Discussion: top 5 medications

[tac57]

I remember a similar topic on another forum and I thought it would be interesting to discuss it here.

So:

If you had to pick only 5 meds to stock a drug bag for use in an austere environment what would they be and WHY?

Be specific. For example, don't say antibiotic, say what specific drug you would take and your rationale.

I will give you a freebie: since i live in Canada where it is not considered a drug, 0.9% Nacl will not be considered a drug for the purposes of this topic (but other fluids will be). Multiple dosage forms of the same drug also count as that one drug.

Also feel free to mention what administration equipment you would like to have along with you (no restrictions here).

So what would be YOUR top 5 medications to take with you?

I'll start it off:

1. Epi 1:1000 - can use to tx anaphylaxis or asthma exacerbation refractory to salbutamol.
2. Either naproxen or ibuprofen. Not sure which one i'd take. For minor injuries.
3. Gravol (dimenhydrinate) 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.
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, likely a fluroquinilone such as levofloxacin or ciprofloxacin. A cephalosporin such as cephalexin would be useful for Abx. prophylaxis for wounds. I'm not sure what would be more critical - the cipro will provide coverage for most types of commmon RTI, UTI and bacterial gastroenteritis issues.

I would also add a few litres of saline and iv start gear. Again, in canada, crystalloid iv solutions are otc and not legally considered drugs.

Edited July 29, 2013 by tac57

[Just Plain Ruff]

I remember a similar topic on another forum and I thought it would be interesting to discuss it here.

So:

If you had to pick only 5 meds to stock a drug bag for use in an austere environment what would they be and WHY?

Be specific. For example, don't say antibiotic, say what specific drug you would take and your rationale.

I will give you a freebie: since i live in Canada where it is not considered a drug, 0.9% Nacl will not be considered a drug for the purposes of this topic (but other fluids will be). Multiple dosage forms of the same drug also count as that one drug.

Also feel free to mention what administration equipment you would like to have along with you (no restrictions here).

So what would be YOUR top 5 medications to take with you?

I'll start it off:

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

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

3. Gravol (dimenhydrinate) 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.

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, likely a fluroquinilone such as levofloxacin or ciprofloxacin. A cephalosporin such as cephalexin would be useful for Abx. prophylaxis for wounds. I'm not sure what would be more critical - the cipro will provide coverage for most types of commmon RTI, UTI and bacterial gastroenteritis issues.

I would also add a few litres of saline and iv start gear. Again, in canada, crystalloid iv solutions are otc and not legally considered drugs.

Just 5?

I would like to see a topical antibiotic

Zofran to control vomiting if you got some nasty stomach bug from eating something nasty or just plain undercooked - this would be after the body got rid of the offending culprit.

might not want to forget the iodine tabs for water purification if needed

And any personal medications that you are currently taking - I usually when travelling for a extended period of time will get a new script filled and have it specifically for travelling.

[triemal04]

With just saying "austere" that's a hard question to answer. Even at the most basic level, different areas will have different requirements for medications, depending on local conditions. Is it a tropical region? Mountainous? Arctic? Desert? Are you in a populated area and it's "austere" due to other causes (war, earthquake, floods, etc)? Will you be relying on locals/the local environment for sustenance and shelter? Interacting with the locals? Will you be mobile or in a fixed location? Need a lot of info before you can really plan for even the smallest needs.

Buuuut...if I had to choose 5 all purpose meds...

Epi 1:1000 (as said, for anaphylaxis/severe allergic reactions, asthma/COPD exacerbation, pressor, etc)

Phenergan (anti-emetic, sedative, and a H1 blocker)

Loperamide (anti-diarrheal)

Cipro (ok all round antibiotic, and will help with some gastritis and diarrhea, depending on the cause)

Lactated Ringer's

Ibuprofen is OTC so it doesn't count (tylenol might actually be better, but I'm not a fan)

[chbare]

If you are going with a fluoroquinolone and have to choose one, why not go with Levaquin?

[triemal04]

If you are going with a fluoroquinolone and have to choose one, why not go with Levaquin?

Personal comfort; I'm more familiar with cipro than I am levaquin.

[chbare]

Levaquin will probably have better coverage. In some hospitals, Cipro is no longer even being used for UTI's due to E. coli resistance.

[emergentmedic]

in no specific order

1-Tylenol/APAP This medication has many uses and specifically if we are talking austere I think of  war time or where soft tissue injuries may be more common and infections, fever etc..

2-broad-spectrum antibiotic- I think this is self explanatory.

3-Ketamine-analgesic, sedation etc.. It's my version of a benzon had a baby with a narcotic! lol..

4-Benadryl-great all around medication. many uses, nausea, allergies etc.

5- Fentanyl- I view austere as  well the end of the world situations and maybe you need to allow someone to go peacefully into the night. Sedate with Ketamine and push a large bolus of Fentanyl and let them go. 

------

6- NS- again self explanatory. I'm leaving this off my top 5 because 

[Off Label]

epi, lido, ketamine, ancef, succs

[Spock]

With all of my DMAT deployments over the past 12 years I can safely say that working in the austere environment is a bigger challenge than all of the thoracic cancer patients I see every day in the operating room.  

My top five would be:

Epinephrine 1::1,000

Aspirin

Benadryl

Ancef

Toradol

Good question and the other posts all have merits but I would't have any RSI drug nor would I have any scheduled opioids.  When we set up a clinic in Texas for Harvey, we immediately posted a large sign in triage that said we would not refill opioid prescriptions.  Saw a lot of people do an immediate about face when they saw the sign.  We still treated over 600 in a week.

Spock

Honorary Gator

 

[Inf]

These are battle-tested and something I'm comfortable with:

1. Aspirin

2. Benadryl

3. Morphine

4. Lidocaine

5. Cipro

Edited February 10, 2018 by Inf