The
following medical advice was taken from an online post. We cannot and do not in
any way support anything stated herein, and nothing should be inferred on the part
of the reader that suggests we have in any way suggested you do anything stated
in what is presented below:
THE
FOLLOWING WAS TAKEN FROM A WEBSITE, WE
DO NOT VOUCH FOR IT:
storage and Rotation of Medications
Medications can be one of the more expensive items in your storage
inventory and there can be a reluctance to rotate them due to this cost issue
and also due to difficulties in obtaining new stock.
Unfortunately, drugs do have limited shelf life. It is a requirement for
medications sold in the US (and most other first world countries) to display an
expiration date. It is my experience that these are usually very easy to
follow, without the confusing codes sometimes found on food products, e.g. --
Exp. 12/00=December 2000.
I cannot endorse using medications which have expired. But having said
that it is my understanding that the majority of medications are safe for at
least 12 months following their expiration date. A colleague recently did some
aid work in the Solomon islands and a local pharmaceutical warehouse gave him a
number of expired drugs. They stated that the drugs were safe to use for at
least another 18 months. As with food the main problem with expired medicines
is not that they become dangerous, but that they lose potency over time, and
the manufacturer will no longer guarantee the dose/response effects of the
drug. The important exception to this rule is the tetracycline group of
antibiotics, which can become toxic with time, there may be others that I am
unaware of but it is very difficult to obtain this information. Let the buyer
beware, the expiry dates ARE there for a reason.
In addition, I recommend that if you are acquiring medications on a
doctor's prescription that when you have the prescription filled you explain
the medications are for storage (you don't need to say exactly what for), and
request recently manufactured stock with distant expiration dates.
The ideal storage conditions for most medications is in a cool, dark, dry
environment. These conditions will optimize the shelf life of the drugs. A
small number of drugs require refrigeration to avoid loss of potency. These
include insulin, ergometrine, oxytocin and some muscle relaxants. Others such
as Diazepam rapidly lose potency if exposed to the light.
Antibiotics
Antibiotic Recommendations
Antibiotic Recommendations. In some cases access to antibiotics may be
very limited. The following is my preferred list of antibiotics. If your
limited in what you can get, I suggest you purchase and expand in this order. All
are good broad spectrum antibiotics and have different strengths and weakness.
I suggest you purchase an antibiotic guide, most medical book shops have small
pocket guides for junior doctors detailing which drug to use for which bug and
outlining sensitivities.
A Broad spectrum Penicillin (e.g.-- Amoxycillin+ Clavulanic Acid)
A Quinolone (e.g.-- Ciprofloxacin)
A Cephalosporin (e.g.-- Cefaclor)
NOTE: If allergic to Penicillin, I would advise A Quinolone as a first
choice with some Metronidazole as a anerobe back-up. Alternative would be
Erythromycin.
Antibiotic Summary
The Bugs:
A basic understanding of how bugs (read bacteria) cause infections is
required to appropriately use antibiotics. I will not discuss viral or other
infective agents here. This is not the forum for a proper discussion, so
consider this a brief introduction. There are HUNDREDS of bacteria, I will only
discuss common disease causing ones in man.
Four Classes of Bacteria
Gram positive ( + ve )
Gram negative ( - ve )
Anaerobes
Others
Gram positive bacteria stain blue and gram negative bacteria stain pink,
when subjected to a gram staining test. It is related to the presence or
absence of a coating in the cell wall of the bacteria. Anaerobic bacteria are
ones which require no oxygen to grow. Bacteria are also described by their
shape (cocci = round, bacilli = oval) and how they are grouped together
(chains, clusters, pairs)
Gram Positive Bacteria ( Gram +ve)
Staphylococcus: Commonest pathogen is S. aureus. Gram + cocci in clumps.
Causes boils, abscesses, impetigo, wound infections, bone infections, pneumonia
(uncommonly), food poisoning and septicaemia. Generally very sensitive to
Flucloxacillin as first choice and Augmentin and the Cephalosporins. A strain
which is resistant to the above, known as MRSA and is currently treated with
vancomycin.
Streptococcus: Gram + cocci in pairs or chains. Most are not pathogenic in
man, except Strep pneumoniae and the Strep pyogenes. Strep pneumoniae causes
pneumonia, ear infections, sinusitis, meningitis, septic arthritis, and bone
infections. Strep pyogenes causes sore throats, impetigo, scarlet fever,
cellulitis, septicaemia and necrotising fascitis. Very sensitive to
penicillins, cephalosporins, and the quinolones.
