From: James B. Svacha
Sent: Friday, September 23, 2005 8:17 AM
To: T159HA Mailing List
Subject: [t159ha] Re: [t159members] The REAL trek report

All,

Please keep a close eye out of ticks from this (and any) hike. I, unfortunately, found a very small deer tick on me yesterday evening. That is 5 days later. Like I said, it was very small.

Prior to removal (it was very small and difficult to remove), I looked up best removal methods:

The patient arrives with a tick attached to the skin, often the scalp, often frightened or disgusted and concerned about developing Lyme Disease, Rocky Mountain Spotted Fever or "tick fever."

What to do:

• Promptly remove the tick. Grasp the tick with a pair of forceps and slowly pull up until the tick mouth parts separate from the skin. If the mouth parts remain embedded, anesthetize the area with an infiltration of 1% Xylocaine and use a # 10 scalpel blade to scrape (dermabrade) these fragments away.
• Instruct the patient or family to record the patient's temperature daily for the next two weeks and to notify a physician or return to the ED at the first sign of a temperature above the baseline.
• If this was a 5mm Ixodes or deer tick, which was attached for more than a few hours, consider prescribing antibiotics to prevent Lyme disease (doxycycline 100mg bid x 10d, amoxicillin 500mg tid x 10d). Instruct the family to watch for a pink patch at the site, which could be the beginning of erythema chronica migrans.
• If this was a 1 cm Dermacentor or Amblyomma tick, reassure the patient and family that the likelihood of developing Rocky Mountain spotted fever is very small ( l %) and that if it should occur, prompt treatment will be quite effective upon development of fever. It is counterproductive to give prophylactic antibiotics in an attempt to prevent RMSF.

What not to do:

• Do not use heat, occlusion, or caustics to remove a tick. A multitude of techniques have been promoted, but they may only increase the chance of infection
• Do not contaminate your fingers with potentially infected tick products.
• Do not mutilate the skin attempting to remove the tick's "head." Usually what you see left behind is cememtum secreted by the tick, easily scraped off.