

Pharmaceuticals:

Antihistamine.

Alternative/Natural Remedies:

Clove oil topically.

Ice topically to soothe.

Mix baking soda with a small amount of water to form a paste and apply topically.

Mud applied topically may soothe if nothing else is available.

Caterpillars

Caterpillars are all over the world and come in a large variety of sizes and colors. Some caterpillars have spines containing toxin.

Symptoms of Caterpillar Toxin Contact

From caterpillars with hollow spines and venom glands:

Instant pain.

Redness.

Swelling.

Systemic symptoms are rare but may occur, including:

Fever.

Headache.

Nausea and vomiting.

Swollen lymph nodes.

Impaired blood clotting (rare).

From caterpillars or moths:

Conjunctivitis.

Itching.

Papular Rash (an area of abnormal skin tissue that is less than 1 centimeter around).

Redness.

Upper respiratory irritation.

Treatment for Caterpillar Toxin Contact

Apply and remove adhesive tape to remove spines.

Pharmaceuticals:

Antihistamine.

Anti-inflammatory.

Corticosteroid.

Cat-Scratch Disease

Cat-scratch disease is not surprisingly most commonly caused by cat scratches, but dog and monkey bites can also pass on the disease, as can thorns and splinters.

Symptoms of Cat-Scratch Disease

Chills.

Insect bite -like papule (solid elevation of skin with no visible fluid; can be brown, purple, pink or red in color and varied in size).

Mild fever.

Nausea.

Painful and tender lymph nodes, usually of arm or leg.

Rashes.

Treatment for Cat-Scratch Disease

Will usually self-resolve within months.

Pharmaceuticals:

Antibiotic: ciprofloxacin 500 mg twice a day.

Fleas

Fleas are tiny, wingless, blood-sucking, external parasites. They suck the blood of birds and mammals, including humans.

Common areas for flea bites are ankles, armpits, breast, groin, legs, underside of elbows, underside of knees and waist line.

Symptoms of Flea Bites

Hives.

Itchy.

Rash.

Red halo around bite.

Several small, red, bite-bumps in groups or straight lines.

Soreness around bite.

Treatment for Fleas Bites

Flea bites will dissipate in time.

Eradicate (see below).

Avoid scratching.

Pharmaceuticals:

Antihistamine.

Eradication of Fleas

Botanical dust mixed with a borate powder or boric acid. Do not breathe in. Coat the area and then vacuum after 24 hours.

Insect Growth Regulator (IGR), e.g., Nylar.

Very fine salt: coat the area and then vacuum after 24 hours.

Insects: General

Due to the incredible number of different insects, it is useful to have a general diagnosis and treatment for those you cannot identify easily.

Prevention is the best way to avoid attack. There are many insect repellents out there. If no insect repellents are available, you can use smoke to fumigate them.

General Symptoms of Insect Bites or Stings

There are a wide range of symptoms depending on the species. Common general symptoms are:

Allergic reactions.

Pain.

Swelling.

Welts.

Multiple stings:

Diarrhea.

Respiratory distress.

Vomiting.

Note: even a single sting may bring on anaphylaxis, which is life threatening; Must Read - Immediate First Aid – Anaphylaxis.

General Treatment for Insect Bites or Stings

Treat critical systems as needed.

Charcoal: activated charcoal is preferable. If that is unavailable, mix tea and wood charcoal (not briquettes) and add milk of magnesia if available.

Use a specific antidote/treatment if available/known.

Lice

There are basically 3 types of lice: head, body and pubic. They are most commonly spread with close contact and the sharing of personal items such as pillows, combs, towels etc.

Lice can transmit disease (depending on the type), but they are species specific, i.e., a human cannot get lice from anything other than another human.

The best protection against all types of lice is good hygiene. When in unhygienic situations, check for them as part of your daily hygiene routine; Must Read – Prevention – Personal Hygiene - Daily Hygiene Routine for Survival/Collapse Situation.

Eradication of Lice

It is preferable to throw out or destroy (burn) anything that might be infested. If you cannot/do not want to destroy or throw it out you have a few other options:

Alcohol: soak the infected things in strong alcohol.

Hot water: wash the infected things in very hot water.

Suffocation: place the infected things in plastic bags to suffocate the lice, and then air outside. Suffocate for 2 weeks, or 5 weeks for body lice.

Head Lice

Head lice causes itching and sometimes a rash but they do not carry disease.

