Medicine Chest

[bensolomon]

In the dish,

I am a pulmonary and critical care physician. In my opinion, the greatest risk will be food borne illness, skin and soft tissue infections from cuts from shells and coral, sudden allergic reaction from bee/insect stings or food or exposure to plant toxins called anaphylaxis, and lastly water born illness from drinking local water or taking a dip under a beautiful waterfall or swimming in that beautiful fresh water lagoon.

Other things on the list, are bacterial pneumonia, appendicitis, diverticulitis, sinus infection, ciguatera, and ratty old urinary tract infection, plus and minus yeast infection for the female crew.

My suggestion, which is what I keep on board is the following. Instructions on when to use what will be after the list:

Ciprofloxacin 400mg twice daily get 28 pills
Metronidazole 500 mg three times per day get 48 pills
Augmentin 875 mg twice daily get 28 pills
Zithromax 500 mg daily get 10 pills
Diflucan 400 mg daily get 9 tabs
Prednisone 10 mg tabs 4 tabs all once for three days, then 3tabs at once for three days, then 2 tabs for three days, then 1 tab for three days, then stop.
Epinephrine pen bring two
Benadryl
Celebrex 200mg twice daily
Motrin
Acetaminophen

For Abdominal issues like diarrhea, appendicitis, diverticulitis take the Ciprofloxacin and metronidazole for 7 days.

For fever, cough, and infected appearing sputum, take Augmentin for 7 days and Zithromax for 5 days.

For urinary tract symptoms take Cipro for 3 days.

For skin infections from salt water take Cipro for 7 days.

Sinus infection take augmentin for 5 days.

For allergic reaction take prednisone.

Life threatening allergic reaction (sweating, fast heart rate, wheezing, difficulty breathing, stridor (obstruction to inflow of air at the vocal chords.....this makes a noise on inspiration) use the epi pen.

Yeast infection, take diflucan for 3 days.

If you end up needing any of these medications, some of them can cause a reaction when in direct sunlight. You’ll have to shield yourself from the sunlight while taking the antibiotics.

Also, the epinephrine pens, come a practice dummy. You’ll want to practice with this and be familiar with it so that if you ever need to use the EpiPen you will use it correctly.

Regarding the potential for small lacerations, get a prescription for derma bond. The wound has to be dry and have stopped bleeding prior to applying the derma bond. You will also need something called Steri-Strips to hold the bonded skin in place while the glue sets. You also want two one liter bottles of sterile saline and a sterile 20 mL syringe to use for wound wash out prior to applying the derma bond glue. Make sure the wound is dry before using derma bond.

My disclaimer is that this is not a substitute for medical supervision. If you or your family has bloody diarrhea or any prolonged abdominal symptoms, you should seek medical attention immediately. Some of those syndromes will require surgery to be cured. Although the antibiotics may make you feel better and may prevent death, in certain cases as in an appendicitis or a ruptured diverticulitis, surgery would be necessary. Also, pneumonia can get worse, despite antibiotics as can some skin infections. Please, if you or your family get ill, and you don’t see improvement within 48 hours, get help.

Best wishes,

Ben
S/V Dawn

[Seaworthy Lass]

Originally Posted by InTheDish

Seaworthy,

Good points! I have had to resort to just using Neosporin for an eye infection my son got while we were back country fly fishing a number of years ago. Poor kid got a cinder in his eye and it cascaded. The tough guy insisted we hike out.

Severe allergic reactions can occur with Neosporin. It is not the best choice of antibiotic.

SWL

[JPA Cate]

Carry something that works for each one aboard (people vary) to treat seasickness or vomiting. [The latter can come if you've caught the flu ashore and it erupts after you've left.] To the latter end, we carry compazine suppositories. We didn't have them the one time we could possibly have used them, and they stay in the fridge. If you can't even keep water down, try sitting or standing to have your sips.

Once prepared with what makes you feel well prepared, then don't worry about it. The further afield you do go, the less readily available what you might need becomes. I agree with you to cover yourself. You may wind up giving away your meds to a local nurse's station before you come home, where you can get more, and keep them up to date.

Do add eye meds, with instructions. When you're swimming, you're exposed to bacteria you do not normally meet. Eye infections are possible even if you're not prone to them. We carry Povidone for coral cuts, never had one get infected, and aloe for sunburn. Mostly we are well protected against sunburn, but long dinghy rides in wet t-shirts was my downfall.

Think about mosquito prophylaxis--it's best to just not get bitten. Take it seriously. Personally, we avoid internal meds against malaria, etc. Mosquitoes carry so many nasty bugs, you're best off, imo, to be serious about denying them access below decks, and if you have to (like some got in and you're not sure you killed them below)even wear bug juice to bed. I like the Cutter stick repellent for my face and ears. Picardin based repellents, too, worked for us. And, DEET, but my skin didn't like how it feels. Some of all cruising is experimentation. That's how I finally found something to keep seasickness away.

Anti seasickness drugs is something you should have aboard even if none of you need it. First off, you may be in different conditions and it is suddenly triggered; second, someone may come aboard who will need it.

A.

