Content of onboard medicine chest

[Kim Klaka]

[QUOTE=seadago;2194811]Onboard Medicine Chest

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!!!

Lots of advice already given on content of medical kit. May I suggest one over-arching principle: don't carry anything you are not confident about administering safely. That leads onto an important issue parallel to the kit - the appropriate training to use it. Clearly a first aid course is a start, but most cruisers need to know what might be considered third aid. Find an advanced course, do it several times to embed the learning.
Ok, just one suggestion regarding the proposed contents. I'd be very wary of taking anything to keep you awake for 24 hours in bad weather. You really won't know how long the bad weather will last, and once the medication has stopped working you will probably have much lower capacity to make good decisions.

[Maka]

Great Info.

[tinysailor]

When diving in remote locations, and in consultation with our GP our drugs list usually contains a minimum of the following:

Drugs list:-

Injectable:
Hartman’s solution
Lidocaine
Hydrocortisone
Epi pen

Oral Administration:
Phernergan
Cetirizine
Fexofenadine
Loratadine
Sudafed (the good stuff)
Tramadol
Oxycodone
Codeine
Paracetamol
Voltaren
Ibuprofen
Antibiotics (various)
Gastrostop
Hydrolyte (Rehydration sachets / effervescent)
Ventolin (blue asthma pump)
Canestan

Nasal admin:
Saline solution
Otrivine (decongestant)

Eyes:
Chlorsig drops
Saline solution

Topical:
Zovirax**(cold sore cream)
Soove (bite cream)
Voltaren gel
Canestan

Toddler:
Dymdol
Antibiotics for toddlers

A GP letter accompanies this list.

Please excuse the brand names / chemical names mixture throughout the list!

Access to oxygen is always a must too for us however that's more for decompression related sickness and to run the rebreathers.

The expiry dates need to be carefully managed as Chlorsig drops for instance only last for 28 days and must be kept refrigerated.

General rule of thumb has been that if we don't take it, we end up needing it.

[CarlF]

An important thing I carry for serious medical problems is my Delorme Inreach for global two way communication with a doctor - either my own or the medical staff available to the GEOS emergency center that Delorme uses.

I've found it connects much more reliably at sea than SSB radio or even satphones. As anyone under 30 will tell you, anything worth saying can be said in 160 characters

[HankOnthewater]

T.Sailor, your list is a good starting point, although including fluids/medications that needs to be injected/infused in one's veins, means that special equipment (needles, syringes, tubing) and medical training (ie doctor) is needed. Things like Epipen do not need such specific training.

Maybe you or others can expand that list by listing the reason for inclusion,ie
- Tramadol, strong pain relief

Lastly I suggest that we use all generic names, not brand names as some medications are marketed by companies under different names in different countries, particularly as readers on this forum are from all over the place.
For example:
Promethazine (instead of Phenergan), an antihistamine, also used for prevention of seasickness, and as an aid to sleeping (using its sedative side effect).
Edit, added later: just noted T.Sailor already noted this point!
Hmmm, if someone could make a table???? Or find one on the net?

Lastly, some of the medications listed can only be obtained on a doctor's script, like oxycodone (an opioid drug) whilst others are OTC (over the counter), but even this can be different from one country to another.

[tinysailor]

Thank you Hankonthewater. Typing on the iPhone is a bit limited, however there's some excellent recommendations you've listed above.

Years ago I completed Diver Medical Training with Advanced Life Support, it was an exceptional course, however I would be unwilling to be administering injections or trying suturing, however the needles etc required we have often carried as the hospitals in some locations can be questionable.

The one phrase I distinctly remember from the GP trainer was that if the patient wasn't experiencing enough pain relief, giving more of the same won't change anything and you need to 'up the drug'.

Please note I'm not a GP!!!!!!

[nauticalnomad]

I keep magic mushrooms in my grab bag just incase im in the life raft for a week or 2..

[ontherocks83]

Originally Posted by HankOnthewater

Lastly, some of the medications listed can only be obtained on a doctor's script, like oxycodone (an opioid drug) whilst others are OTC (over the counter), but even this can be different from one country to another.

How receptive are foreign countries if they find opioids in your med kit? I understand they might be in a prescription bottle but does anyone have experience or knowledge if this can cause problems.

[Olddave]

Originally Posted by tinysailor

The expiry dates need to be carefully managed as Chlorsig drops for instance only last for 28 days and must be kept refrigerated.

General rule of thumb has been that if we don't take it, we end up needing it.