Symptoms of Head Lice

Itching.

Rash.

The nits (louse eggs) look like small bits of dandruff that stick to your hair. They are easily seen with a black light.

Treatment for Head Lice

Eradication.

Run a fine tooth comb through the hair.

Olive oil may be applied to the comb which may make the nits easier to remove.

Wash hair with medicated shampoo:

Start with dry hair.

If you use hair conditioners, stop for a few days before using the medicine.

Apply medicated shampoo to the hair and scalp.

Let sit for 10 minutes, then rinse.

Check with the comb after 8 and 12 hours.

Repeat the process in 7 days.

Change clothes daily if possible.

Medicated Shampoos:

Nix lotion (1% Permethrin) will kill both the lice and their eggs.

Rid shampoo (Pyrethrum) will kill the lice but not their eggs.

Kwell shampoo (Lindane) is much stronger and may cause neurological side effects in children.

Various natural shampoos are also available.

Pubic Lice

Pubic lice (crabs) may be either lice or mites. Although they usually start in the pubic hair, they can extend anywhere there is hair.

The infestation is usually passed by sexual contact and is not prevented with a condom.

Symptoms of Pubic Lice

Severe itching.

Treatment for Pubic Lice

Use same treatment as for head lice.

Body Lice

Body lice actually live on dirty clothes (especially the seams) as opposed to the body. They only go to the human body to feed and can live without a host for about a month.

Body lice carry infectious disease.

Treatment for Body Lice

Eradication.

Removal of the infested clothing. Destruction of the infested clothing is strongly advised.

Mammalian Bites

Apart from the obvious wound, other problems an animal bite can cause are the transfer of disease and a higher chance of infection than many other types of wounds. Rabies is a potentially fatal infection that can occur, as is tetanus; Diagnoses and Treatments – Musculoskeletal System – Tetanus.

Keep your vaccinations up to date.

Treatment for Mammalian Bites

Different animals carry different diseases, e.g., plague is carried by rats and fleas, whereas tuberculosis is usually associated with deer, elk and bison. Regardless of what bites you, initial field treatment is the same, even if bitten by a human.

Remove any rings or bracelets that may get stuck if swelling occurs.

Treat wound, clean thoroughly; Must Read - Open Wounds, Skin Infections and Sepsis - Open Wounds.

The antiseptic of choice is benzalkonium chloride (BZK) as it has some effect against rabies; Diagnoses and Treatments – Environmentally Induced – Animals, Terrestrial - Mammalian Bites – Rabies.

If over the next few weeks after being bitten there are any of the following symptoms, seek advanced medical care:

Diarrhea.

Fever.

Nausea.

Vomiting.

Rabies

Rabies is a fatal, viral disease which any mammal can contract. Bats, cats, cattle, dogs, foxes, monkeys, raccoons, skunks and wolves are the greatest risk to humans.

Vaccinations are available.

Symptoms of Rabies

Symptoms in rabies victims are usually delayed for about 30 days. After this symptom-free period, victims may experience:

Fatigue.

Fever.

Headache.

Loss of appetite.

Increased symptoms are:

Irritability.

Disorientation.

Hallucination.

Seizures.

Eventually the patient may enter paralysis, go into a coma or suffer cardiac or respiratory arrest.

Treatment for Rabies

Once symptoms start to show, chances of survival are slim.

Immediately treat wound after any possible exposure, e.g., when bitten.

Seek advanced medical care.

If animal saliva has come in contact with your eye, irrigate it well with water and seek advanced medical care.

Mosquitoes

Mosquitoes are all over the world. Usually their bite results in nothing more than itchiness and minor swelling. For some people the symptoms can be a bit worse, e.g., hives. Unfortunately, mosquitoes also transmit a number of potentially deadly diseases.

Prevention of Mosquito Bites

Avoid mosquito infested areas: they are attracted to standing water and moist areas, and, are most active at dusk and dawn.

Keep up to date on all relevant immunizations, especially if traveling to at-risk countries; Must Read - Prevention – Vaccinations.

Wear long clothing and insect repellant; if no insect repellents are available, you can use smoke to fumigate them.

Dengue Fever

Dengue Fever is a tropical disease.

Symptoms of Dengue Fever

Diarrhea.

Fever.

Headache.

Muscle and joint pains.

Skin rash akin to measles.

Vomiting.

