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Old 15-04-2020, 06:43   #106
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Re: Upgrading your Boats Medical Locker

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Originally Posted by s/v Jedi View Post
On another note and more on topic: over the years of cruising we found that almost every (medical) problem aboard is minor and can be fixed with just a couple of items. This lead to our “mini comfort bag”.
Agreed. The good professionally assembled kits have this too these days, so that you aren't searching through all of the serious supplies for simple stuff.

A similar kit can be useful for the dinghy too, if you use it for extended trips away from the boat.

In fact you can easily have several of these "mini comfort bags". They are very helpful.

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Old 15-04-2020, 18:32   #107
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Re: Upgrading your Boats Medical Locker

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Thanks Paul, that is exactly what I was hoping for which I will transcribe to my Medical Inventory Excel spreadsheet (unless someone already has this in Excel).
My GP here in Subic has offered to provide prescriptions for what I need so we can be complete when ready/allowed to leave.

I have a very old (1993) Mayo clinic interactive CD that helps correlate vitals and symptoms with internal diagnosis..
Does anyone have something more modern that can be downloaded as an interactive and graphic reference?

You might take a look at this app: Residents use it all the time--- you can see them in the hallway hiding around the corner when they leave an exam room clicking away...lolol (im a nurse)


https://apps.apple.com/us/app/5-minu...lt/id301865751
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Old 15-04-2020, 20:22   #108
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Re: Upgrading your Boats Medical Locker

I am an orthopedic surgeon with a bit of trauma experience. Training is the key element. Unfortunately, a weekend classroom course, even with simulations, is going to fall short of ideal, especially when you haven't looked at the course material in months. Immersive training is much better but hard to come by. Things that sound easy on the Internet, like suturing are vastly different in real life. We have students rotate with us. They come to the OR, see lots of suturing done first hand. With the patient asleep so pain is not an issue, in a controlled environment, with an experienced person standing beside them, and practice in the lab prior... Suturing is hard if you have never done it yourself. Draining an abscess- a poke with a needle is inadequate. It needs an incision. Your first incision is hard. In the memorable words of my senior resident, "that was good, but now with your second incision, cut thru the skin." After seeing lots of surgery, I had performed a scratch. You can watch a lot of YouTube, but it's very different when you are in the hot seat.
Dirty wounds- boats are clean, generally. Unless you get a wound from greasy machinery, not a ton of washout will be needed, just flush it out with running water. Dirty wounds have dirt. Unless you have plants aboard, generally not. The danger is Clostridium in soil, a bacteria that causes gangrene and similar troubles. Staples quicker and technically easier than sutures and probably hurt less without anesthetic. Most wound closure is not required. It can wait a week or two. Bleeding? Someone mentioned a lot of blood from a finger. Believe me, that's not a lot of blood. Put pressure on it. Stick your finger in the wound if needed. Hesitant? Immersive training and it becomes routine. Wrap it up snug. Don't squeeze the crap out of it- too tight a dressing can be catastrophic.
AED? Unless you or a crew are at risk, probably negligible value. Thinking might help someone not on your boat? Precious short window of opportunity. Consider you are anchored, by the time you grab it, dinghy over and figure out how to use it, it's game over. Even down the dock is going to a seem like a long way. For those who have one onboard, when was the last time you looked at it. Could you apply and activate it without reading the instructions? We have one in the office and I will admit I could not. Likelihood of use? In a business with traffic of 1000 people per day, the AED is likely to be used once in 5 years.

My medical kit is sparse. Most stuff I can improvise. Many minor ailments take care of themselves. Major problems either need evacuation. If they are amenable to inexpert treatments, they are probably not that big a problem. I focus on things where I can make a difference. Think especially of things where you can prevent worsening. Trauma, finger injuries, especially crushed/mangled, CoBan(aka VetWrap), splint material, burn salve and a limited selection of antibiotics. GI problems, especially diarrhea, can be disabling. I have a stapler, but as backup to benzoin and steri-strips. There is hardly ever harm in leaving a wound open. Also think teeth and eyes. I know nothing about them.
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Old 16-04-2020, 03:29   #109
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Re: Upgrading your Boats Medical Locker

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... I did the first responder training while in the army and tourniquet technique was part of that, while it was not allowed for civilian use. When talking to civilian medics I got the same BS over tourniquet like you kill someone when you use a tourniquet. I believe they have come around and it’s now legal for civilian use as well... go figure...
Indeed.

