Has anyone had any luck putting together an emergency medical kit that includes useful, if not essential, prescription medications?
I would like to be prepared to treat anaphylaxis (allergic reaction), angina and infection during extended trips in areas far away from quick medical assistance. The meds would include Bactrim for UTI or diarrhea, Cephalaxin as a broad spectrum antibiotic for other infection, sub-lingual nitroglycerin for angina and an Epipen or two for acute allergic reaction. Something strong for pain control would be ideal as well.
Who’s done it and how?
practing medicine??
A few thoughts:
Angina isn’t something that just pops up in the middle of a wilderness trip, it’s a condition and anyone who has it will have their own nitro. Unless you’re carrying a BP cuff or have very good assessment skills, I wouldn’t consider giving someone nitro. Carry aspirin and a satellite phone instead.
As far as epi-pens, if you’re travelling with someone who has a severe allergic reaction to bees or PI they’ll have their own epi. Again, unless you have good assessment skills you can just as easily hurt or kill someone with epi as help them, especially if they have a cardiac condition.
I personally carry Amoxicillin, but unless you know the allergy profile of your paddling buddies don’t give them an antibiotic!! Drug allergies are common and can be fatal, unlike UTIs.
Another drug I always carry is prednisone because I’m very allergic to poison ivy. But you need to know the dosage and wean plan. I’m not recommending this!! I have a prescription.
Pain meds are a good idea though I’ve never carried them: percoset or vicodan for fractures, tons of ibuprofen for everything else.
I think the most important thing to have for a real medical emergency is the option of evacuation and wilderness medical training before the trip.
Lyn
Take a course
– Last Updated: Apr-12-07 2:17 PM EST –
There are courses you can take on wilderness first-responder medicine, and they will be able to not only give you a list of items that would make sense to pack, but teach you how to use them approriately.
Of the items you suggest bringing along, only the epi-pen makes sense. I think the epi-pen is actually a great idea.
More useful than nitro would be aspirin. Nitro can stop the pain of angina, but isn't going to do a lot to stop heart muscle damage, which aspirin may do.
As for antibiotics, unless you are taking a trip to a third world contry, I wouldn't really recommend them. In general, if someone gets acutely ill to the point where they need antibiotics right then, you are going to want to evacuate them to civilization where they can see a doctor who will be able to prescribe them to him. Treating with antibiotics on the way to the doctor isn't going to really be any benefit, and might interfere with what the doctor would want to do. Plus there is the risk of allergic reaction.
A seriously strong pain killer would be a good thing - could save someone from dying of shock - morphine might be a little tough to get :) but if you have some leftover demerol, toss that in.
If you want to get hardcore about saving a life in the field, buy an AED, could save someone from heart attack, drowning, etc.
Pressure bandages. You definitely want something more hardcore than a few bandaids to staunch serious bleeding.
Electrolyte powder. If someone gets serious diarrhea, or even is going into shock, it could help.
Nitro
Contrary to reefmonkey’s discussion, nitroglycerin will do more to prevent heart damage than aspirin, and quicker, which is why it is prescribed for angina. Aspirin has the effect of thinning the blood, allowing it to flow around a clot. Nitro has the effect of (among other cardiogenic benefits) dilating the blood vessels, allowing much improved blood flow.
That being said, I would never suggest to someone that they take anything other than aspirin UNLESS they have been given a prescription from their doctor for nitro. If someone who has never taken nitro before decides to take it for the first time because of some chest pain without having ever taken it before, they could dangerously bottom out their blood pressure and die. Or at least get a rip roaring headache. (Another interesting tidbit…taking nitro while also taking a medication like Cialis or Viagra can also kill you due to dangerous blood pressure drops).
For anaphylaxis, definite thumbs up on the epi pen, unless you are older than 50 or have a cardiac history. Otherwise, check with the doc. Another good, easy to obtain med for allergic reactions is benadryl. The chewable kind.
-rs
Understood
Excellent comments. For clarity, I am a Registered Nurse and have many years work in Cardiology. I am versed on the indications and contraindications for the meds listed and have administered each many times in the past. Admittedly, past experiences were with patients or individuals that had these agents prescribed for their own use.
I would further agree that one should prioritize the use of over the counter treatments and favor evacuation if indicated (have marine VHF and EPIRB), but I would like to be as prepared as possible to render immediate treatment in advance of a possible prolonged wait for rescue. “The Golden Hour” to initiate treatment would call for these medications as well as the training mentioned here by others.