Gram Negative Bacteria ( Gram -ve )
Neisseria meningitidis: Gram -ve cocci in pairs. Common cause of bacterial
meningitis, may also cause pneumonia and septicaemia. Can be rapidly fatal.
Sensitive to penicillins, cephalosporins, quinolones, cotrimoxazole and
tetracyclines.
Neisseria gonorrhoeae: Gram -ve cocci in pairs. Causes gonorrhea.
Sensitive to high dose amoxycillin (single dose), Augmentin and also
cephalosporins and quinolones.
Moxella catarrhalis: Gram -ve cocci in pairs. Common cause of ear and sinus
infections, also chronic bronchitis exacerbations. Sensitive to Augmentin,
Cephalosporins, Quinolones and Cotrimoxazole and tetracyclines.
Haemophilus influenzea: Gram -ve cocco-bacilli. Can cause meningitis (esp.
in children under 5), epiglottis, cellulitis and a sub group cause chest
infections. Sensitive as M.catarrhalis
Escherichia coli: Gram -ve bacilli. Normally found in the bowel. Causes
Urinary infections, severe gastroenteritis, peritonitis (from bowel injury),
septicaemia. Drug of choice is a quinolone or cephalosporin.
Proteus sp.: Gram -ve bacilli. Lives in the bowel. Causes UTI's,
peritonitis (from bowel injuries), wound infections. Drug of choice is the
quinolones.
Anaerobes
Bacteroides sp. gram negative bacilli. Normal bowel flora. Commonly causes
infections following injury to the bowel or wound contamination, causes abscess
formation. Treated first choice with metronidazole or second with
chloramphenicol or Augmentin.
Clostridium sp. Gram positive species. produce spores and toxins.
C. perfringens/C.septicum - common cause of gangrene, treat with
penicillins or metronidazole
C.tetani - tetanus - For tetanus and botulism, the damage is from toxins,
not the bacteria themselves
C. botulinum - botulism
C. difficille - causes diarrhea following antibiotics. treat with
metronidazole
Others
Chlamydia sp: Includes C.pneumonia, responsible for a type of atypical
pneumonia and C.trachomatis, responsible for the sexually transmitted disease
chlamydia. It is best treated with Tetracyclines or as second choice a
macrolide.
Mycoplasma pneumoniae: A cause of atypical pneumonia. Treated best with a
Macrolide, with a second choice of a tetracycline.
The Drugs
Penicillins - These act by preventing replicating bacteria from producing
a cell wall. A number of bacteria produce a enzyme which inactivates the
penicillins ( B-lactamase).
A number of varieties:
Benzyl Penicillin: Injectable preparation. Antibiotic of choice against
severe Strep pneumoniae and Neisseria sp infections such as chest infections,
meningitis and cellulitis.
Phenoxymethylpenicillin (Penicillin V): Oral preparation of above. Usually
used only for the treatment of sore throats (strep throats), in other
infections largely replaced by amoxycillin which is better absorbed.
Flucloxacillin: Oral and IV drug of choice for Staph infection such as
cellulitis, boils and abscess and bone infections. Also usually effective
against Strep, but not first choice.
Amoxycillin: (newer version of ampicillin): Oral and IV. Effective against
most gram positive and negative bugs. Limited use secondary to B-lactamase
resistance in many bugs. This is overcome with the addition of Clavulanic Acid
( e.g. Augmentin). Overcoming this resistance, makes this combination my ideal
survival antibiotic, with good gram positive, negative and anaerobic cover.
This drug I feel is the best "broad spectrum" antibiotic commonly
available, other AB's may be better for specific infections but this is the
best all purpose one.
Cephalosporins - Same method of action as penicillins. Developed in three
generations (now four, but not widely available). The third generation e.g.,
Cefotaxime (Claforan, IV only) and Ceftriaxone (Rocephin, IV only) have the
most broad spectrum. They are effective against most gram positives and
negatives and some variable anaerobic cover. The second generation e.g.,
Cefuroxime (Zinacef, oral and IV) and Cefaclor (Ceclor, oral only) also have
good general cover, but are not as effective against some gram negative
bacilli. This loss of gram negative cover expands to most gram -ve cocci and
bacilli in the first generation cephalosporins e.g., Cephalexin (Keflex, oral
only) and Cephazolin (Kefzol, IV only). The third generation is ideal for use
in those with very severe generalized infection, meningitis or intra-abdominal
sepsis (e.g., penetrating abdo wound or appendicitis, with metronidazole added
in) and the second generation offer a good broad spectrum antibiotic for
general use in skin, wound, urinary and chest infections.
