Blog changes

The Adventure Doc Blog is undergoing a few changes to match the new websites. These will take place over the next few days and your patience is appreciated! In the meantime, please visit our new homepage at:

www.AdventureDoc.org

New websites!

We are very excited about work on our new websites at: www.AdventureDoc.org and www.AdAccomp.com that detail our complete services. Please have a visit and offer us your thoughts!

Happy new year

Happy new year from the Gulf of Carpenteria! I hope every one has a safe, happy, healthy and adventurous 2012!

Erik

Giardia and Travelers

Giardia

Condition: A diarrheal illness resulting from parasitic infection

Infectious Agent: Giardia intestinalis, a protozoan parasite

Signs and Symptoms: Symptoms can range from aysmptomatic to a variety of gastrointestinal complaints including diarrhea, abdominal cramping, bloating, fatigue, flatulence and nausea. Diarrhea is classically foul smelling and greasy. Symptoms generally present 1-2 weeks after exposure and are generally self limiting after 2-4 weeks.

Diagnosis: Giardia cysts or trophs are not always seen in the stool of infected patients. Examining up to three stool samples over several days can increase investigative power.

Transmission: Ingestion of fecally contaminated food or water including water swallowed while swimming; contact with fecally contaminated surfaces such as diaper changes, caring for an infected person or sexual contact.

Treatment: Metronidazole, tinidazole, nitazoxanide and furazolidone are drugs known to have efficacy against Giardia. Because of the difficulty of definitive diagnosis, empiric treatment can be started in patients with appropriate symptoms and history.

Prevention: Travelers should follow strict food and water precautions. There is no vaccine or role for preventative antibiotics.

Epidemiology: Found worldwide, the risk of Giardia infection increases with duration of travel. Roughly 31 of 1,000 travelers seeking medical care are diagnosed with giardia. This is most commonly seen in travelers from South Asia, Middle East and South America although it has been in seen in travelers from all regions of the world. Long-term travelers (>6 months) have a much higher incidence than shorter-term travelers. In Nepal, Giardia is found in 10% of stool samples from patients with complaints of diarrhea.

Amebiasis and Travel

CDC dpdx

We have decided to start using some of the work that has been put into some of our education modules, traveler/patient hand-outs and internal training material here on the blog. So there is going to be a new feature of a brief examination of a disease, condition or piece on travel health a lot more frequently. To get this started I have selected Amebiasis mainly because it starts with the letter “A”.

Amebiasis

Condition: A parasitic infection that often affects the gastro-intestinal tract causing diarrhea; may spread to other organs of the body (liver) to form abscesses

Infectious Agent: Entamoeba histolytica, a protozoan parasite

Signs and Symptoms: Crampy, water and sometimes bloody diarrhea; weight loss; 1/3 of patients have a fever; asymptomatic infections may be seen

Diagnosis: PCR testing is standard; microscopically indistinguishable from E. dispar which is non-pathogenic

Transmission: Fecal-oral route such as eating or drinking fecally contaminated products

Treatment: Metronidazole followed by iodoquinol or paromomycin

Prevention: Food and water precautions including ice and frequent handwashings; avoidance of fecal exposure during sexual activity; there is no vaccine against amebiasis and prophylactic medicine is not advised

Epidemiology: Found worldwide, especially in the tropics; more common in areas of poor sanitation; most commonly seen in travelers returning from South America, South Asia and the Middle East; Long-term travelers (>6 months) are considered higher risk than shorter-term travelers; only 10-20% of infected patients become symptomatic

Remote and Expedition Medicine Class

Adventure Doc Ambulance

Adventure Doc is busy preparing for an upcoming class on remote and expedition medicine for some of our new paramedics. The class is a bit modified for our own crew and will be focusing on the following topics for the first block of education:

  • Suture Skills and Wound Care (suture, staple, glue and wound care)
  • Tropical Medicine Basics (malaria, dengue, yellow fever, helminthes, leptospirosis and leishmaniasis)
  • Environmental Medicine (heat, cold, altitude and motion sickness)
  • Medical Kit Construction (case based scenarios)
  • Field Water Disinfection (pathology, methods, storage and pitfalls)
  • Adventure Doc Standing Orders and Treatment Protocols
  • Chartwork, Cas-Evacs, Documentation and Trip Deployment
  • Pharmacology Basics (antibiotic basics, pain management, altitude and diarrhea)
  • Traveler’s Diarrhea (diagnosis, treatment, management and prevention)

While there are many more classes and training modules that are required to learn prior to accompanying our travelers and adventurers in the field, these classes and modules make up the core foundation of skills and knowledge. The classroom lectures are combined with a lot of hands on training of wound closure on tissue models, medical equipment familiarity and skill stations. Detailed course materials will also be provided for home study and more detailed mastery of these subjects.

