TY  - CHAP
M1  - Book, Section
TI  - Management of the Critically Ill Traveler
A1  - Sandrock, Christian
A1  - Black, Hugh
A1  - Fowler, Robert
A2  - Schmidt, Gregory A.
A2  - Kress, John P.
A2  - Douglas, Ivor S.
Y1  - 2023
N1  - 
T2  - Hall, Schmidt and Wood’s Principles of Critical Care, 5<sup>th</sup> Edition
AB  - KEY  POINTSWhile  the  incidence  of  the  critical  illness  among  travelers  is  small,  the  importance  of  its  evaluation,  diagnosis,  treatment,  and  public  health  response  can  be  profound.  This  is  acutely  highlighted  with  the  SARS-CoV-2  pandemic  of  2019  to  2022.1,2Regardless  of  etiology,  the  early  approach  to  the  critically  ill  traveler  should  include  a  detailed  travel  history,  an  appropriate  range  of  diagnostic  tests,  attention  to  infection,  prevention  and  control  practices  appropriate  for  the  syndrome  and  clinical  suspicion,  and  involvement  of  public  health  authorities  as  appropriate.3–5Antimicrobial  resistance,  particularly  with  carbapenem-resistant  gram  negative  pathogens,  is  increasing  in  returning  travelers  and  this  directly  impacts  appropriate  initial  antimicrobial  therapy  and  subsequent  patient  outcomes.6,7Severe  Plasmodium  falciparum  infections  should  be  treated  with  parenteral  therapy  recommended  for  (e.g.,  intravenous  artesunate),  and  may  require  coordination  with  local  medication  supply  or  public  health  authorities  in  jurisdictions  where  therapies  are  in  limited  supply.8,9Influenza,  coronaviruses,  and  viral  hemorrhagic  fevers  may  all  present  with  a  febrile  illness  along  with  an  acute  hypoxemic  respiratory  failure.  Early  attention  to  infection  prevention  and  control,  supportive  care,  syndrome-appropriate  therapies—e.g.,  lung  protective  ventilation  strategies  for  acute  respiratory  distress  syndrome;  steroids  and  antivirals  for  COVID-19;  antivirals  and  monoclonal  antibodies  for  a  variety  of  viral  illnesses  when  indicated—are  the  mainstay  of  therapy  in  the  critically  ill.4,10,11Rickettsial  diseases  will  include  a  fever,  myalgias,  headache,  and  often  include  a  rash  or  eschar.  In  many  cases,  such  as  Rocky  Mountain  spotted  fever,  Rickettsial  disease  is  difficult  to  distinguish  from  other  infections  until  the  rash  appears.  Early  therapy  with  doxycycline  is  essential  in  improving  outcomes.12,13Ulcers  and  painful  lymph  node  syndromes  of  plague  (Yersinia  pestis),  tularemia,  and  anthrax  may  present  as  a  rapidly  progressing  pneumonia  and  require  antimicrobial  therapy  for  both  treatment  and  prophylaxis.14,15The  coronaviruses  SARS-CoV-2,  MERS-CoV,  and  previously  SARS-CoV-1  have  emerged  as  important  potential  sources  of  acute  respiratory  failure  in  a  critically  ill  traveler.  The  worldwide  pandemic  causes  by  SARS-CoV-2  remains  the  largest  event  associated  with  the  critically  ill  and  travel  and  has  influenced  the  management  of  critical  illness  worldwide.16,17Attention  to  appropriate  infection,  prevention  and  control  practices,  and  involvement  of  public  health  officials,  as  appropriate,  are  important  components  of  the  management  of  infectious  causes  in  the  critically  ill  traveler.4,5  
SN  - 
PB  - McGraw Hill
CY  - New York, NY
Y2  - 2024/09/11
UR  - accessanesthesiology.mhmedical.com/content.aspx?aid=1201806463
ER  -