Symptoms of Dengue Hemorrhagic Fever:

Bruising and bleeding from the gums, mouth and nose.

Treatment for Dengue Fever

There is no specific antiviral drug for Dengue fever and complete recovery can take up to a month.

Treat dehydration; Diagnoses and Treatments - Circulatory System - Dehydration and Volume Shock.

Treat symptoms.

Japanese Encephalitis

Japanese encephalitis occurs all year round in tropical and subtropical areas, and during the warmer months in temperate climates.

Vaccinations are available and recommended if visiting high-risk countries, especially in rural areas; Must Read - Prevention – Vaccinations.

Symptoms of Japanese Encephalitis

Less than 1% of people infected will become ill. This means that in most cases, no symptoms will show.

Symptoms that may develop:

Chills.

Fatigue.

Fever.

Headache.

Nausea.

Vomiting.

Severe:

Encephalitis (inflammation of the brain) develops in about 1 in 300 infections.

Coma.

Paralysis.

Seizures.

Treatment for Japanese Encephalitis

There is no specific treatment.

Treat dehydration; Diagnoses and Treatments - Circulatory System - Dehydration and Volume Shock.

Treat symptoms.

Malaria

Malaria prophylaxis (prevention) medications are available and recommended if visiting high-risk countries, especially in rural areas. There are many types to suit different needs, e.g., dosages per day, short/long term travel, various strains etc.

An antibiotic recommended in the First Aid Kit that can also double as a malaria prophylactic is doxycycline; Must Read – First Aid Kit.

Dosage for doxycycline as a malaria prophylactic:

100 mg once a day.

Start a couple of days before exposure (travel to endemic area).

Continue daily during exposure.

Continue for 4 weeks after exposure.

Do not exceed 4 months of medication, i.e., only stay in the exposed area for 3 months.

Symptoms of Malaria

Confusion.

Fever and chills that are recurring.

Flu-like symptoms that do not respond to normal treatments.

Headaches.

Jaundice (yellow coloring of the skin and eyes).

Muscle pain.

Nausea.

Respiratory difficulties.

Tiredness.

Vomiting.

Treatment for Malaria

Seek advanced medical care.

Keep well-hydrated.

Pharmaceuticals:

Avoid NSAIDs, acetaminophen may help.

Antibiotic: doxycycline 100 mg twice a day for 7 days.

Note: depending on the strain of malaria, doxycycline may need to be used in combination with other medications. If you suspect you have malaria, seek advanced medical care for definite diagnosis and treatment.

West Nile Virus

West Nile virus is found in temperate and tropical regions of the world.

Symptoms of West Nile Virus

The majority of people will not have any symptoms. 20% of infected people may have the following:

Difficulty concentrating.

Fatigue.

Fever.

Headache.

Nausea and vomiting.

Rash.

Swollen lymph nodes.

Under 1% of infected people may develop Encephalitis or Meningitis; Diagnoses and Treatments – Head – Brain – Meningitis.

Treatment for West Nile Virus

No specific treatment is available, but it will usually self-resolve within a few days.

Treat symptoms.

Seek advanced medical care if have altered mental state, severe headaches and/or stiff neck.

Yellow Fever

Yellow fever is most common in the areas of Africa and South America. It mostly affects the liver and can be deadly.

Vaccinations are available and recommended if visiting high-risk countries, especially in rural areas; Must Read - Prevention – Vaccination.

Symptoms of Yellow Fever

Mild symptoms usually dissipate within days.

Dizziness.

Fever.

Headache.

Loss of appetite.

Muscle aches, particularly in your back and knees.

Nausea and/or vomiting.

Red eyes, face or tongue.

Sensitivity to light.

Severe:

The mild symptoms may return and also bring other symptoms which may be fatal:

Abdominal pain.

Bleeding from your nose, mouth and eyes.

Brain dysfunction.

Decreased urination.

Jaundice (yellow coloring of the skin and eyes).

Liver and kidney failure.

Vomiting, sometimes of blood.

Treatment for Yellow Fever

There is no specific treatment for Yellow Fever.

Treat symptoms.

Seek advanced medical care.

Pharmaceuticals:

Avoid NSAIDs.

Cutaneous Myiasis

Cutaneous myiasis occurs when certain fly species lay an egg on the skin, which then hatches and enters the skin.

Symptoms of Cutaneous Myiasis

Feeling of something under the skin.

