Pick 5 meds...

Discussions of the best (or worst) equipment to have on hand for use in the event of an injury during an emergency.

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Re: Pick 5 meds...

Post by dallas » Sat Aug 03, 2013 9:49 pm

TacAir wrote:For OTC (no Rx required)


Ocutricin brand ophthalmic solution (bacitracin, neomycin, and polymyxin B ophthalmic) good for eyes and ears + is triple antibiotic, so good for boo-boos that might get infected. Buffered for use as an ophthalmic solution so the cost is higher, offset by multiple uses possible.
You should never use neomycin in the ears. It can leave you deaf.

There is no doubt that some ingredients of older ear drops, especially but not limited to aminoglycosides, have the potential to cause severe cochlear and vestibular ototoxicity. Neomycin is probably the most toxic of the aminoglycosides followed by gentamicin and tobramycin.
http://www.australianprescriber.com/magazine/31/2/40/1" onclick="window.open(this.href);return false;

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Re: Pick 5 meds...

Post by Nickthezombiehunter » Sat Aug 03, 2013 10:21 pm

For the guy calling me a troll, feel free to review my previous posts. You will see I am nothing close to being a troll. My comment is directed at many people don't know what meds do what and what to use them for. Which was very evident after I looked over the posts in this thread. So lets raise the stakes a bit. After this post please reference why you picked the prescription medication you did and what you intend on treating with it. This will quickly reinforce my point. For the guy trying to call me out, here are 2 concerns I have seen in the previous posts and i can share some medical "dazzle". First off, many picked hydrocodone for the their list I assume for pain management. So what's one of the biggest side effects of multi day and longer usage? Constipation. It's not bad in short runs but in longer runs it can be an issue. I wonder if any one factored that in? It's also a CNS deppresant and a med that can cloud judgement/ decesion making process. Not ideal in a bug out of PAW situation is it? The other was by the OP. He said he was trying to pick between aleeve(naproxen) and ibuprofen(Advil). Ok lets talk and compare the two. They both are NSAIDs and can work to reduce swelling. The differences are ibuprofen has anti-pyretic properties where as naproxen doesn't. Naproxen is targeted for joint pain and joint issues. That's why their commercials are targeted toward arthritis patients. So if you have a fever, naproxen will not help. So back to the OP, decide where you need this Medication to treat at.

Don't get me wrong I'm trying to call certain people out and call them stupid or anything. I have no problem teaching anyone that wants to listen. Feel free to ask me anytime. One of my current jobs is an educator and I love it. But that's not what this thread started as. To the fellow ZS14er we can get together anytime and chat man. The ZS14 group will come first if H town gets into the shit.

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Re: Pick 5 meds...

Post by okiebill » Sat Aug 03, 2013 10:51 pm

Nickthezombiehunter wrote:For the guy calling me a troll, feel free to review my previous posts. You will see I am nothing close to being a troll. My comment is directed at many people don't know what meds do what and what to use them for. Which was very evident after I looked over the posts in this thread. So lets raise the stakes a bit. After this post please reference why you picked the prescription medication you did and what you intend on treating with it. This will quickly reinforce my point. For the guy trying to call me out, here are 2 concerns I have seen in the previous posts and i can share some medical "dazzle". First off, many picked hydrocodone for the their list I assume for pain management. So what's one of the biggest side effects of multi day and longer usage? Constipation. It's not bad in short runs but in longer runs it can be an issue. I wonder if any one factored that in? It's also a CNS deppresant and a med that can cloud judgement/ decesion making process. Not ideal in a bug out of PAW situation is it? The other was by the OP. He said he was trying to pick between aleeve(naproxen) and ibuprofen(Advil). Ok lets talk and compare the two. They both are NSAIDs and can work to reduce swelling. The differences are ibuprofen has anti-pyretic properties where as naproxen doesn't. Naproxen is targeted for joint pain and joint issues. That's why their commercials are targeted toward arthritis patients. So if you have a fever, naproxen will not help. So back to the OP, decide where you need this Medication to treat at.

