Content of onboard medicine chest

[seadago]

Onboard Medicine Chest

A few years ago my wife and I went scuba diving in Pemba (amazing spot, BTW!), a little island off the coast of Tanzania. We were on a small liveaboard anchored in a shallow cove on the west coast of the island, and diving on the reefs offshore off a rubber duck. To cool off during the hottest hours of the day, we would just jump over the side, and climb back onboard up the ladder. On the first day, the poor girl developed an allergic reaction to... something! It started on the inner side of her forearms; no blisters, but blotched and discoloured skin, quite ugly looking really. Within 12 hours, it had extended to her torso and neck, and she was a bit feverish. I had some antihistamines on my travel bag, over the counter stuff for hay-fever, which did not help. She was very uncomfortable, and the prospect was to abort the trip and go back to Dar-es-Salaam (via Zanzibar) to seek treatment there.

We searched for the culprit everywhere on the boat; bedding, food, any potentially toxic materials or products on board she may have come into contact with. There was no distinctly localised lesion on her skin, so I deduced it could not be a sting from a marine organism, and being anchored in the middle of the bay, there was little chance of a biting insect getting to us. I even checked carefully the inside of our wetsuits, just in case we had picked something up from the ocean in the previous dive. Nothing!

As luck would have it, that day came onboard a couple from the UK. A medical doctor and his wife that were trekking across Africa on a sabbatical. The guy (shame, can't remember his name!) looked a my wife, produced two innocuous looking pills from a bag, and presto....the following morning she was feeling well enough to dive again!!

This episode impressed upon me the importance of having a well equipped medicine chest on board when cruising.

The long story above comes into context because I am now planning a long cruise (possibly, who knows, circumnavigation), and need the help of fellow cruisers (particularly those with a medical degree/training) to put it together, beyond the regular content of any first aid kit, or pre-existing conditions of the crew.

Constraints as follows:
Geographic area: tropical and sub tropical (i.e. unlikely I will ever have to treat for frostbite).
Specific conditions and/or medicine groups:

• Topical antiseptics (powder or cream form) for skin lesions, abrasions, burns, sweat itch, etc.
• Stings and bites; anything from blue bottles to horse flies, not shark attacks!
• Antihistamine and general anti-allergenic compounds (as per the story above).
• Dehydration, sunstroke, sunburn.
• Food poisoning, diarrhoea, nausea/vomiting, constipation.
• Digestive track cramps, period pains, etc.
• Products that will keep me awake – something stronger than caffeine... Not asking for advise on mind-altering substances. Rationale is having to stay awake and alert for 24 hrs to cope with unexpected bad weather.
• Topical and/or internal anti-inflammatory compounds – sprained ankles, damaged knees, twisted thumbs, tendinitis, that sort of thing, short of a downright bone fracture
• Antibiotics/antibacterials. This is a very wide topic, I know, so I'll try to narrow it down with a few condition: (1) eye, ear, sinus infections, (2) fungal infections – wet skin, finger nails, etc, (3) infected wounds from coral, rock, shell cuts, sea urchin spines, fish hooks, etc, (4) urinary track infections, (5) took infections/abscesses
• Pain killers – not necessarily opiates, but stronger than paracetamol.

Ok, above but a few. Any other out of your experience that I have not thought about, please instruct me!

Repeat, the purpose of this exercise is not to equip a bush clinic, but to put together an emergency get-me-out-of-trouble, mostly symptomatic, medicine kit that will allow me to get to where I can seek qualified medical care if required.

Many thanks in advance for your input and advise on this topic!!!

And now, the conclusion of the story..... Eventually, I did find out who the culprit was. In time, I too developed a rush, exactly in the same place my wife did at the beginning, the inside for my forearms and wrists!! It was only a slight skin rush on me, but too much to be a coincidence. I was evidently reacting to something. I tracked it down to climbing up the boat ladder after one of my cool-off dips. Sure enough, encrusted on the side bars of the ladder was a covering of orange coloured sponge. In grabbing the side bars and pulling myself upwards on the ladder, the inside of my forearms was rubbing against the sponge, right in the place were the rush developed!!

[MarkJ]

I take only 3 drugs

Heroin - eases pain
Cocaine - makes you think you're getting there faster
LSD - during storms one can be in another place.

[Thumbs Up]

The topic is "onboard medicine chest" but what about first aid? I have no medical training but I know that most first aid kits are a joke. You should top the list with items necessary in an actual emergency. You need large sterile wound and burn dressings and lots of them, suture kits, and plenty of povidone-iodine (Betadine) solution. I would add a Sawyer snake bite and sting kit. (it is called the "Extractor"). New generation large waterproof band aids are important. Burns and skin abrasions are very dangerous in the tropics because of their potential to get infected. You should also have good tweezers and needles and scalpel for digging out splinters and spines and don't forget ace bandages. You could put together a large assortment of common "medicine chest" remedies but if you are in a hot climate all of these items have a very limited shelf life. I think that it is better to equip yourself for a real emergency first and not worry so much about rash creams and headache medicine. There are also some so-called "natural remedies worth having: GSE (grapefruit seed extract), Sovereign Silver, tea tree oil, neem oil, aloe vera to name a few. Also you should think about prevention: quality sunblock, fishermans gloves, and always dab povidone solution on cuts and abrasions as soon as possible (triple antibiotic ointment aka"neosporin" doesn't seem to do anything once something like staph sets in)

[seadago]

Hi ThumbsUp
Thanks for your views, and I agree with you, a first aid kit is necessary, and it is in the plan. I have a bit more practical experience with those, having been trained as a medic during my national service. Pharmacology's not my forte though, hence my request for help.

