Our Medical Kit

[Seaworthy Lass]

Hi Dhillen
A few comments and recommendations:

I would add Gastrolite (sachets or tablet form) for rehydration (following diarrhoea, vomiting, excessive sweating etc). Kids particularly can deteriorate very rapidly with dehydration.

A drug for diarrhoea would be useful. Loperamide is effective, but can't be taken under the age of two.

I would also add some unit dose saline sachets (useful for wound and eye rinsing) and an ocular antibiotic (we carry Ciloxan).

All the prescription drugs you have listed can be stored at 'room' temperature, but the definition of this is often only up to 25 degrees (77 F). You are likely to be storing the drugs for a couple of years, so apart from being easy to grab, keep the kit somewhere as cool as possible, without a high risk of water damage (conflicting requirements I know).

I am not sure where you are planning to travel, but keep a copy of your GP's prescrition for the drugs you are carrying.

Read the instruction leaflet carefully each time before using any of the drugs.

Ask your GP for their mobile/home phone number in case of an extreme emergency.

We left Australia with a well stocked kit nearly six years ago. Interestingly and amazingly here in Greece I have not needed to present a prescription for any of the drugs that I have replaced (all due to expiry, not usage thankfully!). Also the cost is a fraction of Australian prices.

Safe sailing.

[jgbrown]

I use saline wound wash. Works great, use lots, flush regularly and change bandages often.
iodine has issues as well imo.

I like steri strips instead of stitches, topped with gauze and some of that crepe style bandage.
Cut to the bone along my finger a couple weeks ago with a dirty exacto knife at work. It's healed almost perfectly, though the scar tissue is a bit stiff.

[hellosailor]

The clear waterproof bandages might be 3M Tegraderm brand. They're similar to what hospitals apply over IV needles these days. 3M have a number of medical products like that now which work very nicely.

What is "waxed gauze" ? A non-stick gauze, like Tefla pads?

I find plain cotton gauze rolls to be very useful. It may be old fashioned but using one of them to secure a gauze pad onto an arm or leg works well without the need for tape or adhesive, both of which seem to cause allergic reactions in more people every year.

[JPA Cate]

jgbrown:

My dermatologist told me, rub the scar crosswise with lubricant. He recommended Vaseline (petroleum jelly), but I like Vitamin E Oil better. The concept is that the cross-scar rubbing breaks down the little threads of scar tissue, leaving a more supple scar in the long run.

Hope this helps.

[s/v Jedi]

Klinitulle; a waxed gauze, like impregnated with a fatty substance so that it does not stick to the wound so much:

[s/v Jedi]

Originally Posted by donradcliffe

Cipro is best for gram negative and Augmentin is better for gram positive--we carry both.

Yes, that is what I was told. I should add Augmentin even though I never needed it. I have used the Cipro at least 5 times in 10 years: once for ourselves, once for a cat and 3 times for other cruisers. In every case a doctor on the telephone was relieved to hear Cipro was available. The cat dose was tricky; one pill was many doses...

[s/v Jedi]

Originally Posted by susswein

When I took my wilderness first responder vlass (WFR) Cipro was the recommended drug of choice as a GI antibiotic; Augmentin for everything else.

Some other stuff I carry:

- Quick-clot. Designed for the military, use in large open wounds to prevent blood loss.
- Flagyl or equivalent for giardia
- an anti-emetic
- a muscle relaxant (for dislocations)
- super glue
- a big assortment of cough/cold/decongestant/antihistamines
- clear, waterproof bandages (forget the name). These have stayed on for a week of rafting in the grand canyon, and you can see through to see how the wound is healing.

I go light on bandages, but heavy on meds, since cotton clothingcan substitute for bandages.

I think the single most important skill I learned in the WFR class was how to do a focused spinal exam.

Now, this puts me in research mode again
The Celox I listed is the best quick-clot type treatment around I learned so got that covered. The cough/cold/antihistamines were already covered by the OP so I didn't list them. I'll need to look into the rest. What type of muscle relaxant do you carry?