Don't get me wrong I'm trying to call certain people out and call them stupid or anything. I have no problem teaching anyone that wants to listen. Feel free to ask me anytime. One of my current jobs is an educator and I love it. But that's not what this thread started as. To the fellow ZS14er we can get together anytime and chat man. The ZS14 group will come first if H town gets into the shit.

-N

Don't need to review your previous posts I was only talking about your contribution to this thread... I'm glad you took the time to really contribute to this thread, I learned something... Thanks

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Re: Pick 5 meds...

Post by okiebill » Sat Aug 03, 2013 11:12 pm

The more I read the harder time I have sticking to my guns on packing Loperamide...

I agree that nature needs to take its course and that treatment of the cause not the symptom is the solution so Antibiotics, water and re hydration salts may be the order of the day.

If you shit yourself more then once there is a larger issue / if you only shit yourself once it has passed... Thinking out loud here after beverages :lol:

I think I would pull Loperamide and just treat with any of my stocked antibiotics (Cypro / Flagyl) or substitute in a Diloxinade / metronidazole combo such as Anizol.

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Re: Pick 5 meds...

Post by Kevin108 » Sun Aug 04, 2013 12:21 am

Iburprofen - NSAID, good for muscle and joint pain as well as headaches, with caffiene
Aspirin - For hear attack victims and those who dislike ibu
Benadryl - For allergic reactions
Neosporin - For healing cuts
Enbrel - I've suffered from psoriasis since birth and arthritis since 12. Sort of a fan of the stuff.

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Re: Pick 5 meds...

Post by greenbeetle » Sun Aug 04, 2013 11:22 am

Keith B wrote:I learned the benefits of ranitidine from a courteous ER doc many years ago. The five drugs I carry in my backwoods kit are:

1)Ibuprofen-I'm not a big fan of naproxen, this takes away the aches and pains of the trail.

2)Imodium-cause no bowel movement is better than too many bowel movements

3)Benadryl-Alpha blocker for allergic reactions

4)ranitidine- Beta blocker for allergic reactions, also good for heartburn and acid reflux after the buffalo chicken MRE.

5)Zyrtec-for those seasonal allergies that Benadryl is too much for.

Ranitidine is an H2 blocker, not a beta blocker which is something you wouldn't use in an allergic reaction anyway. Zantac is used as an adjunct in treatment of allergic reactions combined with H1 blockers, steroids and epinephrine in some cases. If you could choose only one histamine blocker for allergic reactions, H1 blockers are probably the way to go.

Benedryl is not an alpha blocker. 1st generation H1 blocker.

I'm like you, I have to have claritan or zyrtec in the woods these days.

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Re: Pick 5 meds...

Post by greenbeetle » Sun Aug 04, 2013 11:32 am

okiebill wrote:OTC:


If I could only take 5 of these I would take any combination of the top two or three in each category. Schedule II Painkillers while being nice to have are not the priority, infection control in an austere environment is the real challenge.

Narcotics can be dangerous especially to those who haven't taken them before so I can see why many people stay clear of them but I wonder about emergencies such as fractures, trauma or kidney stones that may otherwise be debilitating without pain control. I can see where narcs might have a role.

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Re: Pick 5 meds...

Post by okiebill » Sun Aug 04, 2013 12:02 pm

greenbeetle wrote:
okiebill wrote:OTC:


If I could only take 5 of these I would take any combination of the top two or three in each category. Schedule II Painkillers while being nice to have are not the priority, infection control in an austere environment is the real challenge.

Narcotics can be dangerous especially to those who haven't taken them before so I can see why many people stay clear of them but I wonder about emergencies such as fractures, trauma or kidney stones that may otherwise be debilitating without pain control. I can see where narcs might have a role.
Of course for the purposes of this discussion being limited to only 5, I would still favor a broader selection of ABX over a high power pain killer, knowing that I have Tylenol / Motrin and in a pinch could administer a high dose of benadryl as a knock-out / sleep aid...