Fever (rare).

Pain.

Lesions.

Swollen lymph nodes (rare).

Treatment for Cutaneous Myiasis

Simple pressure may force it out.

Covering the breathing hole with animal fat or nail polish may cause the larva to emerge.

If that does not work, inject 2 ml of local anesthetic (if available) into the base of the lesion to force them out with pressure.

If that does not work or is unavailable, cut it out, ensuring the larva does not rupture.

Mites and Chiggers

Chiggers

Chiggers are a type of mite that are found all over the world and favor moist and/or green areas, e.g., gardens, forests, parks.

They are extremely small, red creatures that are best seen with a magnifying glass and/or when they are in groups.

Prevention is the same as for mosquitoes; Diagnoses and Treatments - Environmentally Induced – Animals, Terrestrial – Mosquitoes.

For other mite bites, see scabies (below).

Symptoms of Chigger Bites

Extreme itchiness.

Red and may be flat, raised or resemble a blister.

Usually occur in the folds of the skin, e.g., armpits, behind knees.

Treatment for Chigger Bites

Chiggers do not cause any diseases and will go away on their own.

Itching will last for several days, lesions up to 14 days.

Avoid hot water, e.g., baths and showers.

Do not scratch.

They do not burrow into the skin so there is no need to try to remove them.

Treat itching and inflammation.

Pharmaceuticals:

Antihistamine.

Calamine lotion.

Corticosteroid creams.

Scabies

Scabies is caused by mites that burrow into the skin. These mites cause an allergic reaction resulting in extreme itchiness. Scabies itself is not contagious, but the passing of mites is via close skin contact, sharing of towels etc.

Symptoms of Scabies Bites

Bites are most common between the armpits, buttocks, fingers, genitals of men, navel, outside of elbow, waistline, wrist (palm side) and sides of breasts in women.

Rash with tiny blisters/sores.

Severe itching, worsening at night.

Treatment for Scabies Bites

Treat all people and clean at the same time to prevent re-occurrences.

Clean clothing and linen well as if bedbugs; Diagnoses and Treatments - Environmentally Induced – Animals, Terrestrial – Bed Bugs.

Pharmaceuticals:

Permethrin cream on bites and under the fingernails.

Porcupines

Porcupines are rodents with sharp quills. They are found in Africa, the Americas, Europe and Southern Asia.

Porcupine Quill Removal and Treatment

The sooner they are removed the easier it will be.

Do not cut them before removal.

Pull them straight out from the base, along the same line they entered.

Ensure there are no fragments left in the skin.

If in deep, a small nick in the skin can be made to allow the barb to be extracted.

Treat the wound; Must Read - Open Wounds - Skin Infections and Sepsis - Open Wounds.

Consider rabies vaccine; Diagnoses and Treatments – Environmentally Induced – Animals, Terrestrial – Mammalian Bites – Rabies.

Scorpions

Scorpions have pincers which can hurt, but only the tail injects venom. The venom usually affects the nervous system.

Symptoms of Scorpion Sting

Difficulty swallowing.

Increased saliva output.

Irritability.

Pain, numbness, and/or tingling in the area of the sting.

Rapid breathing and heart rate.

Restlessness or twitching.

Sweating.

Weakness.

Treatment for Scorpion Sting

Remove jewelry from the affected limb (swelling may occur).

Wash the area with soap and water.

Pharmaceuticals:

Antihistamine.

Antivenin (anticipate anaphylaxis); Must Read - Immediate First Aid – Anaphylaxis.

Snakes

There a lots of different kinds of snakes in the world. Some are harmless while others may be deadly. Best practice would be to steer clear of all snakes unless you have sufficient information about local subspecies.

Symptoms of Snake Bite

Exact symptoms are varied and depend on the species.

Pain at bite site.

Puncture wounds from fangs.

Treatment for Snake Bite

Snake bite treatment revolves around minimizing tissue damage, reducing effects of venom and preventing further complications, e.g., anaphylaxis, respiratory distress.

Be prepared for anaphylaxis, infection, respiratory distress and other complications; Must Read – Immediate First Aid.

Do not attempt to kill or capture the snake.

Remove any constrictive items from bitten limb in anticipation of swelling.

Immobilize bitten extremity with splinting.

