Medicine for the Outdoors
Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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The Significance of Fever Associated with Soft Tissue Infections

Skin and soft tissue infections are commonplace in the outdoors. As with every other medical problem, there may arise the issue of when to seek medical care or even when to evacuate the victim. For a medical professional, many of these decisions are made subjectively from experience. For non-medical people, it is always helpful to have something objective upon which to base your diagnostic and decision making.

Alfredo Sabbaj and colleagues published an article entitled "Soft Tissue Infections and Emergency Department Disposition: Predicting the Need for Inpatient Admission" in the journal Academic Emergency Medicine, volume 16, pages 1290-1297, 2009. This paper describes an urban, emergency department-based study that looked at patients with nonfacial soft tissue infections to attempt to determine which of them required inpatient admission for antibiotics, wound care and/or observation. While it was not a study carried out in a wilderness setting, it is, I believe, instructive for these settings. The premise upon which I base this statement is that if a person requires admission in an urban setting because of certain features of an infection, he or she would optimally benefit from admission in any setting. So, certain soft tissue infections are worrisome.

After looking at multiple elements of the histories and physical examinations of 674 patients, the authors concluded that the presence of a fever (either measured at the time of examination or reported by the patient as part of the history) best predicted the need for a greater-than-24 hour hospital stay. Interestingly, animal and human bites were also associated with a longer hospital stay. The former certainly applies to an outdoor setting.

What is a fever? Based on the data from this study, it should be considered to be an oral temperature greater than 37.8 degrees Centigrade (100 degrees Fahrenheit), although it may be lower if the temperature recording is accurate. How does this information get applied in the outdoors? If someone has a fever associated with a skin or other soft tissue infection, then an antibiotic(s) is indicated, and perhaps halting the journey until there is improvement or beginning to head towards medical care (e.g., possible hospitalization).
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About the Author

Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.