Primary care
-
Wilderness medicine is not a single entity. It encompasses clinical practice, instruction, and research as they pertain to wilderness settings. Clinical practice often takes place in removed settings far from traditional medical resources and facilities. ⋯ The decision of what treatment should be initiated and if the patient requires evacuation to definitive care often is difficult. There are four phases of an SAR event: location, access, stabilization, and evacuation. Evacuation may require the assistance of organized search and rescue services.
-
The primary care practitioner often is the first clinician sought out by a returning traveler, and it is important that he or she be alert to the possibility of exotic illness while remembering the more mundane causes of fever. Malaria remains one of the most serious diagnoses in a febrile traveler and should be looked for repeatedly. Other diagnoses may be suggested by exposure history and patterns of laboratory findings. A directed diagnostic workup, rational empiric therapy, and appropriate consultation are the tools with which the primary care provider successfully can manage the challenging dilemma posed by the returning traveler with fever.