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  • William W. Forgey, MD

Body System Symptoms and Management - Nose, Mouth and Throat

Excerpt from The Prepper's Medical Handbook. Page reference numbers point to more in-depth treatment and self-reliant care available within the book.



NOSE


Nasal Congestion

Nasal congestion is caused by an allergic reaction to pollen, dust, or other allergens, and viral or bacterial upper respiratory infections. Bacterial infections can be cured with antibiotics, but otherwise all are treated similarly for symptomatic relief. Use Percogesic, 1 tablet every 6 hours as needed, for nasal congestion or discomfort. Drink lots of liquid to prevent the mucus from becoming too thick. Thick mucus will not drain well and can pack the sinus cavities with increasingly painful pressure.


If the patient has no fever, do not give an antibiotic. A low-grade temperature is probably viral and still does not warrant an antibiotic. If a temperature greater than 101°F (38°C) is present, treat with an antibiotic such as doxycycline, 100 mg twice daily, or Zithromax, as indicated on page 285.



Foreign Body Nose Injury

Foul drainage from one nostril may well indicate a foreign body. In adults, the history of something being placed up the nose would, of course, help in the diagnosis. In a child, drainage from one nostril must be considered to be the result of a foreign body until ruled out.


Have the patient try to blow his nose to remove the foreign body. With an infant it may be possible for a parent to gently puff into the baby’s mouth to force the object out of the nose.


While having a nasal speculum would be ideal, any instrument that can be used to spread the nostrils open will work; for example, the pliers on your Swiss Army knife or Leatherman tool. Spread the tips apart after placing them just inside the nostril. The nostril can stretch quite extensively without causing pain. Shine a light into the nostril passage and attempt to spot the foreign body. Try to grasp the object with forceps or another instrument. If the foreign material is loose debris—such as a capsule that broke in the patient’s mouth and was sneezed into the nostrils—it is best to irrigate this material out rather than attempting to cleanse with a Q-tip or other tool. Place a bulb or irrigation syringe in the clear nostril. With the patient repeating an “eng” sound, flush water and, hopefully, the debris out the opposite nostril.


After removing a foreign body, be sure to check the nostril again for an additional one. Try not to push a foreign body down the back of the patient’s throat, where he may choke on it. If this is unavoidable, have the patient bend over, face down, to decrease the chance of choking. After pushing the object farther into the nose and the upper part of the pharynx, hopefully the victim can cough the object out. If you are using this technique, first read the sections on nosebleed (see below) and foreign body airway obstruction (page 16).

Nosebleed


If nose bleeding (epistaxis) is caused by a contusion to the nose, the bleeding can be impressive but is usually self-limited. Bleeding that starts without trauma is generally more difficult to stop. Most bleeding is from small arteries located near the front of the nose partition, or nasal septum. The best treatment is direct pressure. Have the victim squeeze the nose between her fingers for 10 minutes by the clock (a very long time when there is no clock to watch). If this fails, squeeze another 10 minutes. Do not blow the nose, for this will dislodge clots and start the bleeding all over again. If the bleeding is severe, have the victim sit up to prevent choking on blood and to aid in the reduction of the blood pressure in the nose. Cold compresses can provide a slight amount of help.


Continued bleeding can result in shock. This will, in turn, decrease the bleeding.The sitting position is mandatory to prevent choking on blood from a severe bleed and, as indicated above, will aid in the reduction of blood pressure in the nose. Taken to the extreme degree, this position aids in allowing shock to occur.


Another technique that can be tried is to wet a gauze strip thoroughly with the epinephrine from the syringe in the Rx Injectable Medication Module. The epinephrine can act as a vasoconstrictor to decrease the blood flow and allow clotting.


Those having only nonprescription medical supplies will have to use the Opcon-A eye drops, which will not be as powerful in bloodvessel constriction. First clear the nose of blood clots so the gauze can be in direct contact with the nasal membranes. Have the victim blow his nose gently or use the irrigation syringe. Place the epinephrinesoaked gauze in the nose and apply pinching pressure for 10-minute increments. The gauze may be removed after the bleeding has stopped.


Nose Fracture

A direct blow causing a nasal fracture (broken nose) is associated with pain, swelling, and nasal bleeding. The pain is usually point tender, which means a very light touch elicits pain, indicating a fracture has occurred at that location. While the bleeding from trauma to the nose can initially be intense, it seldom lasts more than a few minutes. Apply a cold compress or a damp cloth that can cool by evaporative cooling. Allow the patient to pinch his nose to help reduce bleeding.


If the nose is laterally displaced (shoved to one side), push it back into place. More of these fractures have been treated by coaches on the playing field than by doctors. If it is a depressed fracture, a specialist will have to properly elevate the fragments. As soon as the person returns from the bush, have him seen by a physician, but this is not a reason for expensive urgent evacuation. Provide pain medication, which should be necessary for only a few doses. It is rare to need to pack a bleeding nose due to trauma, and this should be avoided, if possible, due to the increased pain it would cause.