“Tourniquet use in the civilian prehospital setting”
“Tourniquets are an effective means of arresting life threatening external haemorrhage from limb injury. Their use has not previously been accepted practice for pre hospital civilian trauma care because of significant concerns regarding the potential complications. However, in a few rare situations tourniquet application will be necessary and life saving. This review explores the potential problems and mistrust of tourniquet use; explains the reasons why civilian pre hospital tourniquet use may be necessary; defines the clear indications for tourniquet use in external haemorrhage control; and provides practical information on tourniquet application and removal. Practitioners need to familiarise themselves with commercial pre hospital tourniquets and be prepared to use one without irrational fear of complications in the appropriate cases ...”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2660095/

“... When a traumatic injury on an arm or leg leads to rapid blood loss, a properly applied tourniquet is the most important piece of equipment you can have. A tourniquet will safely limit the amount of blood the victim will lose before receiving hospital treatment ...”
https://redcrosstourniquet.com/

“... The European Resuscitation Council (ERC) First Aid Guidelines 2015 state that when direct pressure cannot control severe bleeding, tourniquets and haemostatic dressings are now advised. ILCOR (International Liaison Committee on Resuscitation) fully supports this ...”
https://firstaidforlife.org.uk/tourniquets/
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Old 16-04-2020, 06:07   #110
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Re: Upgrading your Boats Medical Locker

OK, tourniquet is on, bleeding stopped...now what? To throw a reality on this, you have about 6 hours until the limb dies from lack of blood flow. Now hopefully the arterial injury will clamp down and clot, and hopefully there are collateral vessels that will allow perfusion after the tourniquet is removed. If the tourniquet has to remain in place, you need immediate medical attention. If you are offshore, unless there happens to be a naval vessel nearby, it may not be salvageable.



Gord's post critical words PREHOSPITAL SETTING


Not to mention shock. Shock in medical terms is not related to emotional distress. It is the body's response to a major injury, like blood loss or limb trauma. The body does a good job at compensating early on, but the compensatory mechanisms can be exceeded and a downward spiral follows. People generally tend to be dehydrated on passage. Lots of fluids required to treat shock. Needs an IV. Hard to start an IV on some people, especially if they are dry and a bit overfed. If you are not proficient, close to impossible.



Tourniquets are easy to improvise. Don't bother with one unless you are planning on going into combat.
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Old 16-04-2020, 06:15   #111
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Re: Upgrading your Boats Medical Locker

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I am an orthopedic surgeon with a bit of trauma experience. Training is the key element. Unfortunately, a weekend classroom course, even with simulations, is going to fall short of ideal, especially when you haven't looked at the course material in months
Everything you write is correct... for you, being a professional surgeon.

It’s how you write: you can improvise... because you are a trained professional. Stopping a bleeding is much easier to accomplish for you than it is for the average sailor.

This is not opinion because it has been researched. I’m sure anyone wanting to know more can find it with Google. What I learned in training, and read in research documents is that any civilian can stop bleeding from a wound, incl. arterial bleeding with the right gear and instruction.

Even for difficult bleedings where trained medics can stop it in 80% of the cases using bandages and hand pressure, a civilian without previous experience but with product instruction, can stop it in 100% of the cases using Israeli battle dressings and a clotting agent like Celox. (They tested that on pigs, not humans...) This proves that for average sailors that have no medical careers, having these simple, cheap products aboard and studying the instruction videos, can save lives in situations where sometimes even a doctor without those products can not.

If that isn’t enough reason to carry this then may be someone will hear you on the radio calling for medical evacuation
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Old 16-04-2020, 20:25   #112
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Re: Upgrading your Boats Medical Locker

From my experience I wholeheartedly agree with what Nick on Jedi is suggesting.

Simply put.... Be Prepared! ...as best you can.