Quinolones - Acts by inhibiting DNA replication in the nucleus of the
replicating bacteria. New generation of antibiotics. Most common is
Ciprofloxacin. Very broad spectrum cover, except anaerobes. Excellent survival
AB, but my second choice due to amoxycillin + clavulanic acids better cover of
anaerobes. Effective for most types of infections except intra-abdominal sepsis
and gangrene.
Macrolides - Acts by inhibiting protein synthesis in the replicating
bacteria. Includes Erythromycin and the newer Roxithromycin and Clarithromycin.
Often used in people with a penicillin allergy, however it does have a reduced
spectrum (esp. with Gram negatives), but is an alternative to tetracycline in
Chlamydia. First choice in atypical pneumonias e.g., with Mycoplasma pneumonia.
Co-Trimoxazole - Acts by interfering with folate metabolism in the
replicating bacteria. Previously a very broad spectrum antibiotic, now has a
much more variable response rate due to resistance. Still useful for urinary
and, mild chest infections.
Metronidazole - Acts by directly damaging the structure of the DNA of the
bacteria/protozoa. Drug of choice for anaerobic infection. Should be used with
another broad spectrum AB in any one with possible fecal contamination of a
wound or intra-abdominal sepsis (such as severe appendicitis). Also the drug of
choice for parasitic infections such as Giardia.
Others - There are many other antibiotics available. I have only discussed
the common ones above. For further information I refer you to any Antibiotic
guide, of which there are many.
www.survival-center.com/med-faq/med-7.htm
This is an interesting viewpoint- good info too, from a
MD's perspective:
www.oism.org/ddp/medkit.htm
compiled by Jane M. Orient, MD, with assistance from many others
Patients often ask what medical supplies they should store. This is a very
good question; after a nuclear war it might be easier to find some person with
medical knowledge than to locate drugs and supplies. The question is very
difficult to answer. Every physician would make a different list.
No physician today would like to be without certain drugs, especially
antibiotics. Unfortunately, all drugs are perishable. After the expiration
date, they begin to lose their potency, and some (especially tetracycline) may
contain toxic byproducts. This means that supplies should be rotated,
increasing the cost of this type of "insurance." However, most of us,
in a desperate emergency, would use outdated drugs in preference to none at
all.
In putting together your own kit, you will need to take your own family's
situation into consideration. And you will need the cooperation of your
physician for obtaining prescription drugs. Finally, you will need to consider
how much you can afford to spend. Do not buy drugs until the basics (food,
water, ventilation, shelter, etc.) are provided. Remember that the human race
survived for many centuries without modem medicine - but could not survive more
than a few days without water.
In constructing this list, various assumptions are made about the
situation. One is that major surgery will not be practical under shelter
conditions. This requires highly trained personnel and at least $1000 worth of
instruments. A person with appendicitis would have a better chance with
antibiotics and rest, taking nothing by mouth except medications and clear
liquids, than with surgery by amateurs. (In the event of a nationwide disaster
such as a nuclear war, our lack of protected hospitals like those that exist in
Switzerland would cost lives that might be saved.)
Many items could be added to the list. For example, persons who know what to
do with them might want to store materials for splinting or casting fractures
(which could be splinted by expedient means in the absence of such materials).
Intravenous solutions (and the means of administering them) might also be
stored. Because of expense, space requirements, and the need for some expertise
in their use, they are not listed here.
Wholesale prices (c. 1987), when available, are given in brackets.
DISINFECTANTS
Betadine scrub (1 pt) [$2.70]. Use for cleansing intact skin -- the detergent
is very toxic to tissues.
Betadine solution (1 pt) [$2.70]. The solution may be used to cleanse
wounds, preferably in a 1:100 dilution (about 3 drops per ounce of water). With
dilution, the tissue toxicity is less, and the concentration of free iodine
(the antimicrobial agent) is actually greater. Betadine is not suitable for
water purification. (For that purpose, one can use tincture of iodine, which is
2% iodine and 2% sodium iodide in alcohol, at a concentration of 3-5 drops per
quart of clear water or 10 drops per quart of cloudy water.)
