Melissa & Dave - Adventures at Sea

Melissa is helping Joan put together an emergency medical kit for Saltydog.  Before we left Seattle 19 months ago, Melissa assembled a first aid kit.  Since assembled, we have never had to open it, and hope we never will.  We also stocked a number of medicines on the boat.  These medicines have come in handy on numerous occasions for treating ourselves as well as a number of other cruisers along the way when medical care was not within easy reach.  As Melissa documented what's in our kit for Joan's benefit today, it dawned on her that the list might be helpful to other cruisers.

The way the list was originally assembled through some web research, consultation with Melissa's brother who is a paramedic, and then finally in conjunction with our doctors back home.  Everyone had their own perspective on what commonly used medicines should be in a well stocked emergency kit.  Along the way we've added to the list as things came up, and now seem to be able to take care of most things that come up - an ear infection, occasional bit of bad food, etc.  

Now here is the disclaimer - I AM NOT A DOCTOR, I AM NOT A NURSE, I HAVE NO MEDICAL TRAINING WHATSOEVER.  If you use this list, you do so at your own risk!!!  In fact because drugs can interact, you could be taking some regular medication that would be contra-indicated with one of these drugs.  So you would be smart to take this list back to your doctor and together with him/her decide what should be in your own kit.  Think of the list as a starting point for a conversation with your doctor.

Most of these items can be obtained in Central America for a lot less money than in the US.  So the one mistake we made originally was filling the prescriptions back home where we paid more for them.  If there is a drug that we have not been able to find in Central America - over the counter - we've made note of it.

Apsaras Emergency Medicine Kit 

Antibiotic uses/dosages 

Nitrofurant Mono/Macrobid – bladder infections – 100 mg every 12 hours for 7 days with food 

Dicloxacilina - puncture wounds/skin infections - 500 mg every 6 hours for 7 days, or for 3 days after acute inflammation resolves, depending on the nature and severity of the infection. 

Cipro (for aerobic bacteria – i.e. “grows in oxygen environment”) 

Zithromax (for anaerobic bacteria – i.e. “grows without oxygen”)

Skin Creams 

After bite – for bug bites 

Bacterial Infection - Mupirocin Ointment 2% -– 3 times per day x 10 days 

Mild Itching – over the counter anti-itch medication containing Benadryl

Severe inflammation/itching – Steroid Betametasona 0.1%

Fungal Infection – Clotrimazole & Betamethasone Dipropionate Cream

Pain Killers

Tooth Ache - Hurricane Topical Anesthetic Gel 

Bladder Infections - Uricalm/Phenazopyridine – 200 mg orally 3 times a day after meals. Do not administer for more than 2 days. 

Ibuprophen – best for any pain related to inflammation such as back/neck ache or injury - 200 to 400 mg orally every 4 to 6 hours as needed. Doses greater than 400 mg have not been proven to provide greater efficacy.  The maximum amount of ibuprofen for adults is 800 milligrams per dose or 3200 mg per day (4 maximum doses) – more than the max causes liver failure. 

Acetaminophen/Paracetamol – best for headache, fever - 1000 mg every 6 hours or 650 mg every 4 hours, with a maximum single dose of 1000 mg, a minimum dosing interval of 4 hours, and a maximum daily dose of 4000 mg. 

Misc

Severe Allergic Reaction - epinephrine injection – In the US this comes in an automatic injector called an “Epi Pen” that give the right dosage.  However, EpiPens are not available anywhere in Central America.  Down here you have to get a bottle with the drug along with syringes.  In Panama you can’t get it without a prescription – but easily available in Mexico.  Subcutaneous: 0.1 to 0.5 mg (0.1 to 0.5 mL of 1:1000 solution). May be repeated every 20 minutes to once every 4 hours as needed. 

Yeast Infection - Diflucan/Fluconazole 150mg – 1 tablet for yeast infection / 100mg per day for 14 days for severe fungal infections of the ear 

Sleeping Pills - Lunesta – for overnight trips when you MUST sleep to be safe

Mild Muscle Relaxer - Cyclobenzaprine Clorihidrato 10mg – good for muscle injuries – 5 to 10 mg - 3 times a day.

Malaria - Malarone or Atovaq/Proguanil – 250mg – 1 x day starting 1 day before entering malaria infested area and continuing for 7 days after leaving the area.  This is not available at all in Central America in a pharmacy.  They only use it when someone contracts Malaria and then only in the hospital to treat it.  The idea of taking it preventatively is unheard of in these poor countries.

Over the Counter

Motion Sickness – Dramamine or Stugeron. You can get Stugeron over the counter in almost every country BUT the US (not sure about Canada). 

Cold/Sinus Meds 

Diarrhea – Imodium 

Lost tooth filling repair kit - if you lose a filling out at sea, might be days before you can see a dentist!

Swimmer’s Ear - Swimmers ears wash or you can use 50/50 vinegar/water.

Benadryl – take as directed – except for severe allergic reactions (someone’s throat starting to close up when you have no epinephrine) can be dosed up to 400mg per day.

Heart Attack - Aspirin – One aspirin taken early in the course of a heart attack can reduce damage.