First Aid for your First Aid Kit

Roy and Marlene Verdery in Cartagena


Puerto Escondido May 2, 2014
– It was one of the most interesting seminars at this year’s Loreto Fest, and a large crowd of cruisers strained to hear Dr. Roy Verdery’s talk.

Dr. Verdery, an internist and  hospitalist, is the author or co-author of dozens of  scientific articles as well as being an avid sailor.

His Loreto Fest talk was entitled  Medicine for Cruisers but what he actually delivered might have been more accurately entitled:  First Aid for Your First Aid Kit.

For just one example of his extraordinary suggestions:  do you have your home physician’s email address? did you get her permission to be able to email her when you have a serious problem?

Or this:  do you have four very specific antibiotics and know precisely which one is to be used for which infections?  Should you urinate on a sting ray wound or use hot water?

In fact, every onboard first aid kit should include a copy of  the notes Dr. Verdery used for his Loreto Fest talk.  But how to get a copy – that’s the question!


Here are Dr. Verdery’s notes. An Adobe Acrobat version is available for download at the bottom of this posting, as is a place to leave a comment or ask a question. All will be forwarded on to Doc Verdery!


 

Medicine for Cruisers – Loreto Fest 2014

Roy Verdery, MD, SV Damiana

Notes provided for educational purposes only. In the event of illness, consult a physician.

* Discuss all drugs with your physician, carefully addressing your allergies, side effects, and when to take them .

These recommendations are for healthy adult cruisers older than 18.


Special populations, children (They are not just little adults.), pregnant women (especially 3rd trimester), chronically ill, and expatriates require extra thought and planning.

Before you leave the dock talk with your physician about any medical concerns, make a list of your medical problems, get a copy of your most recent laboratory tests, carry copies of all prescriptions. Find a physician you can call or e-mail and establish passwords if necessary.
Physicians in Mexico are usually well trained, speak English, and have up-to-date equipment, especially in major cities. For recommendations, talk with other cruisers and/or refer to IAMAT (International Association for Medical Assistance to Travelers).
Prevention while traveling: Update immunizations: influenza every year, tetanus (dT or dTap) every 10 years, typhoid every 5 years (oral), hepatitis A series once, yellow fever every 10 years if going to Panama, consider hepatitis B and rabies series once. Eat and drink well and carefully, get sleep, don’t overindulge alcohol, avoid drugs and unprotected sex. Don’t smoke.  Cover up and use sun block and repellant for sunburn and mosquitoes. Take malaria prophylaxis. Discuss  prophylaxis for helminths (worms), amoebae, and other parasites with your physician. Refer to http://www.cdc.gov for most recent recommendations.

What can you expect to treat and what will you absolutely need.

(* = talk with your doctor about this)

1) Diarrhea, gastroenteritis, heartburn Pepto Bismol, immodium, antacid (e.g. Tums), ciprofloxacin* (500 mg, 2/d x 3d)
2) Lacerations and skin infections Bandages, steristrips or butterfly closures, Neosporin or bacitracin, antibiotic*
3) Colds Tylenol, decongestant (e.g. pseudoephedrine), cough syrup
4) Allergies Tylenol, antihistamine (e.g. diphenhydramine – Benadryl)
5) Seasickness Meclizine or dimenhydrinate, scopolamine patches, oral hydration fluids
6) Sprains or minor fractures Ace bandage, cold/hot pack, splint, antiinflammatory (e.g. Aleve)
7) Sunburn Sunscreen, sunburn ointment
8) Insect bites, stings, rashes Repellant, antihistamine, ointment (e.g. Vaseline), hydrocortisone, antifungal

What you can prepare to treat and what you might need.*

 

