Got that aspirin thing down
Yup, everything you said about aspirin is correct…I wasn’t trying to simplify it, but didn’t think it needed a dissertation. But aspirin, while effective during a heart attack, is more effective as a preventative when taken daily. Nevertheless, if I had a choice between the two if I knew I was suffering from a true heart attack due to a clot occluding an artery, out on a canoe trip, aspirin wins hands down.
But nitro, given appropriately with someone ready to deal with a potential drop in blood pressure (IV established) is more effective. That is the only point I was trying to make. That’s why every protocol for chest pain in the US calls for both nitro and aspirin to be administered, usually along with Morphine Sulfate.
It’s all good.
-rs
Tough choice
Every time I’m on a trip to the great outdoors, i hear “Oh good, Chuck is here, he’s an EMT”, and I think to myself, so what? I mean, it would be great to have Epinephrine and Nitro and Solu-medrol (or whatever the new replacement is) and especially that wonder drug, Oxygen, if I have the knowledge of what it is used for and have the opportunity to use it, but…even apart from the prescription issue or duty to act or acting beyond my licensure, I would not feel comfortable using something other than an over-the-counter drug unless I also had the proper assessment tools to get a better idea of what I was looking at. Anaphylaxis is pretty easy, I only need my eyes, but chest pain? Give me a stethoscope, sphygmomanometer, EKG monitor, Pulse-Oximeter, and a good patient history before I go further. Just not practical for the woods, and places a big liability over me.
So I bring a basic first aid kit and my brain, and an ability to get more advanced help to us if necessary. If you do that, you’re ahead of a lot of others.
-rs
Wilderness Anaphylaxsis
A response to Lyngo's question. A bit of background....I was a military paramedic for 22 years, now retired. I have treated a multitude of emergencies in some of the most remote godforsaken wilderness on this planet. Usually alone with sat phone contact to a physician a thousand miles or more away. My expierences with anaphylaxsis outcomes were all positive using epipens. Of course I was dealing with a young (fairly), fit population. I'm not saying it was a picnic, some were touch and go, but they all survived. Cardiac was another story entirely, poor outcomes as we had limited supplies and abilities on hand. They improved dramatically with quick access to air evacuation.
Sorry, I was a cell bio major in college
accounts for my dissertation on prostaglandins.
Similar sentiments…
15 year EMT, 10+ as part of my profession, but you get out in the wilderness away from the gear in the back of the meat wagon and your options become much more limited. Prevention, prevention, prevention. Read up on wilderness medicine (take the book if need be–usually room in a sea kayak) and have a way to summon help that you have a high degree of condidence in if it comes to that.
Reality
If they crash on ya in the middle of nowhere they are dead. CPR makes survivors feel better about it, but unless you get em to a hospital fast… No expert, but an EMT for a decade a while back. Used to lay awake at night wondering if I’d get through a guiding career w/o any deaths. I was fortunate.
My point is that all that training is awesome, and carefully supplied FA kits are smart. But, the MI in the field doesn’t have a happy ending.
A question about aspirin for heart attac
I was wondering, if you are having a heart attack, would it be better to chew the aspirin than swallow it whole? If so, is it better to swallow the chewed aspirin or put it under your tongue?
Chew chewable but
Swallow regular tablets. Don't put under tongue. Nitro is specifically formulated to be delivered under the tongue quickly but aspirin will sit there and can present a choking hazard, be ineffective, and be generally unpleasant (causing further stress, not good). Chewing may also present a choking/gagging hazard by 'powdering' the tablet. Patient's mouth is likely bone dry and there's a risk of aspiration of the fine particles in the tablet.
If you're travelling with aspirin specifically for cardiac emergencies, don't carry enteric coated. Baby aspirins designed for chewing are best, but must be kept dry. Speaking of dry, this subject is getting there. Wish we could all carry morphine, the perfect drug for all emergencies!
Lyn
Edit: one more thing. Don't put anything in the mouth of an unconscious person.