I think professionals may have more of a "liability" mindset whereas we layman look at it as a last resort to save a life, with hopefully remote professional medical guidance.

As to Suturing, we practice first on Oranges and then filleting salmon
Often you do need to cut to clean.

I do hope we can keep this thread positive and focussed on sharing emergency "at sea" knowledge and tips

I found that USCG FLEET SURGEON in Hawaii was a good resource for medical emergencies in the pacific

Cruising medical PhD"s have been a good source of suppliers.
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Old 17-04-2020, 22:08   #113
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Re: Upgrading your Boats Medical Locker

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Originally Posted by s/v Jedi View Post
If that isn’t enough reason to carry this then may be someone will hear you on the radio calling for medical evacuation
Indeed, we all carried one in a pocket when on ops or exercises. Spares in vehicle kits.

On the dive boat we had a flare box full of them, because you could be dealing with more than one casualty. The tropical version came with strong pain killing tablets inside, morphine.

In the British Army, the instructions were to apply up to three bandages on top of each other if the bleeding didn't stop with the first, combined with elevating the limp if applicable and using pressure points. A quick mention of pressure points, I doubt most of us could hold enough pressure with our hands for more than a couple of minutes. But a well placed size 10 boot likely to be much more sustainable.

Only used a AED once, it worked and he lived, but probably down to the fact we had a nurse instructor who taught intensive care, the dive boat had oxygen on board and the AED from an ambulance when it eventually arrived. We won't mention the ambulance oxygen set was empty so we had to revert to using mine off the dive boat
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Old 16-05-2020, 07:29   #114
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Re: Upgrading your Boats Medical Locker

Recommend the book Your Offshore Doctor - a Manual of Medical Self-sufficiency at Sea, Revised Edition in paperback or Kindle version, available on Amazon. Up to date, extensive discussion about diagnosis, treatments, medical kits. Check it out.
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Old 31-03-2021, 09:54   #115
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Re: Upgrading your Boats Medical Locker

Wow you guys are life savers (I mean that literally) As a disclaimer I am new to this world but on the list I have gleaned from a lot of different sources and assuming there are no limits on being able to purchase or obtain prescriptions I have come up with t he following list as well as the list of books or resources below. I need to go through this thread in closer detail and add to it with all of your advice. Maybe I can put together a google doc and we can collaborate on a fully comprehensive guide of items and course to consider:

Medical
First Aid
2 First Aid Kits Minor/Major (to carry in Dinghy or on shore hikes)
Vaseline
Film Cannisters for holding small items
Betadyne or anti-septic cream
Alcohol (over 70%) <potential fire hazzard>
Burn Pack
Cut Pack
Sea Sick Pack
Viral Pack
Fungal Pack
Stitch Pack
Light Pain Pack
Nausea/food poisoning Kit
Surgical gloves
Misc Bandages and clotting kits
Splint
Tourniquet
Latex gloves
scalpels
IV Kit
scissors
Clamps
Disposable Syringes
Epi-Pen
Dermabond
Finger OX meter
Bloodpressure Monitor


Ongoing Medical Needs
Asthma meds or allergy cremes
Ointments
Breathing Masks and small ox bottle/generator
Flow meter

Health Improvements
Vitamins
Probiotics
Toothpaste & Brush
Hand Sanitizer
Aloe and Skin Creme

Medications
Antibiotics
Cipro/Levofloxacin,Zpacks
Azithromycin
Bactrim

Allergic Reaction
Epipens & epinephrine
Claritin
Nasal Spray

Cold/Flu
Tamiflu
Anti-cough Meds
Seasickness

Food Poisoning and Diarrea
ImodiumAD
Cipro
Pepto
Hydration Salts
Anti-Malarials
Malarone
Mefloquine

Painkillers
Aspirin
Ibuprofin
Oxi
Doxycycline

Sedatives
Ambien

Anti-Fungal

Diflucan
Antifungal skin and foot cream—Lotrisone and Nizoral are good choices.
Hydrogen Peroxide
Antacid


Other Ideas

EarPlanes—Pressure-regulating ear plugs will reduce pain associated with air travel. Especially recommended if you have trouble clearing your nasal passages.

