Case Study: Embedded Tick while Backpacking
Photo by Eva Darron
The setting
The Setting: You’re on day 6 of a week-long backpacking trip on the Appalachian Trail in New York. The last few days have been beautiful, and you’re so glad to be enjoying this time outside. You and your friends decide it’s time for a break, so you sit down to enjoy some cool water and a snack. All of the sudden, one of your friends says, “Hey, I think there is a tick on me.” You wander over and offer to help out.
SOAP Report
Subjective
Your patient is a 22 year old male whose chief complaint is “there is a tick on me.” There was no mechanism of injury and the patient is currently A+Ox4.
Objective
Patient Exam: The patient is found sitting on their backpack. The physical exam shows a small tick embedded in the patient’s leg and the tick looks engorged. No other injuries are found and CSMs are intact in all four extremities.
Vital Signs
| Time | 1400 |
| Level of Responsiveness (LOR) | A+OX4 |
| Heart Rate (HR) | 94, strong, regular |
| Respiratory Rate (RR) | 16, regular, easy |
| Skin Color, Temperature, Moisture (SCTM) | Mucous membranes pink, skin warm, dry |
| Blood Pressure (BP) | Strong radial pulse present |
| Pupils | PERRL |
| Temperature (T°) | Not taken |
History
| Symptoms: | None |
| Allergies: | Patient states they’re allergic to penicillin. They have not been exposed to penicillin. |
| Medications: | Patient states they take albuterol to manage their asthma. |
| Pertinent Hx: | Patient has a history of asthma. No other relevant history. |
| Last in/out: | Unremarkable for the patient. |
| Events: | Patient says he stopped for a break and noticed the embedded tick in his leg. |
STOP READING!
What is your Assessment and Plan? Think about this before moving to the next page.
Assessment
- Embedded tick that looks engorged.
Plan
- Remove the tick with tweezers.
- Consider seeing a healthcare provider for prophylactic antibiotics in the next 72 hours.
Anticipated Problems
- The patient starts to not feel well and leaving the backcountry becomes more challenging.
Comments
Ticks carry a variety of diseases that can be transmitted to humans, and Lyme disease is the most common tick-borne illness in the United States. If you notice a tick on your body, remove it as soon as possible. To remove the tick, use tweezers to grasp the tick as close to the skin as possible and pull steady traction in line. After removing the tick, wash the area thoroughly with soap and water.
Do not apply ointments, chemicals or heat to remove a tick. These are not credible methods.
Tick borne illnesses can present with a variety of symptoms. If someone is bitten by a tick, monitor them for rashes or ulcerations. Other signs and symptoms include muscle aches, joint pain and fever.
If you suspect you are in a Lyme endemic area, prevention includes evacuation of all individuals who have an engorged tick if a doctor can be seen within 72 hours to evaluate for antibiotic prophylaxis. Anyone who has a rash, muscle aches, joint pain, and fever, regardless of having a known tick bite, should also be evacuated.
To prevent being exposed to tick borne illnesses, practicing tick avoidance is important. Wearing pants and tucked in long- sleeve shirts can help, as can using tick repellants such as DEET, Picaridin, and IR3535. Permethrin, an insecticide, can be applied to clothing and helps repel ticks. Permethrin should not be applied directly to the skin.
It is also recommended to perform tick checks twice daily. Looking over your body daily can help you spot a tick and remove it before it embeds itself. Some tick-borne diseases require prolonged attachment to transmit disease, so removing ticks as quickly as possible is advised.
End of the Tale
You pulled the tweezers out of your first aid kit and carefully removed the tick in your friend’s leg. After removing the tick, which was obviously engorged, you wash the area with soap and water. You snap a quick photo of the tick, which might be helpful in diagnosis if your friend develops an illness.
After a discussion with your friend, you both agree that going to the clinic once you leave the backcountry tomorrow is a wise idea. Since you’re in a Lyme-endemic area and you found an engorged embedded tick, going to a healthcare provider for antibiotic prophylaxis is advised.
You enjoy the last day of your trip and make a stop at the local clinic on your way home. The Physician Assistant who saw you prescribes prophylactic antibiotics and applauds you for your diligence in seeking timely care.
Topics: Wilderness Medicine