Chlorine bleach (e.g. Clorox) (a 5.25% solution of sodium hypochlorite)
Dry pool chlorine ("burn out" or "shock treatment") is
65% calcium hypochlorite. A solution of about the same concentration of hypochlorite
as commercial bleach can be made by dissolving about 24.5 gm. (about 10
tablespoons) of the powder in 1 gallon of water. CAUTION: The dry material
gives off chlorine gas in small quantities, enough to cause symptoms in some
persons. Keep container tightly sealed, and prepare solutions in a
well-ventilated area.
Use of hypochlorite for water purification:
volume clear cloudy
1qt 2 drops 4 drops
1 gal 8 drops 16 drops
5 gal 1/2 tsp 1 tsp
Allow 30 minutes for the chlorine to kill all the microorganisms (see
Nuclear War Survival Skills).
For cleaning instruments and surfaces, a dilution of 1:10 is recommended.
Such solutions are relatively unstable and should be freshly prepared. Scrub
off the blood and body fluids (organic materials react with the chlorine and
destroy it), then allow the instrument to soak in the disinfectant. Note that
tuberculosis organisms are uniquely resistant to chlorine
Do not use hypochlorite for irrigating wounds (as was done during World
War I), because it dissolves blood clots.
ANTISEPTICS
Acetic acid, 5% (household vinegar, 1 gal). This can reduce the microbial
count (especially Pseudomonas) in infected wounds. Half strength vinegar can be
used to irrigate the ear in external otitis. Use 3 Tbsp per quart of water as a
douche for vaginal infections.
Hydrogen peroxide, 3% solution (1 pt). Some use peroxide to cleanse
wounds. It is helpful as a mouthwash for oral ulcers or Vincent's angina.
DRESSINGS
Bandaids (also useful in construction of a Kearny fallout meter (2 boxes)
Sanitary napkins (1 box) to use as pressure dressings
Gauze pads (4 by 4 inches, 4 packs of 200 each) [$35.00]
Conforming gauze roller bandage (4") (12) [$4.70]
Tape (1 inch, 12 rolls) [$12.35]
Ace (elastic) bandages (4 inch) (2)
Safety pins (box of assorted)
Bedsheet for making triangular bandages, strips as required
Sewing shears
SURGICAL INSTRUMENTS (FOR MINOR WOUND REPAIRS)
Iris scissors (1 curved, 1 straight) [$3.75, $3.45]
Mayo type scissors (one sharp, one rounded blade) [$13.45]
Needleholder [$4.95]
Hemostat (Kelly clamp) (2) [$5.80]
Splinter forceps.
Tissue forceps with teeth [$2.10]
Scalpel handle (#3) [$6.95]
Scalpel blades: (10 each, #10, 11) [$4.70]
Suture needles, assorted (I dozen 0000 nylon, $13.15]
Reusable needles obtained from veterinary supplier
Suture material (catgut from veterinary supplier; cotton and nylon thread)
DIAGNOSTIC EQUIPMENT
Thermometers
Sphygmomanometer [$21.75]
Stethoscope (nurse's) [$4.50]
Flashlight and extra batteries
OTHER CLINICAL SUPPLIES AND EQUIPMENT
Latex gloves (box of 100) [$14.95]
Surgical masks (box of 50) [$13.15]. A mask helps protect against airborne
infections and would be of some benefit in preventing inhalation of small
particles if one needed to go out of doors in fallout conditions.
Syringes (1 box of disposable 3-5 cc syringes and/or several of reusable
glass; several 1 cc syringes for administering adrenalin) [$11.95/100]
Assorted needles (21, 25 gauge) [$7.50 per box of 100]
KY jelly (2 tubes) [$1.90]
Cotton-tipped applicators
Baby ear syringe (a rubber bulb useful for suctioning mouth of newborn or
for irrigating ears)
Umbilical clamps (strips of clean cloth can substitute)
Plastic oral airways of assorted sizes [$4.95]. This simple device can
keep unconscious patient from "swallowing his tongue".