I'm sure someone has a full list of "If I could take anything" meds around here somewhere :D

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Re: Pick 5 meds...

Post by Nickthezombiehunter » Sun Aug 04, 2013 12:28 pm

Keith B wrote:I learned the benefits of ranitidine from a courteous ER doc many years ago. The five drugs I carry in my backwoods kit are:

1)Ibuprofen-I'm not a big fan of naproxen, this takes away the aches and pains of the trail.

2)Imodium-cause no bowel movement is better than too many bowel movements

3)Benadryl-Alpha blocker for allergic reactions

4)ranitidine- Beta blocker for allergic reactions, also good for heartburn and acid reflux after the buffalo chicken MRE.

5)Zyrtec-for those seasonal allergies that Benadryl is too much for.
Ok lets talk about this entry
1-ok
2- your theory that no BM is better than to many is grossly inaccurate. BM is your body's way of removing waste. Stop that process and you will be having issues. But I'm quessing you are talking about the diarrhea problem. Again it's your body's way of removing whatever is upseting your poor tummy. There is a fine line between stopping this natural process and making it worse. Bottom line use caution when taking Imodium.
3- Benadryl is not an alpha blocker. Not even close.
4- claratin is not a beta blocker. Even further away then number 3.
But I can define them for everyone
A1 heart
A2 lungs- dilation/decrease resistance. Think albuterol

B1 heart - constrictor- aka beta blocker. It blocks the receptor site from being activated.
A2 lungs - constrictor

What you are referring to is the H receptor site like some else mentioned.

A quick tip is that Zantac does have properties to help with allergic reactions.

5- seasonal allergies ok cool.

So lets talk about your final 3 entries. It is ill advised to mix claratin and Zyrtec at the same time. If you are alternating on a lets say a monthy basis. That's fine. But not taking both in the same day. So you have effectively duplicated bringing the same medication to treat the same issue. My advice, pick the one that works the best and pack that one soley. Not both.

While we are on the subject I want to throw something else in there. Benadryl does NOT cure allergic reaction. It stops or slows down the immflamation process. So the outward visible signs are masked. Like bumps or redness.

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Re: Pick 5 meds...

Post by Browning 35 » Sun Aug 04, 2013 1:33 pm

Nickthezombiehunter wrote: First off, many picked hydrocodone for the their list I assume for pain management. So what's one of the biggest side effects of multi day and longer usage? Constipation. It's not bad in short runs but in longer runs it can be an issue. I wonder if any one factored that in?
Then the person should stay hydrated and eat fruits or vegetables, drink fruit or vegetable juice or eat foods high in fiber to stay regular. Opioid Induced Constipation is a side effect of most pain meds, it's not really that big of a deal since there are plenty of ways to mitigate it.

Otherwise what are you left with? Someone in pain with soft stools? I think most people would be inclined to take the meds to relieve the pain and then just drink some prune or apple juice along with a few glasses of water.
It's also a CNS deppresant and a med that can cloud judgement/ decesion making process. Not ideal in a bug out of PAW situation is it?
Then the care giver who might be giving such a medication to such a pt where this might be an issue should be cognizant of this fact and use a degree of caution when giving it.

If they're in enough pain to be given any sort of narcotic it's not like they're going to be at the top of their game anyway.
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Re: Pick 5 meds...

Post by TacAir » Sun Aug 04, 2013 1:50 pm

dallas wrote:
TacAir wrote:For OTC (no Rx required)


Ocutricin brand ophthalmic solution (bacitracin, neomycin, and polymyxin B ophthalmic) good for eyes and ears + is triple antibiotic, so good for boo-boos that might get infected. Buffered for use as an ophthalmic solution so the cost is higher, offset by multiple uses possible.
You should never use neomycin in the ears. It can leave you deaf.