For more information on Adventure Doc Education Classes open to the general public you can visit our website: http://www.adventuredocclinic.com/classes_and_seminars.html

Adventure Doc is very proud of our paramedics and consider them to be the best providers of medical care in international, remote and austere settings…Anywhere. For those interested in corporate or group training for your paramedics or health care providers please contact us via our website: www.AdventureDocClinic.com

New test post from the road

Here we go with an attempt to post to the blog using a sat phone, broadband and an iPad…I hope this posts!

Updated Servers and Websites

Apologies for not have a fresh post up in the last few weeks!  However, I am very happy to report that we are in the process of upgrading our servers and websites to feature new services and methods of servicing our patients/clients. Those of you who are unfamiliair with our current services can visit our website to learn more:

 

http://www.adventuredocclinic.com/services.html

 

 

Medical Clinic and Facility Consultation

Adventure Doc is very excited about a few new requests we have been receiving to design and build several medical facilities for our clients. This subject was actually the topic of my Master’s Thesis and the original paper can be viewed here: http://www.rrh.org.au/publishedarticles/article_print_830.pdf

These new remote and austere site medical facilities are highly customizable and based on the needs of our clients and patients. A new website is under development and will be completed shortly. This website will detail several new services offered by Adventure Doc:

  • Design and Construction of medical facilities at any location, worldwide
  • Staffing of these facilities with Doctors, Physician Assistants, Nurses and Paramedics
  • Improvement and upgrade of existing medical facilities
  • Addition of laboratory and radiology services to existing medical clinics
  • 24/7 consultation from these facilities to Board Certified American physicians
  • Medical Records and EMR services for patient management

Through Adventure Doc’s unique partnership with an Architectural Firm that specializes in healthcare facilities we are able to add a new dimension to designing and building medical facilities in remote and austere environments.

 

Tactical and Remote Medicine Classes

We are very excited about our new six day program on Tactical and Remote medicine. The course description can be viewed on our website:

http://adventuredocclinic.com/Brochures/TEMS%20&%20Remote%20Medicine%206%20day.pdf

 

Carrying Home Medication While Traveling

Many travelers are taking regular medications for one reason or another. Cholesterol, high blood pressure, thyroid regulation and depression are just a few very common examples of regular, daily home medications. Forgetting these medicines when you travel can have disastrous consequences! A few tips for carrying your home medications include:

  • Always carry your home medications in their original pharmacy bottles

This eliminates the embarrassing and hazardous need to explain to the custom’s officer why the cholesterol tablets you placed in a plastic bag are now crushed and look like a fine, white powder.

  • Carry a copy of your doctor’s prescription with you in your first aid kit

In the event your home medicines are lost, stolen, destroyed or you need refills this script will make it easier to refill at the local pharmacy.

  • Carry enough for your entire trip plus half again as much

If you are traveling for 14 days, bring 21 days worth of medicine. This gives you some comfort room in the event of delays in travel, missed planes or in case you just want to stay a bit longer!

  • Carry essential medications with you in your carry-on bag

Diabetic medicine, blood pressure treatment, diuretics and other essential medicines should be carried in your carry-on bag in case the checked luggage is lost or delayed.

  • Store medications as you would at home

Some insulin needs refrigeration and some medicines need to be kept from direct sunlight. Store your medicines while traveling the same way you do when you are at home.

  • Carry a list of your medicines with you at all times

In the event of an emergency and a trip to the emergency room or local doctor’s office you should be able to identify all your medications, doses and why you are taking them. Write this information down on a piece of paper and carry it in your wallet.

 

Malaria Prevention

When talking about preventing malaria it is first important to understand a few basics about the disease. First, malaria is a global killer with around 1,000,000 million deaths per year. Half of the world’s population lives in a malaria risk zone (3.3 billion people). There are an estimated 250 million cases of malaria each year.

Malaria Basics: A parasitic disease that is spread by infected mosquitoes; Malaria is characterized by fevers, fatigue and muscle aches. As the disease progresses enlargement of the liver and spleen can occur, along with a yellowing of the skin and eyes. Malaria is both treatable and preventable.