Vosol solution—to prevent or treat swimmer's ear.
Corticosteroid cream—such as Cortaid, or Topicort by prescription.

Extra pair of prescription glasses or contact lenses. Copy of lens prescription.

Courses
https://www.bluewatermedicalcourse.com/
(US) CERT Community Rescue and First Aid

Books or References:

American Medical Association Family Medical Guide https://www.amazon.com/American-Medi...e33e4107a001e0
Where There Is No Doctor: A Village Health Care Handbook, Revised Edition*Paperba https://www.amazon.com/David-Werner-...356bdc9ab901dd
Your offshore Doctor https://www.amazon.com/Your-Offshore...420b3f5938355a
WEEMS & PLATH The 12 Volt Doctor's Practical Handbook* https://www.amazon.com/Weems-Plath-D...38c550311dd550

Please I'd love additional input. Maybe I can load this in google docs and people can collaborate or print out. I'm still very new to the idea and dream of setting off on bluewater cruising but I do love planning!
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Old 31-03-2021, 13:22   #116
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Re: Upgrading your Boats Medical Locker

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Wow you guys are life savers (I mean that literally) As a disclaimer I am new to this world but on the list I have gleaned from a lot of different sources and assuming there are no limits on being able to purchase or obtain prescriptions I have come up with t he following list as well as the list of books or resources below. I need to go through this thread in closer detail and add to it with all of your advice. ...
The other thing to consider is how much of each item do you need to take?

That answer is different when:
  • You are an hour from the dock/help.
  • A day from the dock/help.
  • Five days from the dock/help.
  • A week from the dock/help.
  • A month from the dock/help.
  • ...
For example bandages for a bleeding wound How many you need and what size is going to be different depending on the seriousness of the wound as well as how long it will take to get to help. A burn wound can require a quite a few bandages changed frequently and other medicines. How much of each item you take is going to depend on how long it takes to get help.

Later,
Dan
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Old 31-03-2021, 21:00   #117
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Re: Upgrading your Boats Medical Locker

Google Israeli battle dressing and buy a bunch in different sizes. Also, clotting agent.

We even added Ivermectin, zinc supplements etc.
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Old 22-05-2021, 01:29   #118
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Re: Upgrading your Boats Medical Locker

FF/medic (ret) here, I am just a coastal cruiser, but carry Ambu Bag, 4x4, Tylenol, Benadryl, and wear two mantras: 1) don't make the patient worse 2) get the patient off the boat and to a hosp ASAP if serious ie call CG immediately. That's the thing though, what is "serious"? If even the slightest doubt, call CG. Anything involving breathing problems, chest pain, sluggish abnormal behavior (unless drunk), or broken bones/major trauma get the person off the boat ASAP. Btw, trauma in medicine means injury related to "motion". eg a bullet travelling through air, shark jaws clamping down, hitting your head on an anchor. Stay safe.
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Old 22-05-2021, 09:42   #119
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Re: Upgrading your Boats Medical Locker

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FF/medic (ret) here, I am just a coastal cruiser, but carry Ambu Bag, 4x4, Tylenol, Benadryl, and wear two mantras: 1) don't make the patient worse 2) get the patient off the boat and to a hosp ASAP if serious ie call CG immediately. That's the thing though, what is "serious"? If even the slightest doubt, call CG. Anything involving breathing problems, chest pain, sluggish abnormal behavior (unless drunk), or broken bones/major trauma get the person off the boat ASAP. Btw, trauma in medicine means injury related to "motion". eg a bullet travelling through air, shark jaws clamping down, hitting your head on an anchor. Stay safe.
Yes of course, but for blue water cruising that option of getting to hospital is often not available. I recommend to work with a MD who is sailor as well to get prescription drugs etc. aboard as well as for consultation by phone in case of emergencies. We often helped other cruisers by having them call their doctor with a list of the medications we have on board so that the doctor can select an antibiotic that is available immediately etc.
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Old 22-05-2021, 10:08   #120
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Re: Upgrading your Boats Medical Locker

"sluggish abnormal behavior AND drunk"

is normal behavior.....lolol
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