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Being Prepared For The Likely Medical Emergencies At Sea

This is a four-step talk that I have given to help sailors prepare for the most common medical problems when cruising.

  1. Assessing yourself
  2. Preparing your medical kit
  3. Reviewing the most likely emergencies at sea
  4. Looking at my Medical Kit

Assessing Yourself

Assess your type of cruising:

Assess yourself:

Example:

Current Disease: Allergies
Current Treatment: Antihistamine pills (ie. Claritin)
Being prepared for the likely emergencies: 1. Antihistamine eye drops (ie. Opticrom)
2. Antihistamine ointment/cream (ie. Caladryl)
3. Injectable antihistamines (IM Benadryl)
4. Ventolin inhaler
5. Prednisone tablets
6. Injectable adrenaline (ie. Ana-kit or Epi-pen)

Preparing your Medical Kit

Have Reference Materials on board:

Have the right attitude:

Setting up your medical kit:

The Most Likely Emergencies

SKIN

1. Cuts, scrapes and blisters: These are caused caused by coral, boat jobs, objects on shore and shoes

Prevention:
  • very important because all cuts will get infected in the tropics
  • wear gloves, wetsuits, protective clothing, socks, moleskin
  • avoid jewellery
Treatment:
  • stop the bleeding - pressure x 15 minutes
  • clean the wound (hydrogen peroxide, Betadine, Savlon, saline or just fresh water)
Other Supplies:
  • tweezers, scissors, ring cutter
  • steri strips versus sutures
  • bandaids - esp. fingertip, and lots of the regular size (Elastoplast)
  • dressings - include telfa or sofratulle, gauze pads, cling, good tape (3M Transpore or Leukoplast waterproof tape)

2. Infection

Prevention:
  • Antibiotic ointment prophylactically
  • Bactroban or Fucidin are more effective than Polysporin
Treatment:
  • Antibiotic ointment
  • Oral antibiotics (ie. Cloxacillin, Keflex, or Biaxin)
Other Supplies:
  • Scalpel, sterile packing

3. Burns (Sunburn and Thermal)

Prevention:
  • Sunscreen, clothing, hat, sunglasses, awning or bimini
  • Swim with wetsuit or shirt
  • Get pot holders and avoid heeling or rolly anchorages (or buy a catamaran)
Treatment:
  • Aspirin for severe sunburn
  • apply cold water or ice to burn immediately
  • Flamazine (Silver sulfadiazine) or Bactroban/Fucidin
  • Dressing (gauze, etc.)

4. Bug Bites

Prevention:
  • insect repellant (DEET 99% Muskol), clothing, avoid shore at night
  • Citronella candles, coils, mosquito netting or windy anchorages
Treatment:
  • Antihistamine ointment/cream (Caladryl)
  • Antihistamine pills (Claritin)

GUT

1. Seasickness: Everyone is prone.

Prevention:
  • learn what you can and can't do
  • worse if tired or hungry, so eat starchy bland foods regularly and get proper rest
  • premedicate if possible, or as soon as symptoms develop (fatigue, apathy, irritability, nausea, hangover feeling, vomitting, diarrhea)
Treatment:
  • Gravol - oral, suppositories and/or injectable
  • Cinnarizine (Stugeron) - not available in Canada or U.S.
  • Meclizine/ Marzine
  • Scopolamine - Kwells or Transderm patches

2. Dehydration: This can be a result from vomitting, diarrhea and/or sweating caused by seasickness, food intolerance/poisoning, or heat stroke.

Prevention:
  • drink a lot of water - intake in tropics 2L pp/day
  • safe water - chlorine bleach, bottled large jugs, rain water
Treatment:
  • fluid replacement (Gastrolyte,Gatorade, sugar water)
  • IV fluids not practical
  • If diarrhea, "wait and see" - clear fluids for 24 hours, then bland, low fat foods
  • avoid Imodium at first
  • have antibiotics for traveller's diarrhea on board (Cipro, Noroxin or Septra)
  • consider having Flagyl or an antihelmintic on board for parasites (not emergency medicine)

3. Indigestion, Constipation and Hemmorhoids: Bring Zantac and a hemmorhoid preparation.

HEAD

1. Headache

Prevention:
  • sun - sunglasses, hat, awning, drink lots of water
  • stress - good charts, good communication, being prepared
  • alcohol - drink water before going to bed
Treatment:
  • ASA, Ibuprofen, Tylenol extra strength
  • Codeine - Tylenol #1, Tylenol #3

2. Eyes

Problem: Treatment:
Infection (pink eye)
  • Antibiotic drops (Sodium sulamyd 10 % drops)
Foreign body
  • local anaesthetic drops, Q-tips, antibiotic drops, anti-inflammatory drops
Contact lenses
  • disposable with cleaning solution/saline

3. Ears

Problem: Treatment:
Swimmer's Ear
  • antiseptic drops (Bur-o-sol)
  • antibiotic drops (Garasone)
Ear Wax
  • don't use Q-tips
  • Cerumol, mineral oil (Cerumenex)
Middle Ear Infection
  • Amoxil 500 mg capsules, or Biaxin 500 mg capsules, or Zithromax

MUSCLES AND BONES

Prevention:
  • sail in good weather, sail on a catamaran
  • know your limitations
  • "one hand for you, one hand for the boat"
Treatment:
  • muscle relaxants (Robaxisal)
  • anti-inflammatories (Naprosyn)
  • analgesics (Tylenol #3)
  • injectable analgesics (Demerol)
Supplies:
  • instant cold packs
  • tensor bandages - large and small
  • splints
  • triangular bandage (sling)

My Medical Kit

This is what I initially packed for my three-year circumnavigation with my husband. We set out in 1992, and you should keep this in mind. There are certain new medications that would be better choices if I was leaving now. However, the CATEGORIES would remain the same. I would take more of certain things, and less of others. But one never knows what will happen out there, and it is better to err on the side of caution.