Aspririn vs Nitro
– Last Updated: Apr-12-07 3:20 PM EST –
Nitro is a vasodilator, so it will open the blood vessels up around the heart more, allowing more oxygen, that is correct. But aspirin does more than just "thin blood, allowing it to flow around the clot". Aspirin inhibits prostagladin production. Prostaglandins are responsible for several functions in the body that are significant here. One - prostaglandins can actually cause muscle and blood vessels to constrict. Two - prostagladins promote inflammation and muscle breakdown. Three, and most importantly, prostaglandins make platelets "sticky" so that they stick together, forming clots. So when aspirin inhibits prostaglandin production, it also helps keep vessels and muscles from constricting, it reduces inflammation and breakdown of cardiac muscle (heart damage), and it not only allows blood to flow around the clot that is causing the heart attack and pain, it prevents more platelets from sticking to the clot and making the clot larger, and can actually break up the clot.
That makes things different
– Last Updated: Apr-12-07 4:03 PM EST –
You should be telling us what to put in our first aid kits, I am sure you know more than us. :)
Apologies…
Although I have personal experience and confidence in my assessment skills and ability to treat emergent situations, I have rarely found myself more than a few feet from a crash cart full of appropriate medicine used for Advanced Cardiac Life Support (ACLS) interventions.
My pursuit of kayaking, away from quick medical support, is what makes me uncomfortable. Thus the request for any ideas about how others in these situations have obtained prescription medications for emergeny use. This is a topic laced with legal considerations and may prove to be too difficult or tricky to get done. Any information would be appreciated. Thank you for the comments.
RN, too
I agree that changes everything as you obviously can assess the situation, but I’m sure I don’t need to tell you that you need to be very cautious about your license.
It would be very interesting to learn of the incidence and outcomes of anaphylactic reactions in the wilderness. Does anybody know off the top of their heads or do I need to spend the evening on Pubmed?
Lyn
A step more interesting…
Rendering care in the U.S. is most oft covered under the “Good Samaritan” laws, making ones licensure reasonably protected. My first trip will be in Canadian waters on the North shore of Lake Superior. I have no idea what the legal implications might be for rendering care out of country. Who knows if you can even carry prescription meds through Customs?
nurses & MDs are in a different
category. If you gave someone an unprescribed medication, even if it was to save their life…and even if it DID save their life, but caused some long term damage, you bet your sweet license you’d be liable and looking for another career. Sad but true. I read a story in a journal of a RN who tried (successfully) to stop a profusely bleeding wound with an article of clothing. The wound became subsequently infected and…do I need to tell you the rest of the story? Lawyers just don’t play fair, but either do the people who try to get rich quick by using their services.
Lyn
So the question burns…
Do you just make due with what you can buy over the counter? It is difficult knowing how to render care and be told that you cannot. I fully agree that people may exploit their right to bring suit in such situations, but honestly, it is not my license I am worried about, it is the life potentially saved.
I am left with a sense of under preparedness. Are there any other options?
ambushed again!
reading this thread
– Last Updated: Apr-12-07 4:06 PM EST –
sure makes me glad I know nothing about medicine! (Ignorance is bliss)
Good Samaritan act
will not cover your a** if you go beyond what your level of training/licensure allows. As a member of the National Ski Patrol, this is something that is drilled into us from the start - even the nurses on Patrol. Unfortunate, but probably true.
Gnatcatcher
I’m not saying don’t render care
but there is no way to prepare for all emergencies. Just because you know the indications and administration of emergency meds does not bestow on you the responsibility to provide them, especially since it is illegal to do so.
I guess the answer is obvious and probably needs not be said. Know who you go into the wilderness with very well.
Lyn
Nitro will stop heart damage
by dilating vessels and allowing blood flow. Aspirin will increase long term survivability of a heart attack. Morphine will actually decrease blood pressure and will not prevent someone from dying of “shock”.
nope
but being at risk I would like to know.
I always have 2 epipens with me but I would probably think very hard before letting someone else use them.
Word to that…
“I guess the answer is obvious and probably needs not be said. Know who you go into the wilderness with very well.”
The best disaster is one that was anticipated and avoided altogether. There are indeed many ways to prepare that have nothing to do with the meds in your Oh $h!t box 
Thanks.
Am I ignorant or just apathetic?
I don’t know and I don’t care.