What's in a good medical kit

What's in a Good Medical Kit?
Howard Donner, MD
Organizing medical equipment for an expedition requires an enormous amount ofplanning and forethought. No matter how much equipment is hauled in, onecannot possibly prepare for every eventuality.
What should one take? There is a wide range of opinions, from "nothing but atriangular bandage and Swiss army knife" to a collection that would stagger localporters. Surgeons inevitably anticipate trauma, while medical people favor pillsand shots. Remember, overly bulky kits are often left behind.
The contents of a kit depend on many on many factors:• Environmental extremes of trips • Medical expertise of expedition members • Distance from definitive medical care • Availability of rescue (i.e. helicopter) Personal Medical Kits
Personal kits should be carried by each expedition member and include these
commonly used items:
• Non-narcotic
• Sunscreen and lip protection · water disinfection · blister care • Personal medications (for pre-existing problems) Main Medical Kit
The following should be considered for the main medical kit:
Antibiotics
Physicians seldom agree on the optimum antibiotic for treating a given disease.
Prepare for the common problems:
• Upper and lower respiratory infections. (Your choice.)
• Skin and soft tissue infections. Consider a first-generation oral cephalosporin.
Duricef (cefadroxil) is preferable because of the q12-24 hr dosing schedule(i.e. less bulk).
• Bacterial diarrheas – many enteric pathogens are currently resistant to the old standby, Septra. Include a quinolone, i.e., Cipro.
• Giardia – Tinidazole or metronidazole.
• Rickettsial illness (rare) – Tetracycline • Helminthic infections (hookworm, roundworm and tapeworm) – Mebendazole.
• Malaria for prophylaxis or presumptive treatment - mefloquine or chloroquine Analgesics
• Percocet (or other strong p.o. narcotic).
• NSAIDs (non-steroidal anti-inflammatories), e.g., Naprosyn 500. Carry in a large "bucket." Many aches and pains develop on the trail.
Respiratory Treatments
• Albuterol-metered dose inhaler or spinhaler are essential for cold or exercise- induced broncho-constriction, a common malady at higher altitudes. It alsoserves as an important adjunct in treating lower respiratory tract infections.
Ear, Nose and Throat Treatments
• Rhinorockets - lightweight, simple method for anterior nasal packing.
• Afrin or other topical nasal decongestant - a coveted item on mountaineering expeditions; essential for upper airway congestion, which often occurs. Alsohelpful for eustachian-tube dysfunction during altitude changes.
• Corticosporin otic or other topical anti-infective.
• Seldane or other non-sedating antihistamines have myriad uses for allergic • Throat lozenges or hard candy for omnipresent "altitude throat." (Bring a lot.) • Sudafed or other oral decongestant.
Eye Treatments
• Tobrex or other potent topical antibiotic.
• Cyclogyl (cyclopentolate HCI) or other intermediate-acting cycloplegic for relieving the ciliary spasm of photokeratitis or uveitis.
• Tetracaine is essential for corneal examination; also useful in extreme conditions for allowing a climber with disabling photokeratitis to get off themountain (suboptimal treatment!).
• Fluorescin strips for staining corneal defects.
• Eye patches for corneal abrasions, photokeratitis.
Central Nervous System Treatments
• Haldol - Psychotic breaks can occur under the extremes of expedition life.
(Imagine seven days in a snow cave with someone you dislike!) • Caffeine - Useful for a little extra "get-up-and-go," or to relieve caffeine, • Dexedrine - Controversial, although it may be lifesaving under extreme conditions, such as having to get off the mountain under your own power ordie. (Not normally recommended.) • Transderm Scopolamine for motion sickness.
Cardiovascular Treatments
• Inderal LA for chest pain or MI.
• Nitrostat/Transderm Nitro for chest pain or MI.
• Nifedipine for HAPE, angina, hypertension, and uniquely effective for Gynecological Treatments
• Monistat
• Urine pregnancy test for ruling out ectopic pregnancy in the reproductive-age female with pelvic pain and/or vaginal bleeding.
Gastrointestinal/Proctological Treatments
• Pepto Bismol tablets for symptomatic treatment of non-dysenteric diarrhea.
• Imodium is irreplaceable for long bus rides or summit bids.
• Colace and Metamucil for "freeze-dried megacolon." • Compazine suppositories (melt at high temperatures) and tablets (added benefit of respiratory stimulant at altitude).
• Antacid tablets - Reflux is common at altitude.
• Oral rehydration solution (dehydrated packets), e.g. Jeevan jal or Infalyte.
• Anusol HC and Tucks pads (containing 50 percent witch hazel) - hemorrhoids are extremely common on expeditions.