There is no doubt that some ingredients of older ear drops, especially but not limited to aminoglycosides, have the potential to cause severe cochlear and vestibular ototoxicity. Neomycin is probably the most toxic of the aminoglycosides followed by gentamicin and tobramycin.
http://www.australianprescriber.com/magazine/31/2/40/1" onclick="window.open(this.href);return false;
First, thank you for the link. I respectfully disagree with the 'never'.

A quick review for lurkers on the board shows:
What is and how can we treat acute external otitis?

External otitis or "swimmer's ear" is an infection of the skin covering the outer ear and ear canal. Acute external otitis is commonly a bacterial infection caused by streptococcus, staphylococcus, or pseudomonas types of bacteria. The swimmer's ear infection is usually caused by excessive water exposure from swimming, diving, surfing, kayaking, or other water sports.

When water collects in the ear canal (frequently trapped by wax), the skin can become soggy and serve as an inviting area for bacteria to grow. Cuts or abrasions in the lining of the ear canal (for example, from cotton swab injury) can also predispose to bacterial infection of the ear canal. Swimming in polluted water nearly guarantees this condition.

Treatment with buffered medication which contains neomycin and polymyxin, which are antibiotics that work by stopping the growth of bacteria, is usually an effective treatment.

I would NOT use the antibiotic in the case of a perforated eardrum - my apologies to readers of the board for not being specific in that count.
The best course of treatment for a perforated eardrum, esp. with children, would be symptomatic treatment of pain and to seek professional care from ENT specialist. I carry an otoscope and am versed in the use of the device.

The linked article states:
Ototoxicity is a rare but potentially serious complication of the use of aminoglycoside and other cochleo-toxic ear drops.
Fortunately, I am intimately familiar with the people I treat, and have solid knowledge of their medical history and that of their parents, drug sensitivity being a key feature of my notes. I am mostly present even when they receive professional care. I would hope that anyone who reads ZS will make the effort to obtain a solid pt history before any treatment for a non-life threatening condition.

This ototoxicity risk is increased when there is a perforation of the tympanic membrane or a patent grommet. You are correct bring this this up as a complicating faction in any treatment. The modality of the tympanum perforation is key in understanding what treatment would be appropriate. The type of injury - opening, erosion, or rupture to the tympanic membrane (eardrum) may be the result of infection, trauma, or the negative pressure associated with underwater diving or flying.

Further, the article notes that until recently, no alternatives to potentially ototoxic antibiotic ear drops were approved in Australia. The new medicine noted requires a script, usually after a visit to a health care professional.

I'll keep my Ocutricin brand ophthalmic solution im my extended FAK for use as appropriate. Thank you for bringing up issues related to treatment with perforation and the care that should be exercised. As the OP was looking for "Over the Counter" meds, I thought some readers might see the value of an item with multiple uses.

As for the prescription items others have listed earlier in this thread - I, too, enjoin folks from self-medication or handing out drugs based on advice from Dr. Google.

I'm not a doctor nor am I offering medical advice, only journaling what I use for the care of the folks who look to me for treatment. As they say, YMMV.
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Re: Pick 5 meds...

Post by TacAir » Sun Aug 04, 2013 2:02 pm

okiebill wrote:The more I read the harder time I have sticking to my guns on packing Loperamide...

I agree that nature needs to take its course and that treatment of the cause not the symptom is the solution so Antibiotics, water and re hydration salts may be the order of the day.

If you shit yourself more then once there is a larger issue / if you only shit yourself once it has passed... Thinking out loud here after beverages :lol:

I think I would pull Loperamide and just treat with any of my stocked antibiotics (Cypro / Flagyl) or substitute in a Diloxinade / metronidazole combo such as Anizol.
There is this classic thread
http://www.zombiehunters.org/forum/view ... 4&start=48" onclick="window.open(this.href);return false;
where I get schooled. Well worth a look for those that may have missed it....
TacAir - I'd rather be a disappointed pessimist than a horrified optimist
**All my books ** some with a different view of the "PAW". Check 'em out.
Adventures in rice storage//Mod your Esbit for better stability

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Re: Pick 5 meds...