[zeehag]

Originally Posted by Astrid

Cephalexin is a good substitute in cases where penicillin allergies are suspected or present and is a good broad spectrum antibiotic which can treat sinus infections, inner ear infections, respiratory tract infection, UTIs and skin infections.

Erythromycin is slightly more broad spectrum than penicillin, but can be hard on the flora of the digestive tract. If I were chosing between erythromycin and cephalexin, the latter might be a better one to have on hand.

erythro and cephalexins do not cover the spectrum cipro covers, and cipro is readily available in mexico.
i will continue to use cipro for my broad spectrum needs. it works. erythro and cephalosporins do not cover the staph and strep that are waterborne.

ask anyone who has been injured by a staph infected barnacle. takes weeks of CIPRO to clear them.

[s/v Jedi]

Originally Posted by Dhillen

Jedi,

Thanks for the list. I am not familiar with some of these items. "Klinitule" sounds like it might be similar to hydrocolloid dressings which keep the wound moist and facilitate healing.

For jellyfish and other stings the research shows that there is no one "cure," and what works on one kind of sting may aggravate another. We carry a great book on oceanic stings and the different treatments, "All Stings Considered." It was written by two doctors based in Hawaii and has a Pacific Ocean bias but is extremely useful.

For wound closure, it seems the thinking now has changed and closure via stitching or staples is discouraged. Wounds need to "exude," or drain to heal properly. Closing a wound in the field (on a boat) raises the risk of infection which is why we are going with Xeroform (petrolatum dressing) and hydrocolloids.

We also learned that hyrogen peroxide use is now discouraged due to the fact that it kills everything it touches - including the tissue you are trying to save. Povidone Iodine solution is what we carry as a substitute.

Lastly, the blood pressure monitor is a good idea and I will look at adding it to our kit. The space blanket is also good but we are putting those in the ditch bag. In our kit I have a separate section for hypothermia which includes a hot water bottle and packets of Gu Gel - instant energy used by marathoners.

We also carry Vicodin and I asked for hydrocodone or fentanyl and was told in no uncertain terms by my physician, "NO." The druggies have hijacked that market and doctors are under extreme scrutiny if they prescribe these restricted medications.

Thanks for sharing and starting this discussion.

Cheers.

Dhillen

No, Klinitulle is not a hydrocolloid. We have that too, as a cream, but I don't find it important enough to list here. We also carry gauze impregnated with an anti-biotic which is much like Klinitulle except without medication. For a bad wound, it is the difference between being able to change the bandage or not so it's pretty important imho. There must be a US equivalent to Klinitulle.

You really must try the Sting-Kill ampules. Hard to find sometimes but amazon.com works. It truly is a first aid topical for every sting or bite. Add systemic medication for bigger allergic reactions. My wife is very allergic and this takes care of 90% os her trouble. She had to undergo the long treatments with bee poison to be able to further survive wasp stings so a good recommendation Antihistamines and Epipen must be carried too of-course.

Get the stapler and wound closure kits. Do not use these until last resort but you really need to have them when is wound is bad enough and a hospital is more than a day or so away. This is not about properly healing; it is about surviving...

Yes, povidone iodine solution is 1st use. Some people can't have iodine so keep an eye on allergic reactions. Also, I have witnessed wund infection that threatened to get into the bone where nothing helped topically nor systemic and the doctor finally used the hydrogen peroxide which saved the foot. My wife's foot. Yes it left scars but she is pretty happy to still have the foot! Need to carry for last resort emergency and I believe every wilderness/ships kit has it.

Vicodin is also used for "recreational use"; report it when customs forms ask about it. It is an opiotic, controlled substance. We carry it too.

[zeehag]

h202 is excellent for treating fiberglass....you work with fg, you get lil stickers inside skin--h202 removes these..easily=-learned that from my old friend the boatbuilder --hank mckune, of yorktown yachts notoriety...
i will not place anything with iodine into my med kit, as i am highly allergic to that stuff....i would rather have pHisohex. hibiclens is also a decent cleanser.
with betadine on wounds--it prevents healing. use all you want. then wonder why you are not healing as you should. we learned this in cedars sinai in cardiac surgery unit....
have fun with this info.

