Contributor Information

Robert D. Glatter, MD
Attending Physician
Department of Emergency Medicine
Lenox Hill Hospital
New York, New York;
Editorial Advisory Board Member
Medscape Emergency Medicine

Disclosure: Robert D. Glatter, MD, has disclosed no relevant financial relationships.

Marrecca Fiore
Editorial Director
Medscape Emergency Medicine


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Treating Summer's Most Common Injuries and Illnesses

Robert D. Glatter, MD; Marrecca Fiore  |  July 24, 2015

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Slide 1

Summer Illness

Summer is a time for fun in the sun, but it's also a time when certain injuries and illnesses may be more common. Time spent outdoors around water, in the woods, and playing sports can lead to concussions, fractures, sunburn, dehydration, asthma and allergy exacerbations, and other ailments. Here is a list of some of the most common ones and how to identify and treat them.

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Slide 2


For children under 5, drowning is the second leading cause of death. Swimming pools are the number-one culprit, especially those that are not surrounded by fences of a minimum height of 4 feet.

Drowning results in respiratory distress, rapid breathing, tachycardia, confusion, blue lips, and death. The first steps in treating drowning are to call 911 and to try to stabilize the airway prior to first responders arriving onsite.

Once patients are transported to the hospital, they are treated with oxygen and hydration therapy. Radiography is used to rule out pulmonary edema, aspiration, or early pneumonitis. Afterwards patients are monitored. Intubation may be necessary for patients who are unable to absorb oxygen via a mask or cannula.

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Slide 3

Diving and Water Sports Injuries

When it comes to diving, cliff jumping, and other water sports injuries, the main concern is damage to the cervical spine.

Signs of injury include altered mental status, fractures, and lacerations. Patients with water sports injuries should be secured and immobilized, and then should receive quick imaging to assess for cervical spine and/or traumatic brain injury. Patients should also be examined for signs of shock, neck trauma, and concussion. The risks increase in people who are intoxicated and who dive into water that is less than 9 feet deep. Cliff jumping increases the risk for head, neck, and back injuries often sustained on rocky surfaces below the water. Fractures, as well as head and neck trauma, are common in water skiing and tubing. Fracture wounds should be stabilized, while head injuries may require hospital admission and observation.

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Slide 4

Heatstroke and Dehydration

Whether spending the day at the beach, hiking through the woods, or playing summer sports, heatstroke and dehydration are two major causes of illness in the summertime.

Heatstroke is characterized by a change in mental status, confusion, and lack of sweating. The skin turns hot and red. By contrast, patients with heat cramps and heat exhaustion do not display changes in mental status, but exhibit muscle cramping, cool moist skin, a thready pulse, nausea, and dizziness. Dehydration is characterized by increased thirst, dry mouth and swollen tongue, weakness, dizziness, confusion, palpations, sluggishness, and fainting. In extreme cases, dehydration may lead to swelling of the brain, seizures, shock, and kidney failure. Patients with mild symptoms of heatstroke and heat exhaustion should be moved into a cool setting with air conditioning and treated with fluids, as well as ice packs to the neck and groin. Patients exhibiting concerning symptoms should be treated at an emergency department (ED).

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Slide 5

Exercise-Associated Hyponatremia

When exercising, it is possible to drink too much water. Doing so can result in hyponatremia, which depletes sodium levels and can result in brain herniation, noncardiogenic pulmonary edema, and death. To avoid this condition, the general rule is to drink when thirsty and not to overdrink. New guidelines stress that an athlete with exercise-associated hyponatremia presenting with signs or symptoms of encephalopathy should be immediately treated with an intravenous (IV) bolus or infusion of hypertonic saline to reduce brain edema, with additional IV boluses administered until there is clinical improvement.

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Slide 6


Sunburn is one of the top summertime injuries, mostly caused by not regularly wearing or reapplying sunscreen. Even sweatproof and waterproof sunscreens should be reapplied at least every 2 hours to avoid sunburn. To further reduce the risk for sunburn, minimize outdoor activities during 10 AM and 2 PM, when the sun is the strongest, and wear hats and sunglasses. These measures will also reduce the risk for melanoma and other skin cancers.

A blistering sunburn may require treatment at an ED. Blisters that become insensate could indicate a second- to early third-degree sunburn, and should receive immediate medical attention so that the wound can be treated and covered with loose bandaging to prevent infection. Minor sunburns can be treated with aloe and other soothing lotions, as well as nonsteroidal pain relievers.

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Slide 7

Rhus Dermatitis

Contact with poison ivy, oak, and sumac is also common in the summer and can result in an itchy and sometimes painful rash. Often these rashes are mild and can be treated at home using over-the-counter antihistamines, as well as calamine and other anti-itch lotions. If the rash becomes painful and swollen, the patient should seek treatment from a doctor, who can prescribe a short course of oral steroids to reduce the swelling and calm the itching.

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Slide 8

Insect Stings and Bites

Many insect stings and bites, such as those delivered by mosquitoes, can be little more than bothersome. But in certain areas of the country these bugs have been known to transmit certain infectious diseases, such as dengue and chikungunya in the Southeast, and West Nile disease in the Northeast. Although rare, patients who have suffered mosquito bites and are displaying such symptoms as fever, and who live in one of the aforementioned areas, should be tested for these diseases. Bee stings are another summer worry; they can be life-threatening, especially in people who are allergic to bees, have been stung multiple times, or who show symptoms of anaphylaxis. In these cases, the person should be treated immediately with Benadryl and epinephrine injection. A full examination in a hospital ED should also occur in patients who are allergic to bee stings or who are showing signs of anaphylaxis.

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Slide 9

Tick Bites

Tick bites are particularly worrisome because some species carry the bacteria Borrelia burgdorferi, which causes Lyme disease. When a tick is found attached to the skin, it must first be fully removed using a tool such as diamond-head forceps. This will ensure that both the body and legs are removed. Afterwards, patients should be prescribed an antibiotic such as doxycycline or amoxicillin as a prophylactic to Lyme disease.

Image courtesy of Centers for Disease Control and Prevention

Slide 10

Food Poisoning

Picnics are a summer staple, but undercooked meat and condiments like mayonnaise, left out in the sun all day, may cause food poisoning such as salmonellosis. People who contract salmonellosis often have symptoms of bacterial gastroenteritis such as vomiting and diarrhea. Medical treatment should be sought for symptoms of dehydration and bloody diarrhea, which may require intravenous fluids as well as antibiotics.

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Slide 11

Allergy/Asthma Exacerbations

Allergic rhinitis caused by pollen, ragweed, and grass allergies is common in the summer months, as are exacerbations of asthma. People who suffer from these are encouraged to stay indoors during high-temperature and high-pollution days and are encouraged to take their prescribed medications. In the case of asthma exacerbations, shortness of breath, and severe rhinitis, patients should be treated by a clinician or at the ED.

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