May 27, 2016

Interviewer: You come back from a hike and you find that you have a tick on you. Is that something that you need to go see a doctor for? We'll talk about that next on The Scope.

Announcer: This is "From the Frontlines with Emergency Room Physician Dr. Troy Madsen" on The Scope.

Interviewer: Dr. Troy Madsen is an emergency room physician at University of Utah Health Care. If you ever get a tick on you, is that something you need to go see a doctor about? Or is it something you can just kind of take care of on your own? Should I be a "do it myself" kind of guy with a tick or come see you?

Dr. Madsen: It's not an uncommon question. It's more of these questions where I may have a family member ask me this sort of thing, like, "I went out hiking. There's this tick."

Interviewer: Do you go to the ER for a tick?

Dr. Madsen: I wouldn't. Generally, not. It's probably something you could see your doctor for. But there are certain things you're looking for. When we think about ticks, we think about infections. We're fortunate in Utah that the more serious infections you think about with ticks aren't really such a big issue, like Lyme disease and Rocky Mountain spotted fever, which is funny. It's called Rocky Mountain spotted fever, but it's not so much in the Rocky Mountains. I think it was discovered in Denver and that's how it got its name. But it's more in the Southeast that that's an issue.

But regardless, if someone comes and they say, "Hey, I had this tick on me," I'm asking them, "How long was it on you?" They may not know exactly, but they may say, "Okay. I was camping. I've been home for two days." If that's the case, I'll say, okay, it's probably been on there at least 48 hours. Typically in those cases, we give antibiotics to prevent any kind of infection from the tick. Kind of the rule of thumb is if the tick's been there for 24 to 36 hours, we'll start antibiotics just to prevent an infection.

Now, if you've had a tick and it's been on you and you look at that spot where the tick was located and you start to see redness around there, like a circular sort of rash, maybe some puss in that wound that have kind of built up, then I'm more concerned, number one, about an infection from the tick, like a head being embedded in the wound. Or, number two, an infection that a tick has transmitted to you, like Lyme disease. Again, reasons to see a doctor.

But I think the bottom line is if you see a tick on yourself, let's say you're out camping, you pulled the tick off, you get rid of the tick, you don't need to feel like you need to rush right into the ER. Unless you're seeing some of these other things.

Interviewer: So is that the way to get rid of it? Just pull it out gently with tweezers? My dad used to go to the gas cans. I lived out on a ranch and he'd put gas in a a baby food jar and turn it upside down on the tick until it backed out. Or I've heard maybe nail polish. You put nail polish on them and they have to back out.

Dr. Madsen: Yeah, I've heard these things too. Some people have said to put petroleum jelly on it because the tick breathes through its body. I'm not a tick expert. There are probably tick experts out there that are cringing as I say this.

Interviewer: So we don't know if they breathe through their body or not, is what we're saying.

Dr. Madsen: I've heard people say that and then the tick will back out. I think one of the challenges with those is sometimes, it just makes the tick sit there and just makes it kind of moist. And then it becomes harder to pull it out. The thing I've learned is just to grab some tweezers, grasp down by the tick's head.

Interviewer: As close to the head as you can get, close to the skin, probably.

Dr. Madsen: Yep. And then just pull directly back.

Interviewer: Pull straight out.

Dr. Madsen: Pull straight out and then drop the tick in some water, like a toilet or something like that so it's not climbing on someone else or climbing on your pet. Just so you're drowning the tick and getting rid of it.

Interviewer: And if you end up doing that, breaking the head off, then you need to go see a doctor? No?

Dr. Madsen: Possibly.

Interviewer: The body could handle that? Is that what you're . . .

Dr. Madsen: If you did break the head off and you came in, I would probably put you on an antibiotic for a few days and tell you to watch for signs of infection. But the reality is the head's probably not going to be that deep where it's going to cause any major issues. And it's probably just going to work its way out within a few days anyway.

Interviewer: So watch it for those other symptoms you talked about.

Dr. Madsen: Watch for those other symptoms, primarily. You're right. If you came in, I would probably say, "You've got the tick head still in there. Let's just put you on something for a few days just to prevent any infection from that."

Interviewer: But an urgent care could handle that?

Dr. Madsen: Exactly.

Interviewer: All right. Or a doctor the next day.

Dr. Madsen: Exactly, yeah. Not an emergent thing to get into an ER.

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