How to handle a tick in an emergency department? - briefly
Immediately remove the attached tick using fine‑tipped forceps, grasping it as close to the skin as possible, then disinfect the bite site. Assess the patient for infection or disease transmission, document the event, and arrange appropriate follow‑up or prophylactic treatment.
How to handle a tick in an emergency department? - in detail
When a patient arrives with a tick attached, immediate assessment and proper removal are essential to prevent disease transmission and minimize tissue damage.
First, obtain a focused history. Ask about the tick’s duration of attachment, recent outdoor activities, travel to endemic regions, and any prior prophylactic measures. Document known allergies, especially to local anesthetics or antiseptics.
Second, perform a thorough physical examination. Identify the tick’s species, developmental stage (larva, nymph, adult), and location on the body. Note signs of local inflammation, secondary infection, or systemic manifestations such as fever, rash, or arthralgia.
Third, prepare the removal site. Clean the area with an antiseptic solution (e.g., chlorhexidine or povidone‑iodine). Use fine‑pointed tweezers or a specialized tick‑removal tool. Grasp the tick as close to the skin as possible, applying steady, upward traction without twisting. Avoid crushing the body, which could release pathogens.
Fourth, after extraction, inspect the mouthparts. If any remain embedded, attempt gentle removal with the same instrument; otherwise, cover the area with a sterile dressing and monitor for infection.
Fifth, preserve the specimen for laboratory analysis if the patient presents with early signs of tick‑borne illness or if the tick species is unknown. Place the tick in a sealed container with a moist cotton ball, label with date, time, and location of bite, and forward to the appropriate public health laboratory.
Sixth, provide post‑removal care instructions. Advise the patient to keep the bite site clean, observe for redness, swelling, or fever, and seek medical attention if symptoms develop within 2–4 weeks. Offer prophylactic antibiotics (e.g., a single dose of doxycycline) when indicated by regional guidelines, such as for Ixodes scapularis bites lasting ≥36 hours in areas with high Lyme disease prevalence.
Seventh, document all steps in the medical record: tick identification, removal technique, specimen handling, counseling provided, and any prescribed medication.
Finally, educate the patient on preventive measures: use EPA‑registered repellents, wear protective clothing, perform regular body checks after outdoor exposure, and promptly remove attached ticks to reduce the risk of infection.