INFECTIONS - Medicine for Mountaineering and Other Wilderness Activities - page 305

Some individuals are allergic to the penicillins and may have severe, even fatal, reac-
tions to either oral or intramuscular administration (“Anaphylactic Shock,” Chapter 23:
Allergies ) . Anyone who is to receive a penicillin (or any other drug, for that matter) must
be carefully questioned about previous allergic reactions. If a person has a history suggest-
ive of a serious penicillin allergy, a chemically different antibiotic effective against the in-
fectingorganismshouldbesubstituted.Allergiestootherantibioticsandtosulfadrugsalso
occur.
BACTERIAL INFECTIONS
Infections of the respiratory tract, urinary tract, and skin are the most common bacterial in-
fections. These disorders are usually innocuous, although disastrous, widespread infection
can result if they are mistreated.
Abscesses
Abscesses, boils, carbuncles, and pimples are localized skin infections that differ only
in size. They frequently occur at sites of injury and around hair follicles, particularly in the
armpitsandgroin.Theyareusuallycausedbystaphylococciresistanttopenicillin.Staphyl-
ococci release enzymes that cause clotting andobstruction ofbloodvessels andlymphatics
surrounding the site of infection. Since the vascular obstruction blocks the spread of bac-
teria, the infection usually remains localized, but the vascular obstruction also hinders the
access of white blood cells and antibiotics. Other enzymes released by these bacteria des-
troy tissues around the infection, producing an abscess cavity filled with pus (a mixture of
bacteria, white blood cells, and liquefied tissue).
The treatment for such disorders consists primarily of drainage and is similar to the
treatment for infected wounds. Pimples and small abscesses do not need to be surgically
opened. They should be covered until they rupture spontaneously. Squeezing pimples may
force bacteria into the surrounding tissues and tends to spread the infection. A particularly
dangerous area for such infections is around the nose and below the eyes. Squeezing a
pimple in this region (sometimes referred to as the “danger space”) may force bacteria into
veins and lymphatics of the head, which carry them directly to the brain.
Larger abscesses may have to be incised to drain them. After the surrounding and
overlying skin has been cleaned with a preparation such as povidoneiodine (Betadine®),
alcohol, or clean water and soap, a small incision should be made with a sterile scalpel or
razorblade.Alocalanesthetic maybenecessary.Whenalargeabscesshasbeendrained,it
should be probed with sterile forceps to make certain no pockets of infection remain. Then
the skin should be cleansed again, and a small piece of sterile gauze should be inserted
into the opening so it cannot seal off. Finally, the entire area should be covered with sterile
dressings.