[Dhillen]

Jedi,

Got it. I will get some Sting-Kill. Allergies, like short tempers, seem to run in the family (my fault, I'm sure!) so anything that helps mitigate is welcome. Your recommendation about hydrogen peroxide for use when nothing else works is a good one too.

I did not know about the possible allergies with iodine usage. Thanks for pointing it out. I need to do some more research here.

Somebody mentioned cough medicine - so basic and I had forgotten it. This is a useful thread to be sure.

Cheers.

Dhillen

[Dhillen]

Seaworthy Lass,

Thank you for the suggestions. I have never heard of Gastrolite but it sounds like a good idea and will add it to my growing list of MORE STUFF I need to get!

The diarrhea drug is important. We have Immodium here in the US and I will pick some up.

We are traveling up to Alaska this summer so the heat issue won't be a problem for the drugs, but again, thanks for pointing that out. Future travels will take us much further south into much warmer water.

I will also get our GP's cell phone number - another great suggestion. We have a satellite phone on board and that would be useful.

Somebody mentioned keeping a copy of the prescriptions on board, especially for the restricted medicines. Another great suggestion. Thanks.

When we crossed the Med in 2004 our favorite stops in Greece were Amorgos and Trizonia.

Cheers.

Dhillen

[tartansail]

Originally Posted by Astrid

Cephalexin is a good substitute in cases where penicillin allergies are suspected or present and is a good broad spectrum antibiotic which can treat sinus infections, inner ear infections, respiratory tract infection, UTIs and skin infections.

Erythromycin is slightly more broad spectrum than penicillin, but can be hard on the flora of the digestive tract. If I were chosing between erythromycin and cephalexin, the latter might be a better one to have on hand.

Be careful with Cephalexin for those with serious penicillin allergy (hives or anaphylaxis) as there is potential cross-reactivity. If someone in the crew has serious PCN allergy, erythromycin is a reasonable alternative for respiratory infections.

I like to have rectal compazine available for severe sea sickness when oral medication won't stay down.

[susswein]

Originally Posted by hellosailor

The clear waterproof bandages might be 3M Tegraderm brand. They're similar to what hospitals apply over IV needles these days. 3M have a number of medical products like that now which work very nicely.

That's the one I was thinking of.

RE: muscle relaxant - I carry flexeril.

And one additional suggestion for the kit - if you don't have a freezer aboard carry some of the instant ice packs.

[S/V Alchemy]

Interesting thread, and as I just finished a marine first aid course, figuring out the contents of our offshore medkit will be upon us soon. My wife worked for many years as a wildlife rehabber and has more or less a vet's level of knowledge, which unsurprisingly gives her a lot of knowledge applicable to wounded sailors...

I don't think there is one ideal kit, as there are considerations of age, fitness level, sailing grounds/nearness to SAR resources, and pre-existing medical conditions to consider. I do think that "survival" should be the guiding light, unless one is already a doctor or nurse-practitioner and can feasibly reduce something serious like a compound arm fracture. Of course, halfway between Panama and the Marquesas, this may be the only option, and in that case, you pack the kit for that.

Most situations, however, are less serious (stings, cuts, GI issues due to sanitation/food, tool-related or sailing-gear-related injuries, minor burns) but have the potential to get more serious (dehydration, infection, shock). So it's good to keep up on the "first to last aid" that replicates aboard what most medicos would do ashore, as the boat is in some respects a nicer place to be ill in than a foreign hospital if there is a language barrier.

I agree with both the comments that many drugs are cheaper and more widely available away from North America, and that a "master list" of drugs and gear, and where applicable, expiry dates, should be laminated into the top of the kit for quick reference.

Something I haven't heard is the making of a subset of the medical kit small enough to take onto the liferaft...the "ditch bag doctor" stuff. Hydration, sunburn and saltwater sores seem to be the biggest issues (assuming you have an EPIRB and a hint that rescue could happen in under a week!).

I can't imagine having a broken limb or a burn in a liferaft, but arguably abandoning ship offers many opportunities to snap a bone or two, but at the same time, it would be hard indeed to use traditional splints or dressings in a raft...might put a hole in the thing as well. Clearly, more reflection is required.