That’s about it
Was out on a campout with a Boy Scout troop. One fella was an EMT, but only I knew it. Was never mentioned so he didn’t have to feel obligated.
For all of us non Medical folks, we rely on the basics. It’s usually enough.
Now as for the RN’s on the thread - - -
If we were on a long trip, I would kinda expect a campfire discussion on the first night out. We all have our quirks, and allergic reactions etc. If they (the RN’s) knew what to expect, even if the proper med’s were not available, at least they would have an idea of what to expect. Doesn’t have to be a formal discussion, just casual. Knowledge is the first tool in the bag.
In the wild, there’s nothing u can’t fix
…with popsicles sticks, duct tape and a loogey.
hey doc
what’s a loogey?
point taken
but: wilderness first aid is no comparisson to urban medicine. If you are serious about your intentions: take a wilderness first responder course and you’ll know what I’m ‘talking’ about.
I’ve travelled with MDs and found that most of them are helpless when they are away from their support group. Out there, you have to make your own descisions. Even to the risk of loosing someone. And without hesitation or second thoughts about lawsuits because somebody might think different about what you’ve done.
As for the Epipen comment (they should carry their own…): you get sensibilized to certain allergens during a given lifespan. Get stung by bees a few times without any reaction. And one day, your body reacts with anaphylactic shock. You don’t carry an Epipen. Because you don’t even know you’re allergic. The medic in your group didn’t spend the $$ to carry a pen. It’s a 3 days paddle to the next village, although your group has a satellite phone: chopper can’t start because of bad wheather. Powerboats can’t travel where you are. You’re dead. Simple as that. Because you should have carried an Epipen-you’re the one who needs it, aren’t you?
If you take a course, you’ll get a list with medications for a kit. The nesseccary ones, the allowed ones, the questionable ones (those you can’t get without prescription like nitro and tylenol3, the absolutely nesseccarry ones. Epipen is in the last group if it was a good course about wilderness first response.
Wilderness first responder class!
No offense to nurses (or other non EMS/ER folks), but most people in the medical profession do not have a good handle on emergency medicine and even those that do rarely have a good grasp on wilderness medicine (most EMS providers get very little if any wilderness type scenarios either- it’s not applicable to what most will ever do). Take a wilderness first responder class or at least buy a book and read it (before you need it). Here’s a free copy of the PJ handbook http://www.operationalmedicine.org/ - go to “textbooks and manuals” then the “special operations” section and click on the pararescue link to download it.
Anyone with a medical condition should have the decency to advise their travel partners and they should have a supply of their meds with them- diabetics are usually fairly good about this I’ve found. Everyone should understand that their chances of surviving a traumatic arrest is less than 1% even when they are across the street from the hospital; their chances go down from there. You’re chances of surviving a cardiac/respiratory arrest after about six minutes without electrical intervention aren’t really worth discussing either (excepting cold water drownings).
Unless you are on an extended trip or going out of the country (a first world country anyways), antibiotics can usually wait till you get back (carry some triple antibiotic certainly, but I wouldn’t worry about orals or injectables other than possibly some metronidazole- Flagyl). Unless you have an idea what you are trying to treat, antibiotics are a shot in the dark and best left to medical staff. If you really feel you need to carry some, you can generally visit a travel doctor, tell them of your plans and get a prescription. You can also order them from out of the country or buy them locally (hint- look up fish supplies; I am NOT recommending this, only offering solutions I have seen others use).
Ibuprofen will handle most pain (although you are going to have to ramp the dosage up, there are safe levels- you’ll have to do your own research). Combining it with acetaminophen (Tylenol) will increase its effectiveness. Again, a travel doctor can help get you set up with a script for pain meds but you will absolutely need to carry the paperwork with you!
As for anaphylaxis, in the event of a true anaphylactic reaction give the Epi. Their chances of surviving the Epi are much greater than surviving the reaction without it. Benadryl capsules can be opened and mixed with a shot of water to have a faster effect (it can also be made into a paste that will relieve swelling/itching); it also works as a sedative/sleep aid- it’s the main ingredient in most OTC sleep meds.