MOUTH AND THROAT


Sore Throat

The most common cause of a sore throat, or pharyngitis, is a viral infection. While uncomfortable, this malady requires no antibiotic treatment—in fact, antibiotics will do no good whatsoever. Strictly speaking, the only sore throat that needs to be treated is the one caused by a specific bacteria (beta hemolytic streptococcus, Lancefield group A), as it has been found that antibiotic treatment for 10 days will avoid the dreaded complication of rheumatic fever, which may occur in 1 to 3% of people who contract this particular infection. Many purists in the medical profession feel that no antibiotics should be used until the results of a throat culture or antibody screen that prove this particular infection have been returned from the lab. On a short trip the victim can be taken to a doctor for a strep culture to determine if the sore throat was indeed strep. When off the grid longer than 2 weeks, it would be best to commit the patient to a full course of antibiotic therapy, realizing that the symptoms will soon pass and the patient seem well, but that it is essential to continue the medication for the full treatment regimen. The number of days of treatment differs depending upon which antibiotic is being used.


There are textbook differences in the general appearance of a viral and strep sore throat. The lymph nodes in the neck are swollen in both cases; they are more tender with bacterial infections, but people with a low pain threshold will complain bitterly about soreness regardless of the source of infection. The throat will be quite red in bacterial infections, and a white splotchy coating over the red tonsils or the back portion of the throat generally means a strep infection— at least these classic indications are present 20% of the time. Sore throats caused by some viral infections (namely infectious mononucleosis and adenovirus) may mimic all the above. From the Rx Oral/ Topical Medication Module, use Zithromax 500 mg as described. The 3-tablet dose provides a therapeutic blood level for 10 days.


Infectious Mononucleosis

Infectious mononucleosis, a disease of young adults (teens through 30 years of age), generally presents as a terrible sore throat, swollen lymph nodes (normally at the back of the neck and not as tender as with strep infection), and a profound feeling of fatigue. It is selflimited, with total recovery to be expected after 2 weeks for most victims—some, unfortunately are bedridden for weeks and lethargic for up to 6 months. Spleen enlargement is common. The most serious aspect of this disease is the possibility of splenic rupture, but this is rare. Avoid palpating the spleen (shoving on the left upper quadrant of the abdomen) and let the victim rest (no hiking, etc.) until the illness and feeling of lethargy has passed. The first 5 days are the worst, with fever and excruciating sore throat being the major complaints. Continued physical activity in persons with this disease can contribute to a prolonged convalescent period.


Treatment is symptomatic, with medication for fever and pain such as the non-Rx Percogesic or ibuprofen, each given 1 or 2 tablets every 4 to 6 hours. A mild form of hepatitis frequently occurs with mononucleosis that causes nausea and loss of appetite. This requires no specific treatment other than rest. If severe ear pain begins, add a decongestant (or just use the Percogesic), 2 tablets every 6 hours, to promote relief of eustachian tube pressure. Due to the uncertainty of diagnosis, treat the severe sore throat as if it were a strep infection, with an antibiotic for 10 days or with Zithromax as indicated above (see Sore Throat on page 59).


Mouth Sores

When mouth sores develop, patients frequently believe they either have cancer or infection, especially herpes. A common reason for a lesion is the sore called a papilloma, caused from rubbing against a sharp tooth or dental work. They may look serious but are not. They are raised and normally orange in color. One can usually find an obvious rough area causing the irritation. Treatment is to avoid chewing at the lesion and to apply 1% hydrocortisone cream from the Topical Bandaging Module every 3 hours. If the Rx Oral/Topical Medication Module is available, use the Topicort 0.25% ointment every 4 hours. An alternative therapy, which can be used simultaneously, is to apply oil of cloves (eugenol).


A canker sore, also called an aphthous ulcer, can appear anywhere in the mouth and be any size. It has the distinctive appearance of a white crater with a red, swollen border. Treatment is as above.


If there is generalized tissue swelling, possibly with drainage or whitish cover on the gums, foul-smelling breath, and gums and mouth tissue that bleed easily when scraped, it is possible that the victim has trench mouth, or Vincent’s infection. This is caused by poor hygiene, which is unfortunately common on long expeditions under adverse circumstances. If the white exudate is located over the tonsils, one has to be concerned about strep throat (see page 30), infectious mononucleosis (page 60), and diphtheria. Treat trench mouth with warm water rinses, swishing the crud off as much as possible. If the Rx Oral/Topical Module is available, give the full dose regimen of Zithromax 500 mg tablets for 3 days, or treat with Levaquin, 500 mg, once daily for 5 days.


The mouth lesions of herpes simplex begin as small blisters and leave a raw area once they have broken open. The ulceration from herpes is red rather than the white of the canker sore. They are very painful. From the Rx Oral/Topical Module, apply the Denavir cream every 2 hours. This is not approved for use inside of the mouth, but it is perfectly safe and it works.


Fever blisters are sores that break out on the vermilion border of the lips, generally as a result of herpes simplex virus eruptions. These lesions can be activated by fevers (hence the name “fever blister”) or other trauma, even mental stress. Ultraviolet (UV) light will frequently cause flares of fever blisters. This can be a common problem of mountain travel due to the more intense UV radiation encountered at higher altitudes.Treat as above for the herpes simplex inner mouth lesions. These lesions can be prevented with adequate sunscreen and/ or by taking an antiviral prescription medication.


Gum Pain or Swelling, Tooth Issues, see chapter 5, Dental Care (page 109)


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