Post by okiebill » Sun Aug 04, 2013 4:14 pm

TacAir wrote:
okiebill wrote:The more I read the harder time I have sticking to my guns on packing Loperamide...

I agree that nature needs to take its course and that treatment of the cause not the symptom is the solution so Antibiotics, water and re hydration salts may be the order of the day.

If you shit yourself more then once there is a larger issue / if you only shit yourself once it has passed... Thinking out loud here after beverages :lol:

I think I would pull Loperamide and just treat with any of my stocked antibiotics (Cypro / Flagyl) or substitute in a Diloxinade / metronidazole combo such as Anizol.
There is this classic thread
http://www.zombiehunters.org/forum/view ... 4&start=48" onclick="window.open(this.href);return false;
where I get schooled. Well worth a look for those that may have missed it....
Thanks for the link Tac, A good read :D Schooling is a good thing...

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Re: Pick 5 meds...

Post by RagnarDaneskjold » Sun Aug 04, 2013 5:57 pm

Hmmm... Assuming an imaginary world where I could get my hands on everything I wanted, but could only pick 5:

1) Indomethacin- NSAID, prescribed to me, not optional.

2) Morphine or Dilaudid in pre-measured syringes.

3) Broad Spectrum anti-biotic, oral, probably Amoxicylin or similar.

4) Xanex or similar sedative, for dosing un damaged but panicking bystanders.

5) not sure of this counts as a drug, but a good supply of daily multi-vitamins, for surviving on a less than balanced diet and avoiding rickets, scurvy, etc.


I'm sure others know better, as this is in no way my area. My sister is an RN, reality is, I let her choose meds and medical supplies.

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Re: Pick 5 meds...

Post by Nickthezombiehunter » Sun Aug 04, 2013 8:16 pm

Browning 35 wrote:
Nickthezombiehunter wrote: First off, many picked hydrocodone for the their list I assume for pain management. So what's one of the biggest side effects of multi day and longer usage? Constipation. It's not bad in short runs but in longer runs it can be an issue. I wonder if any one factored that in?
Then the person should stay hydrated and eat fruits or vegetables, drink fruit or vegetable juice or eat foods high in fiber to stay regular. Opioid Induced Constipation is a side effect of most pain meds, it's not really that big of a deal since there are plenty of ways to mitigate it.

Otherwise what are you left with? Someone in pain with soft stools? I think most people would be inclined to take the meds to relieve the pain and then just drink some prune or apple juice along with a few glasses of water.
It's also a CNS deppresant and a med that can cloud judgement/ decesion making process. Not ideal in a bug out of PAW situation is it?
Then the care giver who might be giving such a medication to such a pt where this might be an issue should be cognizant of this fact and use a degree of caution when giving

If they're in enough pain to be given any sort of narcotic it's not like they're going to be at the top of their game anyway.
I respectfully disagree with your statement that a few glasses of water and/or juice will fix constipation. Well, because I have been there done that. So I don't mind sharing a personal story. A few years ago I had the pleasure of tearing up my knee pretty bad. It took 3 surgeries in less than a year to square me away. Needless to say I took quite a bit of hydrocodone in the 1.5 yrs around this time. I was well hydrated and still ended up not feeling so good and having to take "something" to smooth me out. Also in the clinical(in hospital) setting I work at, when a new patient gets perscribed hydrocodone they almost always get some sort of med to help them be regular like Actos or Colace. Even if they are on IV fluids to maintain hydration.
So I just wanted to throw that out there.

The second part I agree with you to a point. Pain is a stimulant. But I disagree with your last sentence that a person has to off their game to take a narcotic. Partly bc of my clinical experience and my own personal one with my knee surgeries. But each one is different.