The Adventure Medical kits do a good job of putting the basics together in one package for you if you don’t want to try sourcing the equipment on your own. Another good company (albeit expensive) is Chinook medical http://www.chinookmed.com/ You can buy complete kits, prepackaged modules, and separate supplies. I don’t work for either one.
Random thought- carry two SAM splints. Unroll them and fold them for more compact storage. If you don’t know what they are or how to use them you need to read up; they have free info and videos on their website http://www.sammedical.com/cgi-bin/WebObjects/SamSite.woa/wa/Products/Splint
Grimloc,
I have made sme pretty sweet first aid kits. I made them for my two new paddling friends. One a transplant nurse (under one year in the feild) and the other a 20 year veteran nurse from the state psycho-hospital (standard admisions and now forensic criminally insaine). The one I have for myself is for me (a speciman of human health) and my buddy with an Illiostomy bag (and ladies, he is recently divorced so if you want a man with no colon…I’ll hook you up)
Anyways, the nurses have fiddled very little with my kits and EVERYTHING fits in a peanut butterjar (the large size of Jif). Granted tese are not for three weeks out, they are 1 to 4 day trips with less experienced paddlers. The meds I put in were just Bayer asprin, acetominiphin, Ibuprofin and children’s chewable Pepto-tablets (taste like bubble gum). Other wise I took an old first aid kit and dispursed the insect bite pads and all those little things, but it was recipient specific.
I am more worried about sprains and sore muscles than an allergic reaction. My kits have a TON of gause, strech gause, “ace” bandanges then I have hand warmer, Instant Ice packs (actually not IN the jar, but they aren’t needed for afternoon outings) a TON of self sticking bandages and alchol prep pads, wet naps, “neosporine” (from the state’s supply closet) and a bunch of “survival” stuff.
The most adventurous thing I carry is petrolium jelly and tin foil in case of a sucking wound. all that is in there for is free jelly and i have the foil already.
your knowlege would be great, but you aren’t going to do surgery past hang nail removal. Go to Border’s and read “Build the perfect survival kit” it is a great book for this kind of topic.
Liveoutside
who has babbled enough here
that military website
is great, thanks for the link.
Lyn
You’re a peds nurse
and you haveta ask? :+)
if
you are involved with the scouts. You should have each persons medical sheet (required).
That sheet shows all known medical problems.(These are also confidential records, not for campfire disscusion)
They should ALWAYS be reviewed by the leaders before the trip ever gets to the campfire stage.
by BSA regs they should also be carried on all trips in case of med needs evac etc, so that the med people know when the last tetnus shot was administered and if the scout or leader is alergic to penicillian etc....review your BSA requirements for doing trips please.
Best Wishes
Roy
sorry if this sounds a little terse, but I've been a scout leader for over 20 years and have traveled many many places in very inaccessiable wilderness spots with scouts. long trips both backpacking and paddling.
Medical conditions Always Need to be reviewed BEFORE any outting. No matter who you are going on the outting with. (not at the first campfire after you are out in the woods). Sorry , there I go again.....this post hits very close to somethings I have been personally responsiable for and am very adamant about. Medical history is not casual stuff when you are traveling in inaccessiable regions.
Rant over now (for the moment)
never peds
that’s why I have a bad back!!
But I guess I know the answer now.
Lyn
also
remember in a alergic reaction, it’s the Benadryl that actually does the work…the Epi, allows you to get it into them…for long evacs that would take days to get them out Prednisone will do the work and you don’t have to keep giving the Benadryl every 3 hours. (prescription only) talk to a doctor before a long trip. Most will help if possiable.(this is not stuff you need for weekenders or overnights, it’s truely long trips in hard to reach places)everything carries risk
Best Wishes
Roy
A lugey
is a large chunk of sputum.