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What’s Up, Doc?
When we want advice concerning various medical questions,
there’s no better place to get the answers than from a hospital doctor
By Jonathan Landis, M.D. • Medical Director • Canonsburg General
Hospital Emergency Department
SUNBURN
CAUSES AND TREATMENT?
Sunburn is caused by unprotected
overexposure to the sun. For minor
sunburn, aspirin or motrin and over-the
counter cooling sprays are effective, in
addition to ice (20 minutes on, 20
minutes off). You do not want to take
aspirin and then go back out into the sun
as it can cause a rash. Generally, a person
does not need medical care for sunburn
unless the burn involves a large portion
of the body, pain is not controlled by
over-the-counter medications or the burn
results in dehydration.
SUNBURN PREVENTION
Sun screen lotion with a SPF of 30 or
more is recommended. Avoid sun
exposure between the hours of 11 a.m.
and 3 p.m. Wear a hat and if extremely
susceptible to sunburn, consider long
sleeves and pants.
HEART EXHAUSTION/HEAT STROKE
Prolonged exposure to sun and heat can
lead to dehydration and a rise in the core
body temperature, resulting in heat
exhaustion and heat stroke. Heat
exhaustion has a variety of symptoms,
including dizziness, headache, vomiting,
passing out and rapid heart rate, to name
a few. When the body stops sweating
to conserve fluids (called anhidrosis), and
the body temperature rises and confusion
sets in, the person is suffering from heat
stroke. This is a potential life-threatening
condition and immediate medical
attention should be sought. We typically
see these symptoms among the elderly
and others who live in homes without
air-conditioning.
LYME DISEASE
CAUSES AND TREATMENT
Lyme’s disease is caused by a bacteria
that is transmitted by the bite of a deer
tick. Lyme’s disease can be prevented
by applying a repellant (CUT/anti-tick
spray) before entering a wooded area.
Also consider wearing a hat and
protective clothing as well as inspecting
susceptible areas (scalp, groin, beltline,
armpits) twice a day when venturing into
wooded areas.
WHEN TO SEEK TREATMENT
Although the deer tick is common to
western PA, we are not in an area where
every tick bite is considered to be Lyme’s
disease. If a rash develops that looks like a
target (expanding red ring with clearing in
the center) 7 to 10 days after the bite, a
person should seek medical treatment.
The red ring is an indication that the
bacteria has expanded out from the
central bite mark and can be treated with
antibiotics. Failure to seek treatment
could result in cardiac and neurological
problems.
INSECT BITES
In western Pennsylvania, most insect
stings are derived from bees, wasps and
hornets which all belong to a family of
insects we call hymenoptera. A few other
insects bite or sting such as deerflies,
horseflies and kissing bugs to name a few,
but the majority of problems are caused
by hymenoptera stings. Unless a person
has a severe allergic reaction, bee and
wasp stings can be treated at home with
Benadryl and ice after removing the
stinger. A person with a severe allergy
should always have an “epi” pen available,
since a severe allergic reaction can be
rapidly fatal.
If a person receives multiple stings
and swelling occurs, emergency treatment
should be sought. A course of steroids
may be prescribed.
If after 24 to 72 hours following a bee
sting, the redness diminishes and then
worsens; cellulitis or phlebitis may have
developed. Again, medical attention
should be sought.
SPRAINS/STRAINS
In most cases, it is difficult to
differentiate between a sprain/strain and a
fracture. If pain and swelling do not
diminish, or mobility does not increase
after 12 hours, seek emergency medical
treatment that will include an x-ray for
verification of a fracture.
FRACTURES
Signs of a fracture include deformity,
difficulty moving a joint or pain and
swelling that doesn’t diminish within 8 to
12 hours after the injury. Emergency
medical care should be obtained.
POISON IVY
DESCRIPTION
Poison ivy, poison sumac and poison oak
are all woody plants that contain an oil
that causes a rash. About 85 percent of
people are susceptible to developing a rash
when exposed to poison ivy. It takes two
exposures to the plant’s oil for the body to
know how to respond. The body’s immune
system develops antibodies as a defense
mechanism when it recognizes the oil
(an antigen). The weepy, crusty, pustular
rash that develops is the body’s visual
reaction to the antigens in the oil.
TREATMENT
There are over-the-counter creams and
sprays that can be applied before potential
exposure to poison ivy. If a person is
pulling weeds and becomes exposed to the
plant’s oil, there is benefit to immediately
washing the area with warm water (it does
take the body some time for it to recognize
the antigen in the oil). Washing will
diminish the severity of the rash.
Spreading cannot occur. If a rash
appears after washing, people may think
that the rash has spread, when, in reality,
the oil has transferred to other parts of the
body, possibly by picking up contaminated
clothes and/or touching another area of
the body with a contaminated body part.
Additionally, if a person has bathed, a rash
cannot be spread to another person.
For mild cases of poison ivy,
hydrocortisone cream, Aveeno oatmeal
baths, and over-the-counter Tagamet and
Benadryl are effective.
For extensive, more severe rashes, oral
steroids are recommended. Washing off
the oil as quickly as possible is key to
preventing the rash.
Rarely does a secondary infection occur
with a poison ivy rash. If redness extends
outside of the initial rash, a secondary
infection may have developed and
antibiotics will be prescribed.
Jonathan Landis, M.D. is the Medical
Director of Canonsburg General Hospital’s
Emergency Department. He is a boardcertified
emergency medicine physician with
more than 14 years of experience. Dr. Landis
received his medical degree from the
University of Texas Medical Branch in
Galveston, Texas. He completed a residency
in emergency medicine at Allegheny General
Hospital. Canonsburg General Hospital’s
Emergency Department was a recent
recipient of the 2008 Hospital Association
of Pennsylvania Achievement Award for
Operational Excellence.
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