1) Urinary (bladder, prostate) infections Water, juice, and/or oral hydration fluids, antibiotic*
2) Bronchitis, simple pneumonia Decongestant (e.g. pseudoephedrine), cough syrup, antibiotic*
3) Ear infection, uncomplicated Decongestant (e.g. pseudoephedrine), Afrin nasal spray, antibiotic*
4) Vaginal yeast infections Nystatin or miconazole cream and/or fluconazole* (150 mg, 1 tab)
5) Minor burns Burn cream, bandages, silvadene or neosporin
6) Toothache (simple) Tylenol, anti-inflammatory (e.g. Aleve), antibiotic*
7) Influenza or dengue, uncomplicated Tylenol, medications for cough, diarrhea, pain, fever
8) Poisonous sea animal encounters**
          Stingrays Hot water
          Jellyfish Vinegar
          Shellfish toxins Tylenol, immodium, oral hydration fluids
          Ciguatera Antihistamine (e.g. diphenhydramine – Benadryl), tylenol, possible evacuation

 

What you cannot treat beyond first aid for airway, bleeding, cardiovascular collapse (shock).

For serious medical problems, a satellite phone or other reliable long-distance radio  communication and list of phone numbers for medical assistance and the coast guard are invaluable. Have a first aid book or quick reference card on board. Consider evacuation insurance.

1) Decompression illness (DCI): decompression sickness (DCS) or arterial gas embolism (AGE)after diving. Recognize, Oxygen, Consult Divers Alert Network (DAN) 1-919-684-9111 (hotline) or 1-800-446-2671, Evacuate
2) Major trauma, fracture, or penetrating injuries (Note that need for a tourniquet will most likely lead to amputation.)
3) Unstable angina or heart attack (give aspirin, full strength or 4 – 81 mg, get medical attention, evacuate)
4) Respiratory distress, shortness of breath, difficulty breathing, unremitting asthma, inhalation injury
5) Infections with high fever, confusion, inability to eat or drink, not responding to treatment, or with hemorrhage
6) Gastrointestinal illness with high fever, bleeding, evidence of obstruction, abdominal pain, or persistent vomiting
7) Urinary tract infection with high fever, back or kidney pain, or hemorrhage
8) Neurologic problems, severe head injury, paralysis, loss of consciousness, new seizure, or persistent confusion
9) Significant burns – face, hands, feet, genitals, 2nd or 3rd degree circumferential or involving >10% body area
10) Acute or decompensated psychiatric illness, hallucinations, psychosis, or incapacitating depression

11) Pregnancy with any problem besides stable morning sickness without dehydration

What to have on board

For serious emergencies:

  • Satellite phone, Spot ™, or other reliable long-distance radio communication and list of phone numbers for medical assistance and the coast guard. Use local HF SSB or 14300 kHz USB maritime mobile nets. Consider evacuation insurance.
  • Oral hydration fluids (including water, 7-up or ginger ale, Gatorade, Electrolit, etc.):

Pedialyte (US), Oral Rehydration Solution (WHO, United Nations).
Recipe: 1 teaspoon (5 g) salt and 4 teaspoons (20 g) sugar in 1 quart (liter) of water for dehydration without shock.

Supplies (no sutures, skin staples, or iv’s – infection risk is too high and too much skill needed):