Foley catheter set [kit that includes catheter and drainage bag, $7.50]
Enema bag
Notebook, pencils, pens
Soap
Measuring spoons
Dropper bottles
Plastic bags
OVER THE COUNTER MEDICATIONS
Acetaminophen (Tylenol) 500-mg "extra strength" (1000 tablets)
[$13.90]
Acetaminophen liquid for children (1 bottle)
Antacid (1000 aluminum-magnesium hydroxide tablets) [$5.75]
Antihistamines
Chlorpheniramine 4 mg and/or
Diphenhydramine (Benadryl) 25 mg (1000 tablets) [$15.65]. Benadryl is also
useful for hives, and of some value for nausea.
Aspirin 300 mg or 10 gr (1000 tablets) [$9.50]
Kaopectate (Some physicians are skeptical of the value of this
time-honored preparation, and recommend Pepto-Bismol instead.)
Laxatives (200 senoxon tablets and 1000 milk of magnesia tablets) [$4.40,
$6.15]. In small amounts, milk of magnesia can also help to replace magnesium
lost in chronic diarrhea.
Petrolatum (vaseline, 1 lb) [$1.80]. This lubricant and emollient is
especially good for diaper rash or for making nonadherent dressings.
Pseudoephedrine 30 mg (1000 tablets) [$7.95].Give one or two tid-qid as a
decongestant.
Tolnaftate powder (Tinactin, 45 gm) [$2.10]. Apply bid-tid for fungal skin
infections.
Zinc oxide (1 lb) [$3.75]. This mild astringent and antiseptic is used in
diaper rash and various skin diseases, or as a sunscreen.
From the Grocery Stores
Baking soda is most important for oral fluid replacement -- see below. It
has been used as an antacid, though it is certainly not ideal. Persons who need
to restrict sodium intake should not take soda for an upset stomach.
Coca-Coca syrup [$6.50/gallon]. One consultant suggested this as being
surprisingly effective for nausea and vomiting.
POTASSIUM IODIDE
To block thyroid gland to prevent uptake of radioactive iodine
contaminating food and water, take 4 drops of a saturated solution daily. (Fill
a brown dropper bottle about 60% full with crystals, then add water until
bottle is 90% full. Shake. Check to be sure that some crystals remain out of
solution. See Nuclear War Survival Skills p. 114.)
PRESCPTION DRUGS
The following is not intended as a self-treatment guide, but as a guide to
choosing drugs for storage. Always seek medical advice before using these
potent drugs, all of which have potentially serious side effects, including
death. Antibiotics should not be used when they are ineffective and unnecessary
(as in viral infections) because of side effects and the risk of selecting out
resistant bacteria.
For guidance in determining quantities, the usual duration of treatment
for an episode of illness is about 10 days. Adult dosages are given unless
otherwise indicated. Abbreviations: bid=twice a day; tid=three times daily;
qid=four times daily.
Do not take outdated tetracycline, as kidney damage may result
Always ask the patient whether he is allergic to the drug. If he has a
history of hives (an itchy skin rash) or wheezing or swelling in the mouth or
throat, do not give the medication, as a fatal reaction may occur.
Antibiotics
Penicillin V 500 mg (1000 tablets) [$48.50]. Give 500 mg qid for
Streptococcal, pneumococcal infections, anaerobic infections "above the
diaphragm" such as abscessed teeth. Although its spectrum is limited, this
drug is relatively cheap and causes fewer side effects such as diarrhea and
vaginitis. Unfortunately, streptococci and pneumococci are increasingly
resistant.
Amoxicillin 250 mg (500 capsules) [$40.75]. Give 250 to 500 mg id for
urinary, middle ear, and lower respiratory infection. This is a broader
spectrum penicillin. Staphylococci are usually resistant.
Ampicillin or amoxicillin for oral suspension 250 mg/tsp (60 doses)
[$15.40]. The suspension is for children who cannot swallow amoxicillin
capsules. Give 1/2 to 1 tsp qid, depending on the size of the child.
Erythromycin ethylsuccinate 400 mg (500 tablets) [$69.35]. Give two
tablets bid for pneumonia or Streptococcal sore throat. The drug is also of
some benefit in Staphylococcal skin infections.
Tetracycline 250 mg (1000 capsules) [$17.70]. Give 250-500 mg qid for
plague and various other insect-born infections; urinary infections; bronchitis;
infected animal bites; some venereal diseases; Rocky Mountain spotted fever.