Just guessing here but I think you will find that Chlorsig drops last 28 days after they have been opened.
There is a very good publication that is carried aboard ships, also from memory I think it is called Ship Captains Medical Guide.
Dave

[JerseyJoe]

Originally Posted by seadago

Onboard Medicine Chest

Constraints as follows:

Specific conditions and/or medicine groups:

• Topical antiseptics (powder or cream form) for skin lesions, abrasions, burns, sweat itch, etc.-Bag Balm
• Stings and bites; anything from blue bottles to horse flies, not shark attacks!-Ammonia
• Antihistamine and general anti-allergenic compounds (as per the story above).-Benadryl
• Dehydration, sunstroke, sunburn. -Hydrate/Sunblock to avoid. Otherwise ice bath, Lactated Ringer Solution, Electrolyte Solution(1 level tsp salt and 4 heaping tsp sugar added to 1 L water),Tylenol and aloe/noxema
• Food poisoning, diarrhoea, nausea/vomiting, constipation. -Loperamide, Ciproflaxin, Dulcolax, Syrup of Ipecac, Activated charcoal tabs
• Digestive track cramps, period pains, etc. -Tramadol
• 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. -Good crew, appropriate heavy weather gear.
• Topical and/or internal anti-inflammatory compounds – sprained ankles, damaged knees, twisted thumbs, tendinitis, that sort of thing, short of a downright bone fracture -Ice pack, Aspirin or Panadol, Traumeel(Arnica Cream), Cortizone
• 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 -Ciproflaxin, Polysporin, Vinegar, Clove Oil, Bactrim, Levaquin.
• Pain killers – not necessarily opiates, but stronger than paracetamol. -Tramadol, Oxycodone
  -Add Quikclot, Epi-pen and Tarascon Adult Emergency PocketBook,

Best defense is a well prepared and knowledgeable crew. Each should be able to take on role of "doctor" and how to do CPR, set a fracture, do sutures. Read up on possible scenarios and flow chart management. Put kits together for certain scenarios.

[MarkJ]

Originally Posted by ontherocks83

How receptive are foreign countries if they find opioids in your med kit? I understand they might be in a prescription bottle but does anyone have experience or knowledge if this can cause problems.

I dunno. But i dont have any prescription drugs on board, except a normal broad spectrum antibiotic.
I dont have known health problems and visit too many weird countries where some of the port officials/customes people may not know, understand, or even be able to translate prescriptions or drug names.

Some countries are so crazy when it comes to drugs that the very word Opioid sends a shudder through my spine... An interesting example is a woman on a murder charge in Indonesia for murdering a POLICEMAN has a maximum prison sentince, if found guilty, of 15 years. But has the death penalty for a few grams, much less than a tablet bottle of opioids.

Sara Connor: Police say Byron Bay mum accused in murder of Bali policeman 'will admit everything' - ABC News (Australian Broadcasting Corporation)

[mikereed100]

Originally Posted by ontherocks83

How receptive are foreign countries if they find opioids in your med kit? I understand they might be in a prescription bottle but does anyone have experience or knowledge if this can cause problems.

I have visited over 40 countries and never had anyone go through my kit. That said, make sure that any prescription meds you carry have your name on the bottle.

[reed1v]

Originally Posted by ontherocks83

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

We kept a lot of super glue on hand to mend wounds. BTW: most countries do not have a "prescription" system in place so you can buy just about any drug you want once you are out of the "Nanny" nations. We stocked up on morphine vials in Nador and various anti seizure meds in Cape town without prescriptions.

[barnakiel]

IMHO

- inshore, just the basics do - some band aids, disinfectant, sunburn cream etc.

- offshore, it is either serious or nothing, for the serious you want morphine and a sat phone, antihistiamine, basic antibitics and the likes should be onboard in any case as you may never need them but someone else might,

We normally carry 4 maybe 5 drugs of the above type and a plain car fisrt aid kit on the boat. We do not have morphine as shops refuse to sell it over the counter.

b.

[reed1v]

Originally Posted by barnakiel

IMHO

- inshore, just the basics do - some band aids, disinfectant, sunburn cream etc.

- offshore, it is either serious or nothing, for the serious you want morphine and a sat phone, antihistiamine, basic antibitics and the likes should be onboard in any case as you may never need them but someone else might,

We normally carry 4 maybe 5 drugs of the above type and a plain car fisrt aid kit on the boat. We do not have morphine as shops refuse to sell it over the counter.

b.

Mexico has tightened up quite a bit on painkillers. US pressure. For other countries further away from the US, if you can not get it over the counter, go see a doctor. Ask at the yacht club for contacts. Prescription in hand should not be a problem. We use to have vials but that required injections. Not good. Pills are way better but less available in many countries.
In a pinch you can make your own powerful painkiller with fairly ordinary ingredients. Problem will be dosage. Might wind up with a comatose patient.A And then there is the alcohol vapors along with ordinary pain killers that will kill any pain; but also might kill the patient if you get the dose wrong.
Where its legal, a gallon of Everclear 95% alcohol can be used for just about anything you need alcohol for and its non poisonous.
Just do not drink it without diluting it real well. If you drink 95%(190 proof) alcohol it will completely dry out your innards and you will die.