Special Operations Forces Medical Handbook

4-80

Campylobacter Milk, beef, chicken, 48 Diarrhea, fever, nausea, vomiting, headache,
jejuni pet animals myalgia. Key: may see bloody diarrhea.
Duration 7 days.

Escherichia coli Salad, beef 24 Diarrhea, crampy abdominal pain, nausea,
headache, fever, myalgias. Keys: may see
hemolytic uremic syndrome and bloody diarrhea.
Duration 3 days.

Salmonella Eggs, poultry, meat 24 Diarrhea, crampy abdominal pain, nausea,
vomiting, fever, headache. Duration 3 days.

Shigella Milk, potato, tuna, 24 Crampy abdominal pain, fever, diarrhea, bloody
turkey salads diarrhea, headache, nausea, vomiting. Duration
3 days.turkey salads

Objective: Signs
Using Basic Tools: Inspection: Patients appear ill and dehydrated.
Auscultation: Abdominal bowel sounds are often hyperactive.
Palpation: Mild to moderate abdominal tenderness. Peritoneal signs (rebound, guarding, point tenderness)
are atypical.
Using Advanced Tools: Lab: Elevated WBC with differential may indicate systemic infection; stool cultures,
blood cultures.

Assessment:
Differential Diagnosis—see Symptom: Abdominal Pain
When the predominant symptoms are crampy abdominal pain and diarrhea, consider non-food-poisoning
etiologies like acute Giardia lamblia or antibiotic diarrhea. When a recurrent past history of symptoms is
present, consider inammatory bowel disease.

Plan:
Treatment

1. Rest


2. Rehydration (oral or intravenous) correction of electrolyte disturbances (see Shock Fluid Resuscitation)


3. Anti-emetics as necessary (e.g., Compazine 5-10 mg IM q 3-4 hours, max 40 mg/day)


4. Antibiotics are unusually NOT necessary, in fact may promote increased carrier rates for Salmonella.

Patient Education
General: Be a cautious consumer. Food left at room temperature is a potential breeding source for bacteria.
Proper hand washing is important in preparation of food, especially when handling raw meats, poultry and
eggs. Wipe down counters before and after preparing food. Avoid wooden cutting boards because they
cannot be easily disinfected.
Diet: If the food smells bad or has not been refrigerated, avoid it.
Prevention; For large outbreaks obtain stool cultures from patients. Obtain stool culture from food handlers
when suspicious of Yersinia enterocolitica, Salmonella or Shigella to prevent further outbreaks.

Follow-up Actions
Return evaluation: Only if symptoms persist, worsen or relapse. For protracted illness or signs of sepsis,
blood cultures may be necessary.
Evacuation/Consultation Criteria: Evacuation is not usually necessary. Consult infectious disease or
internal medicine for systemic toxicity, bloody diarrhea, high fever.