Bandages, bandaids, steristrips, butterfly closures, pressure dressings
Adhesive tape, ace bandages, hot/cold packs, splints (e.g. Sam Splint or Air Splints)
Thermometer, otoscope for ears, blood pressure measuring equipment with training to use and interpret results
Medications (no narcotics due to legal and overdose risks). Stock inexpensive medications and discard when expired.
Sunscreen and sunburn ointment
DEET (insect repellant)
Neosporin or bacitracin antiseptic ointment
Silvadene or other antibiotic burn cream
Waterproof ointment (e.g. Vaseline or Desitin)
Hydrocortisone 1%, antifungal (e.g. terbinifine, nystatin), anti-itch skin cream
Vinegar (for sting-ray encounters)
Pseudoephedrine or other oral decongestant
Oxymetolazine (e.g. Afrin) decongestant nasal spray
Diphenhydramine (Benadryl) or other antihistamine (e.g fexofenadine is nonsedating)
Epi-pen* ™ adult or Jr. if history of severe allergy – dangerous with heart disease – replace if out of date – expensive
Cough syrup (e.g Robitussin, Robitussin DM, or Delsym)
Immodium and bismuth subsalicylate (Pepto Bismol) for diarrhea
Calcium carbonate (e.g. Tums), magnesium – aluminum hydroxide (Maalox or Mylanta) or other antacid
Meclizine (non-drowsy Dramamine) – this is not recommended for children
Dimenhydrinate (Dramamine) – this is ok for children but check doses
Scopolamine patch (Transderm Scop*) – this is not recommended for children
Tylenol (acetaminophen also called paracetemol) – do not exceed 3000 mg / 24h from all sources
Aspirin, enteric coated “baby strength” – 81 mg (not for children or babies with fever)
Antiinflammatory (e.g. naprosyn – Aleve, or ibuprofen – Motrin or Advil)
Drying eardrops (e.g Swim-Ear) – do not use if eardrum is punctured (loss of hearing and/or blood in ear canal)
Antibiotic eardrops (e.g. Cortisporin*) – do not use if eardrum is punctured (loss of hearing and/or blood in ear canal)
Oxygen with valve and mask for divers. Consider taking a Divers Alert Network (DAN) sponsored first aid course.

Malaria prophylaxis medication*: chloroquine, mefloquine, primaquine, doxycycline, or atovaquone – proguanil
Diflucan* (150 mg, 1 tablet) or cream (e.g. nystatin or miconazole) for vaginal yeast infections

Antibiotics*, 3 or 4 different kinds. (Bactrim*, Amoxacillin*, Ciprofloxacin*, and Doxycycline* is one possible list)
Buy $4 discount antibiotics and replace them when they expire. You may need a prescription from a Mexican physician
to buy antibiotics in Mexico.   Carry two different antibiotics for skin infections – effective against Methicillin resistant
Staphyloccus aureus (MRSA) and Vibrio vulnificus (“flesh eating” seawater contaminant), and antibiotics for traveler’s diarrhea
(ciprofloxacin* 500 mg 2/d x 3d), respiratory infections, ear or dental infections, urinary track infections.

 

SUGGESTED ANTIBIOTICS

Antibiotic choice (1st – 3rd choice, nr = not recommended)* GI GU Resp Skin Ear Teeth
Bactrim* (ds 2/d x 3-5 d) – not if allergic to sulfa 2 1 2 1/2 2 2
Amoxacillin* (500 mg 3/d x 5 d) – penicillin relative 3 3 2 1/2 1 1
Ciprofloxacin* (500 mg 2/d x 3-5d) 1 2 nr 3 nr nr
Doxycycline* (100 mg 2/d x 5d) nr 3/1 1 2 2 2
Amoxacillin alternative:
Keflex* (500 mg 4/d x 5d) or clindamycin*  if alergic to penacillin
Doxycycline alternative:
Azithromycin* (250 mg 1/d x 5 d) if doxycycline is too expensive – but doxy is better for MRSA or Vibrio

References:

Brunette, Gary W., ed., CDC Health Information for International Travel 2014, US Department of HHS, 2014, http://www.cdc.gov.
Weiss, Eric A. and Jacobs, Michael, A Comprehensive Guide to Marine Medicine, Adventure Medical Kits, 2005.
First Aid, Emergency Care for the Injured, from http://en.wikibooks.org/wiki/First_Aid.
Gilbert, David N, et al. (eds.), The Sanford Guide to Antimicrobial Therapy, Antimicrobial Therapy, Inc., 2013.

Copyright (c) Roy Verdery, 2014.   May be distributed for free without modification for educational purposes only.

 

Download Dr. Verdery’s complete notes here. You’ll need Acrobat Reader!

Click here for  download link for  Dr. Verdery’s Medicine for Cruisers – Loreto Fest 2014 .  Fill out the form below to ask questions!

 

 

 

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