[Sea Life]

Ann, good advice. I forgot to mention we went to a travel doctor and got shots for Hepatitis A & B, dengue, yellow fever, etc. etc. (can’t remember all)most were good for a few years. Something for the OP to look into, if being cautious.

[scarlet]

Originally Posted by InTheDish

I just love this place, I ask about medicines and am told that my thinking is all wrong!

This year in the Bahamas is the start of what I hope to be a circumnavigation.

Sorry for the misunderstanding, but you only mentioned wintering in the Bahamas..

[JPA Cate]

Make sure your tetanus shots are up, too.

A.

[puffcard]

We carry a huge over the counter med cabinet, maybe use 5%. Nice to have them available. The prescription drugs are harder to prep for, getting a stash of 6 months can be tough.

[wsmurdoch]

How about a couple of QuickClot sponges and some QuickClot gauze?

[StuM]

Jugs of white vinegar for jellyfish stings.

[InTheDish]

Thanks everyone!

My current bag has sterile wash and several different types of QuickClot as well as tampons for the one in a million off chance of a severe puncture wound.

I have no problem grabbing the radio to get help but I would much rather have invested in these types of items that I pray we'll never need than to be caught without them if everything goes sideways and I could have prepared in advance.

As we all know, most disasters are the result of a number of things that cascade like falling dominoes. I would hope to stop any problems at the earliest point.

[Pete7]

Originally Posted by StuM

Jugs of white vinegar for jellyfish stings.

More than once have we sent a diver running up the high street in Ballycastle to the chip shop.

Pete

[Paul L]

Starting on page 125 there is a pretty good list of med kit contents for various categories of sailing.
https://www.yachtingnz.org.nz/sites/...28small%29.pdf

[danielamartindm]

You're good. Maybe pack a sterile scalpel and surgical scissor for debridement or neatening up of wounds prior to suturing, and sutures. You've really done your homework. Kudos.

[Sawbonz]

Originally Posted by bensolomon

In the dish,

Ciprofloxacin 400mg twice daily get 28 pills
Metronidazole 500 mg three times per day get 48 pills
Augmentin 875 mg twice daily get 28 pills
Zithromax 500 mg daily get 10 pills
Diflucan 400 mg daily get 9 tabs
Prednisone 10 mg tabs 4 tabs all once for three days, then 3tabs at once for three days, then 2 tabs for three days, then 1 tab for three days, then stop.
Epinephrine pen bring two
Benadryl
Celebrex 200mg twice daily
Motrin
Acetaminophen

Ben
S/V Dawn

My comments as just a family doctor....

Someone else used big words for this, but get Cipro ophthalmic drops that can be used in the eyes OR the ears. Otic drops can NOT go into the eyes (they contain alcohol).
Use the Benadryl before prednisone. Talk to your doctor before jumping into oral steroids if at all possible.
Good, prescription strength, high-potency topical steroids, i.e. Westcort (Hydrocortisone valerate) for rashes and the inevitable external ear infection where you are also using the Cipro eye drops.
EpiPens are a good idea, but super-expensive if no one has reason to suspect a life-threatening reaction to something, i.e. no history of severe allergic reactions. I absolutely would not advise epinephrine to be drawn up at time of use (like an ampule) as you would have to calculate dosage based on strength and volume for the individual and an error could be deadly.
Compazine suppositories were also a good bit of advice, but I would also keep some Zofran on board in case they don't work. They are our personal nausea drug-of-choice.
Personally, I would skip the Zithromax and use Bactrim by itself. I also wouldn't treat any sinus symptoms until they had been present for 10 days, at least. But I am very conservative.
If you have, or can get, some Vicodin, do it! Injectable anything isn't it.
I would skip the Celebrex. Motrin will do the same thing and, short-term, shouldn't have any significant problems.

The doctor that prescribes these for you will provide instructions. Hopefully this is also the person that you call for advice before administering most of these medications. There is just no way to teach a layperson to be a physician in short-order and misdiagnosis is a big problem, even with the pros. I do believe it is the number one cause of malpractice claims, but don't quote me. Anyway, if you have it on board and your doctor says to take it, you should be good!

I agree that Dermabond is good, but super glue is __basically__ the same thing and is cheaper and easier to get. More important I think is to clean, clean, clean a wound. Describing which wounds are too big, too dirty, or in a bad location is too complicated for a forum and too fraught with risk for my liking. A scar is nothing on someone of your age (50 years sailing...) and something large will eventually heal anyway.

I personally wouldn't bother with a defibrillator. If you had to use it half way across you would also likely have to do CPR until you hit land. The victim would be a bag of mush by then and likely wouldn't have a good outcome anyway.

As to sewing, stapling, debriding and whatnot...I wouldn't do it. If you are a physician and I missed it, ignore that line. We will likely have those supplies when we go, but I have done a fair bit of these procedures and my wife is a surgeon. Look for us and we will be glad to help if we can!

As to expired antibiotics, I still take some that I got in residency in the 90's...use this tidbit as you wish!

[Vasco]

Originally Posted by Pete7

More than once have we sent a diver running up the high street in Ballycastle to the chip shop.

Pete

We've always used ammonia for jelly fish, usually Portuguese man o wars. In a pinch pee will do. When my daughter was three she picked one up once, thinking it was a balloon. She's forty now and still remembers.