Avoid this class of drug in pregnant women and young children, if possible.
A more expensive drug in this class is doxycycline 100 mg, which is given
once daily (twice for severe infections). Doxycycline has fewer
gastrointestinal side effects and is better absorbed than tetracycline with
food in the stomach, but is more likely to sensitize the skin to sunlight.
[Cost is $47 for 500 100-mg tablets; for the higher doses that is $0.18 per day
vs. $0.14 per day for tetracycline.]
Oxytetracycline for intramuscular injection (250 cc, 200 mg/cc) [$24.50
from veterinary supplier]. The dose is about 500 mg bid for severe, life-threatening
infections, or 100 mg tid for mild infections, in which case oral treatment is
probably preferable. The injectable form may be necessary in patients too ill
to take oral medications or for illnesses like plague or anthrax which may be
fatal before oral medication is absorbed. Intramuscular injection causes pain;
a local anesthetic may be given simultaneously.
Metronidazole (Flagyl) 250 mg (500 tablets) [$21.80]. The usual dose is
500 mg tid, higher for some infections (e.g. amebiasis). The drug is effective
against certain protozoans including amoebae and Giardia, and for anaerobic
bacteria such as those that normally inhabit the bowel and the female genital
tract. It can be extremely useful in intraabdominal , pelvic, and wound
infections caused by such bacteria.
Chloramphenicol. The dose is 500 gm qid for anaerobic infections; typhoid
and other Salmonella infections; psittacosis; rickettsial infections; or
meningitis due to Hemophilus or Meningococcus. This drug is very well absorbed
from the gastrointestinal tract and penetrates well into the cerebrospinal
fluid (hence its value in meningitis). However, it causes fatal aplastic anemia
in about 1 in 50,000 persons treated with it, and some drug companies have
stopped manufacturing it.
Trimethoprim-sulfamethoxazole DS (Bactrim, Septra) (500 tablets) [$41.15].
Give one double strength (DS) tablet bid for urinary infections and some types
of bacterial diarrhea, or as a back-up drug for sinusitis, bronchitis, ear
infections (for resistant organisms or allergic patients).
Others: Some excellent broader-spectrum drugs, especially amicillin with
clavulanic acid (Augmentin), cefuroxime (Ceftin), and ciprofloxacin are not
included solely because of expense.
For allergic reactions and asthma
Adrenalin (epinephrine) for injection (30 cc vial) [$5.55]. Give 0.1 to
0.5 cc of a 1:1000 solution subcutaneously for acute anaphylaxis from a drug or
other allergy such as bee sting, or for a severe asthma attack.
Prednisone 5 mg (1000 tablets) [$11.25]. The dosage is variable, usually
starting with 40 to 60 mg, tapering as rapidly as possible. Prednisone is used
for severe cases of asthma, poison ivy, sunburn, and allergic reactions, but is
not a substitute for epinephrine because the response is not sufficiently
rapid. Use with great caution because steroids depress the immune response,
among other side effects; however, the drug can be life-saving.
Theophylline preparation (Theodrine 1000 tablets) [$10.95]. Give 100-3100
mg tid or qid, for asthma. Combinations with ephedrine (such as Theodrine),
while out of favor these days, may be much cheaper. Theophylline is being used
much less often. Tea contains a little theophylline.
Alupent inhaler [$15.65]. In asthma or acute allergic reaction with wheezing,
this has a more rapid action than theophylline.
For nausea and vomiting
Prochlorperazine (Compazine) 25 mg (100 tablets) [$10.75]. Often used for
nausea and vomiting, this drug also may be of some value in acute psychosis.
One consultant recommended promethazine (Phenergan) 50 mg instead [$9.00/1000].
Phenergan does not have the additional indication for therapy of psychotic
disorders.
For Psychologic distress
Phenobarbitol 60 mg (300 tablets) [$11.55]. 30-60 mg is useful as a
sedative. The usual anticonvulsant dose is 90 mg daily. CAUTION: Barbiturate
addiction is very dangerous; fatal withdrawal reactions have occurred.
Haldol (15 cc vial, 2 mg/cc) [$16.35]. Start with 1 mg intramuscularly for
otherwise unmanageable acute psychotic reactions. Monitor the blood pressure.
For Pain
Xylocaine 1 or 2% (two 50-cc vials) [$6.50]. For local anesthesia.