The approach to the medicine chest is slightly different: to treat non life-threatening conditions that can nonetheless spoil the party, or pose a potential risk of something worse developing, like an open sore that can get badly infected.

You mention a few products: "GSE (grapefruit seed extract), Sovereign Silver, tea tree oil, neem oil". What are they used for?

Thanks again

[seadago]

Originally Posted by MarkJ

I take only 3 drugs

Heroin - eases pain
Cocaine - makes you think you're getting there faster
LSD - during storms one can be in another place.

Do I need a prescription for these?

[reed1v]

Go over to the CCA or SSCA sites. Tons of info on cruising meds. We used Epi Pens for stopping allergic reactions to whatever. Does save lives. Not uncommon for folks to go into shock, then cardiac arrest from severe reactions to various toxins(fish, coral, rust, dust, etc). If you are sailing around the world, you will most likely have a crew member get a deadly reaction(lips and other body parts start to swell, can not breath, heart races or slows way way down, etc). Epi pens are expensive in the US but cheap outside the USA. Buy a dozen while you are abroad and put them in your med chest.

[Panacea2183]

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[ontherocks83]

I would set up an appointment with a Doctor that specializes in travel medicine. My wife did one of her rotations with one and they are very helpful.

I would bring your list of concerns and where you plan to be and for how long. They will let you know what you need for vaccines and can usually prescribe medications for typical problems you may encounter in that area.

[FlyTheCoop]

So what were the pills the doc gave your wife? Antihistamine ?

[UNCIVILIZED]

Glad to hear that you guys are okay. And hopefully the experience didn't scare you too greatly.
This theme does come up with regularity, & as a result, there are some really, really good (older) threads on the topic. And when I say older, I mean within the last year or two, so they're still current in terms of onboard emergency medicine.

For instance, I just did a customized Bing search using the key phrase "First Responder" in conjunction with "cruisersforums.com", & got a good number of choices. Such as the one below, which is a good starting point. As Evans Starzinger was kind enough to put a number of helpful links into a post in the thread, which lead to various suggested sites & resources on this exact topic. http://www.cruisersforum.com/forums/...it-147374.html

Of course there are many more such threads like the one above, most of them being very helpful. Both in terms of suggesting what to put into your kit, & how to organize it, as well as suggested training types & courses. Plus why each would be beneficial, & where to sign up for same. And on this topic, training is easily as important as is the equipment/supplies.

[powsmias]

Originally Posted by reed1v

Go over to the CCA or SSCA sites. Tons of info on cruising meds. We used Epi Pens for stopping allergic reactions to whatever. Does save lives. Not uncommon for folks to go into shock, then cardiac arrest from severe reactions to various toxins(fish, coral, rust, dust, etc). If you are sailing around the world, you will most likely have a crew member get a deadly reaction(lips and other body parts start to swell, can not breath, heart races or slows way way down, etc). Epi pens are expensive in the US but cheap outside the USA. Buy a dozen while you are abroad and put them in your med chest.

Interesting that they are so much cheaper abroad, they been under attack lately on news for an increase of over 400% in price.. guesstimate the cost overseas or link?

[Mike Banks]

Include half a dozen Nelaton 30cm urinary catheters--in case you get a really bad urinary problem. 12 French Gauge in size is OK, plus lubricant such as L-Gel.

Another good thing to have, but a bit bulky, is a box of medical examination gloves--also useful for protecting hands during epoxy repairs.

[basssears]

Uncivilized links to some good threads so won't repeat what's in there (epi pens, liquid benadryl, antibiotics for internal issues, antibiotics for external infections, something for the eyes).

But I will add to think QUANTITY, not just what you're bringing... many first aid kits and many med lists account for what happens if you're out hiking and you're 3 hours from help... you could be 3 weeks from help cruising so you better have plenty of what you decide you need... and keep in mind all medicines expire, especially epi pens, so you need to keep up on replacements. If you have a cooperative doctor you might be able to get a prescription for a vial of epinephrine (30 milligrams of epi, costs about $10) as a replacement for arm loads of epi pens (0.3-0.5 milligrams of epi each, ~$150 each)... but don't forget the benadryl, all epi does is keep you alive while the benadryl goes to work.

One thing I would add that I haven't seen mentioned much is a tourniquet... for arterial bleeding it's the only things that might save someone if direct pressure and a pressure dressing doesn't work, and it's not even a guarantee you lose the limb like it used to be (although if you're days out you will lose the limb, but hey, not your life)... Iraq and Afghanistan fine tuned tourniquet all too well, unfortunately.

[ontherocks83]

Quick clot is always a good option for uncontrollable bleeding, you can buy it at most hiking stores like REI.

[seasick]

The best list of meds and how to use them that I have found is the World Health Organization's publication, Where There is no Doctor. Here is a pdf copy: http://www.pathobiologics.org/mmp/op..._2011_full.pdf

The "Green Pages" near the back is the list of must have meds.

Simple OTC meds like Tinactin for fungal infections is a must. We once saved a man on a remote atoll who had athletes foot that was killing him slowly.

Just two Epipins in the USA today will cost you $650. Buying a full med kit is like buying a new car.

The two pills he gave his wife for her allergic reaction were probably Prednizone.