TacAir aren't you a medic? I thought I remember you saying that a few years ago.

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Re: Pick 5 meds...

Post by Nickthezombiehunter » Sun Aug 04, 2013 8:34 pm

A little off topic but still in the same ballpark. 2 more suggestions for your kits

1. Cough drops. Low weight, low volume. Can help make you quieter has your stomp through the woods. Some relief for sore throats. Menthol drops can help clear up nasal congestion. Help with dry mouth if you are decently hydrated.

2. Some sort of multi symptom cold/flu OTC medications like DayQuil. Not much to say here except it sucks ass if you need keep moving but you have the common cold that's been going around the office. God I hope no one says they will just take an antibiotic.

Please let me know if you want more or if you would rather me shut up.

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Re: Pick 5 meds...

Post by Browning 35 » Sun Aug 04, 2013 8:43 pm

Nickthezombiehunter wrote:
Browning 35 wrote:
Nickthezombiehunter wrote: First off, many picked hydrocodone for the their list I assume for pain management. So what's one of the biggest side effects of multi day and longer usage? Constipation. It's not bad in short runs but in longer runs it can be an issue. I wonder if any one factored that in?
Then the person should stay hydrated and eat fruits or vegetables, drink fruit or vegetable juice or eat foods high in fiber to stay regular. Opioid Induced Constipation is a side effect of most pain meds, it's not really that big of a deal since there are plenty of ways to mitigate it.

Otherwise what are you left with? Someone in pain with soft stools? I think most people would be inclined to take the meds to relieve the pain and then just drink some prune or apple juice along with a few glasses of water.
It's also a CNS deppresant and a med that can cloud judgement/ decesion making process. Not ideal in a bug out of PAW situation is it?
Then the care giver who might be giving such a medication to such a pt where this might be an issue should be cognizant of this fact and use a degree of caution when giving

If they're in enough pain to be given any sort of narcotic it's not like they're going to be at the top of their game anyway.
I respectfully disagree with your statement that a few glasses of water and/or juice will fix constipation. Well, because I have been there done that. So I don't mind sharing a personal story. A few years ago I had the pleasure of tearing up my knee pretty bad. It took 3 surgeries in less than a year to square me away. Needless to say I took quite a bit of hydrocodone in the 1.5 yrs around this time. I was well hydrated and still ended up not feeling so good and having to take "something" to smooth me out. Also in the clinical(in hospital) setting I work at, when a new patient gets perscribed hydrocodone they almost always get some sort of med to help them be regular like Actos or Colace. Even if they are on IV fluids to maintain hydration.
So I just wanted to throw that out there.
Well the thing is you have to look at it in the context that the med is taken. Someone who has it in a bag just in case isn't going to have multiple 120 count bottles of Norco's. More like a single 20-30 count bottle unless the person stocking it is a chronic back pain patient or something. It's also going to be a short term thing one way or the other. Either you're going to run out or you'll get back to civilization where they'll see a physician. So it's not like the pt will be taking it long term, so I'll stand by my statement that short term OIC isn't going to be much of an issue.

At least not something that hydration, certain foods or a little extra straining isn't going to take care of. :wink:
If the person maintaining the FAK that has these meds is that worried about 20-30 Norco's binding them up then they can always add a sixth med and have it be colace or some other stool softener. :Shrug
The second part I agree with you to a point. Pain is a stimulant. But I disagree with your last sentence that a person has to off their game to take a narcotic. Partly bc of my clinical experience and my own personal one with my knee surgeries. But each one is different.
Depends more on the injury sustained than the med in my opinion.

Either way they aren't going to be bringing their 'A' game. They'll be hampered by the injury to some degree or they wouldn't need to take the med in the first place.
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Re: Pick 5 meds...