Acetaminophen with codeine 60 mg (1000 tablets equivalent to Tylenol #4)
[$44.05]. Codeine is both cheaper and more effective for pain relief in combination
with acetaminophen (or aspirin). It also relieves severe cough.
Proparicaine ophthalmic solution 0.5% (2cc) [$2.25]. 1 to 2 drops will
anesthetize the cornea of a patient with a foreign body in his eye. Use only
once to enable you to remove the foreign body. Continued use may allow severe
damage to the eye to occur without the patient's awareness.
Nalbuphine hydrochloride (Nubain) (two 10-cc vials, 20 mg/cc) [$29.90]. 10
mg intramuscularly, or more, relieves severe pain. This drug is considered to
have less potential for abuse than morphine because it is also a narcotic
antagonist (that is, it will cause acute withdrawal in an addict).
For heart and blood pressure
Hydrochlorthiazide 50 mg (1000 tablets) [S6.80]. One tablet daily helps to
control, high blood pressure or congestive heart failure.
Nitroglycerin 11150 gr (200 tablets) [$6.30]. One under the tongue as
needed relieves angina (heart pain).
Lanoxin (digoxin) 0.25 mg (100 tablets) [$9.10]. Use under physician's
advice for certain cardiac conditions such as congestive heart failure or
atrial fibrillation with rapid heart rate. The usual maintenance dose is one
tablet per day or 1/2 tablet in the elderly.
Atropine 0.5 mg/cc (30 cc) [$1.35]. Because it speeds the heart rate, this
drug is useful in some heart attack victims if they have a profound decrease in
pulse. More importantly, it is an antidote to many poisons (such as
organophosphate insecticides, some poisonous mushrooms, and chemical warfare
agents such as tabun and sarin).
Miscellaneous
A year's supply of any prescription drug needed by a family member. Rotate
each year. This is especially important for drugs with a short shelf life, such
as insulin. (Insulin lasts about six months at room temperature, but for only
two to six weeks at 80 degrees F.)
Immunizations, especially tetanus, should always be kept current. (Tetanus
toxoid should be given every ten years. For dirty wounds, a booster may be
given if the last dose was more than five years prior to the injury.)
ORAL FLUID REPLACEMENT
Burns
Slightly rounded teaspoon of salt in one qt of water (the equivalent of
half-normal, i.e. 0.45%, saline). Have victim drink 4 to 8 quarts in first 8
hours (sipping slowly), 4 to 8 qts in the next 16 hours, then as dictated by
thirst.
Cholera or other severe diarrheal illness
To one qt: of water add scant tsp Lite-Salt (a mixture of sodium and
potassium chloride); 10 tsp, sugar; 1/3 tsp sodium bicarbonate. (The Russians
use activated charcoal to absorb toxins.)
BOOKS
Cain, Harvey, ed. Emergency Treatment and Management, 7th ed, WB Saunders,
1985 (indispensable).
Emergency War Surgery (First US revision of The Emergency War Surgery NATO
Handbook), Desert Publications, Comville, AZ 86325.
Kearny, Cresson. Nuclear War Survival Skills (indispensable).
Lindsey, Douglas. Simple Surgical Emergencies. Arco Publishing, New York,
1983 (simple wisdom from the ER front lines).
Physician's Desk Reference. This is a compendium of package inserts from
various drugs. It is not the best book for learning about drugs, but doctors
get a free copy every year, courtesy of pharmaceutical companies. Your doctor
might be willing to give you an old one.
Sanford, Jay P. Guide to Antimicrobial Therapy 1988. Order from www.sanfordguide.com.
Werner, David. 97tere 7here Is No Doctor A Village Health Care Handbook.
The Hesperian Foundation, PO Box 1692, Palo Alto, CA 94302. (the basics--including
how to give an injection, how to treat some dislocations and fractures, the use
of common drugs, and assisting at a normal delivery).
Wilkerson, James A. Medicine for Mountaineering. The Mountaineers,
Seattle, Washington, 1985.
A Merck Manual and/or a copy of Current Therapy (the latter comes out
every year so check the used bookstore).
A textbook of medicine, such as Harrison's Principles of Internal Medicine
or Beeson-McDermott Textbook of Medicine, a textbook of obstetrics, such as
Williams Obstetrics, and a pediatrics textbook are also helpful. (Again check
the used bookstore.)
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