Fever in a Returning Traveler
EM Clerkship
Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD
4.9 • 816 Ratings
🗓️ 12 November 2017
⏱️ 9 minutes
🧾️ Download transcript
Summary
If a returning traveler has a fever, think malaria malaria malaria!!!
Step 1: Ask your patient if they have traveled within the last year
* If yes… You should at least CONSIDER malaria
Step 2: If patient says yes, take a travel history
* When did they go* Where did they stay* Where they exposed to anything concerning* Mosquitos* Animals* Weird foods* Sexual partners* Sick people* Where they in developed/tourist areas or “off the trail”
Step 3: Ask about prophylaxis
* Did they see a doctor before leaving?* Did they take any immunizations or medicines prior to departure?* Did they continue prophylaxis as instructed?
Step 4: Go to the CDC website
* Look up the country of concern* Will help establish your differential
Step 5: Test for malaria
* If you are concerned that patient has malaria…* Order thick and thin blood smear
Additional Reading
* CDC Yellow Book (CDC Website)
Transcript
Click on a timestamp to play from that location
| 0:00.0 | Hello, med students. My name is Zach Olson, and thank you for downloading this week's |
| 0:06.4 | episode of the EM Clerkship Podcast. I'm about to tell you a secret about myself. I just |
| 0:15.5 | killed a patient. It was a few months ago, actually, it was only in SIM, but I've only ever completely |
| 0:22.0 | killed two patients in Sim before. Once in a patient with Wolf Parkinson White and atrial fibrillation, |
| 0:28.5 | and I gave a medicine that blocked the AV node to slow down the AFIB, and boom, cardiac arrest. |
| 0:35.0 | And all of the attendings all rolled their eyes. I was a fresh intern. |
| 0:38.3 | It's okay. |
| 0:39.0 | Not going to happen again. |
| 0:41.4 | But the case we're going to talk about today was as a third year resident. |
| 0:46.8 | I was a little sloppy on taking a full history, and my attendings just let me miss it, |
| 0:52.4 | and the patient died. |
| 0:53.5 | And now this case is forever burned |
| 0:56.5 | into my memory i've been doing a ton of reading about it and it's not a topic that we think about |
| 1:02.3 | much so i wanted to cover it at least in the united states even though we should be thinking about this |
| 1:08.5 | we're not this week we're going to be talking travel medicine we're going to specifically be thinking about this or not. This week we're going to be talking travel medicine. |
| 1:12.7 | We're going to specifically be talking about fever in the returning traveler. |
| 1:17.9 | Somebody comes back from a trip to a foreign country where they were exposed to stuff that they have no immunity to. |
| 1:24.2 | And when they come back, they are sick and belazed, maybe febrile, or at least they feel like |
| 1:30.3 | they're having fevers. |
| 1:31.7 | That's what we're talking about today. |
| 1:33.2 | Because it turns out there is a big, big, big, big life threat lurking in these patients. |
| 1:40.8 | It's one of the biggest killers in the world, actually. |
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