Altitude Sickness Treatments
• Diamox - Usual dose 250 mg bid or one 500 mg spansule; smaller doses are effective for improved sleep, i.e. 125mg. qhs.
• Decadron 4 mg tablets for treatment of cerebral edema.
• Lasix 40 mg tablets for treatment of peripheral edema.
Topicals
• Nizoral (or other antifungal).
• Kenalog 0.196 cream (or other intermediate potency steroid).
• Silvadene cream for burns (optional) or Bactroban, Polysporin for topical • Vaseline or other ointment such as Aquaphor or Blistex for treatment of chapped lips or fever blisters. (Some include Zovirax ointment for this.) • Labiosan (or other bomb-proof sun protection for lips).
• K-Y Jelly for rectal or vaginal exams.
Blister Treatments
• Moleskin - Bring tons of it!
• Adhesive foam for fashioning donuts and padding for boots.
• Spenco Second Skin; it’s expensive, but indispensable for painful, ulcerated Wound Supplies
• Tegaderm or OpSite for abrasions.
• Sutures in multiple sizes, both nylon and absorbable.
• Superglue for instantaneous treatment of painful skin fissures Surgical Supplies
• 14G. Angiocath - emergency tube thoracostomy.
• Uncle Bill's tweezers for foreign-body removal.
• Disposable skin stapler (Ten Shot Precise, 3M) - especially useful for scalp Instruments
• Bandage scissors, tissue scissors, needle drivers, and forceps.
• Ten or 20 ml syringes with 18 G angiocaths for high-pressure.
• TB syringes for administration of lidocaine.
Orthopedic Supplies
• SAM splints, both full-length and finger sizes (great for improvising just about
• Kendrick Traction Device is a very lightweight design for femoral traction.
• Adhesive tape for splinting ankles, fingers, etc.
• Ensolite pads (no, you don’t stick these in the medical kit, but they’re mentioned here because they make universal knee immobilizers, anklesplints, C-collars, etc.
• Ace wraps are essentially worthless for stabilizing “blown-out” joints; however, they serve an important function by providing compression. There are alsouseful for holding pressure over taped extremities. (Coban works well, too.) • Fiberglass splints (e.g. 3M One Step).
• Stiff Neck Extrication Collar, if room permits. (This can be improvised.) • Air casts or gel casts are lightweight splints for sprained ankles that allow near-normal ambulation and can be used inside of boot.) Injectable Medications
• Epinephrine 1:1000 is a must!
• Antibiotics – multiples alternatives here; these are included to provide temporizing treatment in the unlikely event of meningitis or an intraperitonealinfection, ie., ruptured appendix or bowel perforation.
• Primaxin (imipenem-cilastatin sodium).
• Rocephin (very expensive and those on a tight budget may consider old- • Narcan where there’s MS, there’s Narcan.
• Valium (consider rectal administration if difficult IV access).
• Depo-Medrol – trigger-point injection for severe tendonitis.
• Toradol IM (ketorolac tromethamine). Note current problems with availability.
IVs
• Multiple sizes of angiocaths (16, 18, & 20 G).
• Blood solution administrations sets.
• A Microdrip administration sets.
• Bacteriostatic normal saline or heparin flushes.
• Anticoagulated blood collection bags (if group transfusion is considered).
• IV fluids – crystalloid for volume resuscitation, e.g. normal saline or lactated Ringers; D5W for administration of medications.
Airway Management
• Oral
• Endotracheal tubes (7.5 8.0) for blind nasotracheal intubations. (Some expeditions carry laryngoscopes, but they’re heavy and bulky. disposableplastic units may be an alternative.) • V Vac suction device (optional) – somewhat bulky but very effective.
• Medical oxygen tanks with regulators, nasal cannulas and 100% non- Dental Kit
• Dental floss has multiple uses including reinforcing splint for avulsed teeth.
• Benzocaine in Orabase (topical anesthetic, anti-inflammatory).
Miscellaneous Medical
• Hypothermia thermometer (Zeal subnormal).
• Stethoscope (often ear-to-chest is adequate).
• Snakebite kit (Sawyer extractor works best).
• Condoms for improvising one-way “Heimlich” valve for use with tube • Paper and pencil is essential for communication.
• Headlamp – essential for any nighttime operations or surgical procedures requiring extra lighting (e.g. dental procedures).
• Foley catheter (16 French with 30 ml balloon can be used as urinary catheter, improvised chest tube, posterior nasal pack).
• Fluorescent surveyor’s tape for marking helicopter landing zone, or finding • Spare sunglasses (protective eyewear can also be improvised if necessary).
Optional (rarely will these instruments change the initial impression or plan):• Oto-ophthalmoscope Wilderness Medicine Letter, Summer 1996

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