The pressure immobilization technique is recommended only for Australian snakes, cobra snakes, coral snakes, mamba snakes and any other neuro-toxic snake envenomation; Must Read - Immediate First Aid - Pressure Immobilization Technique.

Avoid movement.

Do not elevate limb.

Hydrate.

Seek advanced medical care.

Pharmaceuticals:

No NSAID’s. Other analgesics may help.

Antibiotics if advanced medical care is more than 5 hours away.

Antibiotic: cephalexin 7 to 10 days.

Antibiotic: dicloxacillin 7 to 10 days.

Spider Bite

There are many different types of spiders, and many of their bites have no specific treatment.

Most cases will resolve themselves after a few days but some spiders are toxic and their bites may lead to death if untreated.

General Symptoms of Spider Bites

The effects from non-toxic spider bites usually don’t last more than a few hours, but occasionally may last a few days.

Blisters.

Immediate pain.

Rash and/or redness.

Swelling.

Two small puncture wounds.

General Treatment for Spider Bites

Wash well.

Rest.

Treat symptoms.

Note: in the case of the Australian funnel-web spider, use the pressure immobilization technique; Must Read - Immediate First Aid - Pressure Immobilization Technique.

Seek advanced medical care if:

Bitten by a known toxic species, e.g., brown recluse, black widow.

Intense pain.

Local symptoms last more than 24 hours.

Systemic symptoms emerge.

Alternative/Natural Remedies:

Aspirin: mix with water to make a paste and apply it topically.

Baking soda: mix with water to make a paste and apply it topically.

Basil: crush dried basil to a fine dust and apply it topically.

Charcoal: use it as a poultice. Activated charcoal is preferable. If that is unavailable, mix tea and wood charcoal (not briquettes) and add milk of magnesia if available.

Ticks

Different breeds of ticks can transmit a number of different diseases, but prevention is basically the same, i.e., keep the ticks off you.

Ticks must be implanted on humans for at least 24 hours to transmit bacteria.

Tick Removal

Pulling ticks off with tweezers is the preferred method.

Grab the tick as close to your skin as you can.

Pull the tick straight up and try to get all of it.

Disinfect the area.

Other methods include:

Smothering it with petroleum jelly.

Lighting it on fire, although the patient may also get burnt.

Prevention of Ticks

Light colored clothing that covers whole body, e.g., long sleeves.

Regular checks, at least once a day.

Stay away from common tick infested areas, e.g., leaf litter, shaded woodpiles, shrubs along game trails.

Repellents, e.g., DEET (<35%), Picardin etc.

Plants that repel ticks:

Eucalyptus, garlic, lavender, mint and sage.

Rub the leaves on your skin.

Lyme Disease

Lyme disease is spread by the black-legged tick (deer tick).

Symptoms of Lyme Disease

Initial:

Fatigue.

Fever.

Headache.

Joint pain.

Red rash around site.

After weeks or months patients may also experience:

Arthritis.

Infection.

Meningitis; Diagnoses and Treatments - Head - Brain – Meningitis.

Neurological issues.

Rash.

Treatment for Lyme Disease

Pharmaceuticals:

Antibiotic: doxycycline 100 mg orally every 12 hours for 28 days.

Antibiotics, other: amoxicillin, azithromycin and tetracycline.

Rocky Mountain Spotted Fever

A tick transmitted disease spread by dog ticks.

Symptoms of Rocky Mountain Spotted Fever

Initial:

Fever.

Headache.

Light sensitivity.

After 3 to 4 days:

High fever.

Rash.

Treatment for Rocky Mountain Spotted Fever

Pharmaceuticals:

Antibiotic: doxycycline 100 mg every 12 hours until 3 days after the fever subsides, usually 7 to 14 days.

Tick Paralysis

Symptoms of tick paralysis become present within 2 to 7 days of the tick(s) being attached.

Symptoms of Tick Paralysis

Leg weakness.

Paralysis then travels up the trunk to the rest of the body.

Respiratory arrest can occur.

Treatment for Tick Paralysis

Removal of the tick(s) will stop the toxin from being transferred into the body and symptoms usually diminish quite quickly.

Pharmaceuticals:

Antibiotics can be used if you get a rash along with flu-like symptoms that are resistant to medicines.

Antibiotic: doxycycline 100 mg 2 times a day for 14 days.

Antibiotic: amoxicillin 500 mg 3 times a day for 14 days.

Muscle aches and fatigue can linger for a while after treatment.



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