Post by CitizenZ » Sun Aug 04, 2013 9:03 pm

1- Ibuprofen
2- Zyrtec
3- Benadryl
4- Ceralyte (re-hydration mix)
5- Neosporin

-Asthma inhaler (prescription)

In the kitchen kit I also carry (medical uses)

Honey
Tea/coffee
sugar
Iodine water pills
Water and a way to boil it
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Re: Pick 5 meds...

Post by greenbeetle » Mon Aug 05, 2013 7:35 am

CitizenZ wrote:1- Ibuprofen
2- Zyrtec
3- Benadryl
4- Ceralyte (re-hydration mix)
5- Neosporin
This is why people visit this forum. I totally forgot about neosporin, what a great pick IMHO!

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Re: Pick 5 meds...

Post by DrJack » Mon Aug 05, 2013 10:04 am

Nickthezombiehunter wrote:A little off topic but still in the same ballpark. 2 more suggestions for your kits

1. Cough drops. Low weight, low volume. Can help make you quieter has your stomp through the woods. Some relief for sore throats. Menthol drops can help clear up nasal congestion. Help with dry mouth if you are decently hydrated.

2. Some sort of multi symptom cold/flu OTC medications like DayQuil. Not much to say here except it sucks ass if you need keep moving but you have the common cold that's been going around the office. God I hope no one says they will just take an antibiotic.

Please let me know if you want more or if you would rather me shut up.

-N
I thought a lot about this, and if I went with anything it would either be benzonatate or good ol 'tussin. (Hell I even thought about a bottle of Jack if I thought it would last me more than one or two treatments for low morale)

As for Immodium, regulating dosage to prevent backing someone up isn't that difficult.
YOGLO!

tac57
Posts: 22
Joined: Tue Jun 25, 2013 11:59 pm

Re: Pick 5 meds...

Post by tac57 » Mon Aug 05, 2013 10:28 pm

Interesting to see where people are going with this. Lets assume that you have access to anything you want, including controlled substances - the purpose of this thread is to get people thinking about medications, pharmacology and pharmocotherapy in an austere environment (how to do more with less)...

On that note, your lists can include any medication, Rx (including CDSA/scheduled drugs) or OTC - but you have to JUSTIFY WHY you want that medication.

Lets shake it up a bit. If you want, make two lists - one of the meds you would want to have around for EMERGENCIES and another for the day to day stuff.

On the diarrhea and IMODIUM issue: Any diarrhea suspected of being from an infectious cause (e.g. bacterial or viral gastroenteritis, food poisoning .etc) Imodium SHOULD NOT be administered except if co-administered with an ABx. with coverage for the specific suspected pathogen. Ciprofloxicin covers many gram negative GI bugs including E. coli spp. Inhibiting GI motility in these cases can cause severe worsening of the underlying disease process.

iron_angel
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Location: Newport News, VA

Re: Pick 5 meds...

Post by iron_angel » Tue Aug 06, 2013 11:34 am

tac57 wrote:Interesting to see where people are going with this. Lets assume that you have access to anything you want, including controlled substances - the purpose of this thread is to get people thinking about medications, pharmacology and pharmocotherapy in an austere environment (how to do more with less)...

On that note, your lists can include any medication, Rx (including CDSA/scheduled drugs) or OTC - but you have to JUSTIFY WHY you want that medication.
<snip>
Well, if I could have anything, controlled substances and prescription drugs included, it might look more like this: (including IV, which would require a bit more training before I'd be comfortable using it)

Emergencies, assuming I also have a 5-drug non-emergency kit.