Species: There are four main species of malaria parasites: Plasmodium Vivax, P. Falciparum, P. Malariae and P. Ovale. Plasmodium Falciparum is considered the worst and most drug resistent.

Location: Malaria is found in virtually every tropical location on the planet, especially at lower elevations

Malaria Prevention

Talking abot how to prevent malaria is a complex matter. An easy way to remember malaria prevention is the A-B-C-D approach

A: Awareness

B: Bite Prevention

C: Chemoprophylaxis

D: Diagnose early

Awareness is simply realizing that you are entering a malaria zone and are at risk for the illness. In addition, it is wise to know a bit about the disease including signs and symptoms.

Bite prevention centers around the concept that if you are not getting bit, you are not getting sick. The ways to avoid getting bit is to wear long sleeves, long pants and make use of insect repellent. 30-35% concentrations of DEET should be applied to your skin and permethrin should be applied to your clothing. Avoid being outside during peak mosquito biting times such as dusk to dawn. If needed, sleep under a mosquito net.

Chemoprophylaxis means taking a medication to avoid getting sick. For malaria, there are four main types of medications to prevent illness.

Chloroquine-Taken weekly; start 1-2 weeks before entering area and take 4 weeks after leaving

Doxycycline-Taken daily; start 1-2 weeks before entering area and take 4 weeks after leaving

Mefloquine (Larium)-Taken weekly; start 1 week before entering area and take 4 weeks after leaving

Atovaquone/Proguanil (Malarone)-Taken daily; start 1-2 days before entering area and take 7 days after leaving

Diagnosis early means that if you have a fever in a malaria zone it should be treated as malaria until proven otherwise. Do not delay diagnosis and visit a qualified health care provider as soon as you suspect malaria. Travelers can get malaria even when taking their medicines.

Remote and Expedition Medicine Classes

Adventure Doc Education is very excited about finalizing several new course modules and they can be viewed on our main website.  Our Remote and Expedition Medicine classes are highly customizable and have been arranged into two sample programs.  Program one is 5 days in duration while program two is 7-10 days in duration depending on the needs of our participants.

The course modules can be combined into training sessions as short as 2-3 days or up to 15 days.  Details on the subject matter can be viewed on our PDF documents here.

Courses include:

  • Medical Kit Construction
  • Tropical Medicine
  • Suture Skills and Wound Closure
  • Sick Call and Urgent Care Clinic
  • Field Water Disinfection
  • Environmental Medicine
  • Envenomations, Bites and Stings
  • Field Diagnostic Techniques
  • Solar Radiation and Insect Bite Prevention
  • Aeromedical Transport and Evacuation
  • Search and Rescue Basics
  • Clinical Pharmacology in Remote Settings
  • Clinical Microbiology in Remote Settings
  • Fluids and Dehydration
  • Diving Medicine
  • Pregnant Patients in Remote Settings
  • Adult Primary Care in Remote Settings
  • Pediatric Primary Care in Remote Settings
  • Women’s Health in Remote Settings
  • Ear, Nose and Dental in Remote Settings
  • Travel Vaccines
  • Extremity Injuries in Remote Settings

Currently, Adventure Doc is working on completion of our Tactial Emergency Medicine (TEMs) modules and will be offering three day, five day and seven day sessions.  These TEMs classes will also be able to be combined with our Remote and Expedition coursework.  A combination of 4 days of Remote and Expeditionary Medicine with 3 days of TEMs is a perfect example of this.

For more information on these offerings please contact us at: education@AdventureDocClinic.com

New Adventure Doc Website

We are very pleased to report that our new website: http://adventuredocclinic.com/index.html is uploaded and operational!  Please give it a visit and tell us what you think!

Setting new protocols for expedition and wilderness medicine

We have been quite busy with our re-design of the Adventure Doc protocols for treatment of patients in wilderness, remote and expeditionary settings.  I am very excited to be nearly completed with them and the should help our doctors and paramedics in the field a great deal!

These protocols examine commonly encountered medical and trauma assessments on expeditions and adventure travels.  The new additions also include more details trauma/tactical EMS scenarios and standing orders.  This is due to our provision of medical care in potentially hostile environments and our paramedics receiving additional Tactical EMS training.  Everything from altitude sickness and diarrhea to blisters and penetrating chest trauma are covered.  This represents an extraordinary effort on the part of many individuals working with Adventure Doc and I am very happy with the results.

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