1) Oxycodone - If the pain's bad enough that you need this, it's probably an emergency.
1a) Ketorolac - Fewer side effects than the oxycodone and not a controlled substance, but equally it's less effective (usually) and carries a risk of GI bleeding.
2) Diphenhydramine injectable, or, if I already have an injectable form in my non-emerg kit, maybe dexamethasone. I'd think long and hard before using it, but in case of severe allergies or altitude sickness, it has its uses. It's also synergistic with ondansetron as an anti-emetic, though if the ralphing's bad enough to need that, something really bad is going on.
3) Moxifloxacin - gram-neg and some gram-pos coverage. Also works on mycobacteria, though if you're in the position to need that, you're probably frakked.
4) Metronidazole - for anti-protozoal activity. Albendazole is possibly a reasonable alternative that's less nauseating, but has a narrower spectrum of activity. Not sure which one is a better choice.
5) Ondansetron, either injectable or oral disintegrating tablet - hard to rehydrate if you're puking your guts out, and at least for me, vomiting is fucking debilitating even if dehydration isn't an urgent hazard. Unless it's from motion sickness, nothing stops the barfs like a 5-HT3 inhibitor. (And if it *is* motion sickness, use the diphenhydramine.)

If I'm going for a full-on "where there are no doctors, at least not for a damned long time", I'd add azithromycin, co-amoxiclav, IM amikacin or kanamycin and probably voriconazole, too, for further infection coverage, along with lots of training and documentation. (In case I'm the sick one, and my only-minimally-trained mother, say, has to figure out what's ailing me and fix it).

Non-emergency kit:
1) Ibuprofen - pain and fever. This, rather than naproxen, because it's a better antipyretic.
2) Famotidine - same reason as before, allergies and acid and nausea.
3) Diphenhydramine - Allergies, nausea, insomnia.
4) Neosporin or similar ABx ointment.
5) Rehydration mix.
Image

tac57
Posts: 22
Joined: Tue Jun 25, 2013 11:59 pm

Re: Pick 5 meds...

Post by tac57 » Wed Aug 07, 2013 12:47 am

Here are my two lists:

Emergency:

1. Epi 1:1000 - can use to tx anaphylaxis or asthma exacerbation refractory to salbutamol.

2. Salbutamol - b2 agonistic bronchodilator. Useful for bronchoconstriction in various pathologies. This stops the issue before you end up needing the epi.

3. Fentanyl injection and equipment for both iv, im and intranasal administration. Used when you want analgesia w/o the sedative effects of the ketamine.

4. Ketamine - can be used for analgesia, sedation or general anesthesia depending on dose. Pts keep their airway reflexes intact.

5. A broad spectrum ABx for PO and IV/IM use. A cephalosporin such as cephalexin would be useful for Abx. prophylaxis for wounds.

Again have enough for several 10-14 day courses.

the cipro in the non-emerg list will provide coverage for most types of common RTI, UTI and bacterial gastroenteritis issues whereas keflex is good for a wound ifxn.

Non-emerg/longer term care:

1. Either naproxen or ibuprofen. Not sure which one i'd take. For minor injuries.

2. Gravol (dimenhydrinate) po and injection - it is an antihistamine (salt of diphenhydramine). In theory you might be able to use it for allergies as well as n/v if there was no other option.

3. Ciprofloxicin po and injection: Have enough for 5-6 10-14 day courses. I'm putting this here since although it can be used to treat life threatening ifxn's it is also used for more routine stuff such as gi bugs, simple pneumonia or uti.

4. Lidocaine preparations. One could argue that these are emerg, but for the purposes of this i'll put them here. Including both topical forms and Lidocaine for injection-allowing a provider to administer local anesthesia in various forms. It is also an class 1b antiarrhythmic drug, although in wild med this likely will not be of concern.

6. Pepto-Bismol or any other "GI cure all". Takes care or most minor gi complaints effectively.

Omega Dog
Posts: 22
Joined: Sun Sep 16, 2012 11:40 pm

Re: Pick 5 meds...

Post by Omega Dog » Wed Aug 07, 2013 2:59 am

Excedrin Migraine: one of the best all purpose pain reliever in the marker
Benadryl: allergies and hives
Pepcid AC: heartburn and reflex
Tylenol 3: severe pain
Neosporin:

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