We restocked as needed along the way, as medication expired and as our destinations changed (ie. anti-malarial medication). Topical antibiotic ointment was used daily to prevent nicks and scapes from getting infected in the tropical climate. Topical steroid creams were also important due to Alec's sensitive, eczema-prone skin. I would probably take more oral steroids too, as this has become a more recognized short-term treatment for a wide range of ailments.

This is just a sample. You must build your own list based on the first steps outlined above. You must take into account your skills as well. Please remember that I was an Emergency Room doctor and the kit reflects this. Outside assistance may help you choose the correct medication when in doubt, and in some countries it may help to take your own medicines and needles to the hospital.

CATEGORY DESCRIPTION - brand name DESCRIPTION - generic name QUANTITY
Anaesthetic Xylocaine 1% w Epi lidocaine hydrochloride 90 ml
  Xylocaine 1% w/o Epi lidocaine hydrochloride 40 ml
Analgesics - injectable Demerol - 50 mg/ml meperidine 30 ml
  Toradol ketorolac tromethamine 1 x 30 mg
Analgesics - oral Bayer aspirin ASA (acetylsalicylic acid) 100 x 325 ng
  Ponstan mefenamic acid 30 x 250 mg
  Tylenol #1 acetaminophen/codeine 100 x 325mg/8mg
  Tylenol #3 acetaminophen/codeine 50 x 325mg/30mg
Analgesics - oral Tylenol Extra Strength acetaminophen 100 x 500 mg
  Tylenol plain acetaminophen 100 x 325 mg
Antibiotics - oral Amoxicillin amoxicillin 100 x 250 mg
  Bactrim (Septra) sulfamethoxazole/trimethoprim 14 x 800/160 mg
  Biaxin clarithromycin 28 x 250mg
  Ceftin cefuroxime 28 x 250 mg
  Cipro ciprofloxacin 28 x 500mg
  Clavulin amoxicillin/clavulanate 42 x 500mg
  Cloxacillin cloxacillin 40 x 500 mg
  Doryx doxycycline 14 x 100mg
  Eryc erythromycin 60 x 333mg
  Flagyl metronidazole 4 x 500 mg
  Lariam mefloquine 16 x 250mg
  Noroxin norfloxacin 42 x 400mg
Antibiotics - topical Bacitracin cream bacitracin 60g
  Bactroban ointment mupirocin 100 g
  Fucidin cream fusidic acid 15 g
  Neosporin burn cream gramicidin/neomycin/polymyxin B 1 x 90 mg
  Silvadene (Flamazine) silver sulfadiazene 1 x 50 g tube
Antidiarrheal - oral Imodium loperamide 12 x 2 mg
Antifungals - topical Canesten vaginal inserts clotrimazole 6 x 200 mg
  Loprox ciclopirox olamine 30 g
  Monistat cream w applicator miconazole 1 x 85 g
  Terazol w applicator terconazole 1 x 9 g
Antihistamines - oral Benadryl capsules diphenhydramine 40 x 25 mg
  Claritin loratadine 100 x 10 mg
Antihistamines - topical Caladryl lotion calamine/diphenhydramine HCl
Anti-inflammatories - oral Advil ibuprofen 100 x 200 mg
  Anaprox DS naproxen 30 x 550 mg
  Naprosyn SR naproxen 18 x 750 mg
  Toradol ketorolac tromethamine 80 x 10 mg
Anti-inflammatories - supp Feldene suppositories piroxicam 6 x 20 mg
Antilice Kwellada shampoo lindane 50 ml
  NIX Creme Rinse permethrin 59 ml
Antiseasickness Gravol suppositories dimenhydrinate 10 x 100 mg
  Gravol tablets dimenhydrinate 100 x 50 mg
  Transderm Scop. Patches scopolamine 12
Antiulcer Cytotec misoprostol 20 x 200 mcg
  Zantac ranitidine 42 x 150 mg
Anxiolytic Ativan sublingual lorazepam 12 x 0.5 mg
  Ativan tablets lorazepam 50 x 1 mg
  Xanax alprazolam 9 x 0.25 mg
Asthma treatment Ventolin inhaler salbutamol (albuterol) 2 inhalers
Bandages Bandaid Plastic Strips 10 small, 30 regular
  Elastoplast adhesive tape 2.5 cm x 4.5cm - 1 roll
  Elastoplast Airstrips 10 small, 30 large
  Elastoplast cont. strips 1 roll of each - 1" & 2"
  Elastoplast cont. strips 6 cm x 33"
  Elastoplast plastic - pink 3 x 5 cm - 3 m
  Mini/band bandaids 10 small
  Tensor bandages - 2",3",6" 1 of each
  Tensor bandages - 4" 2
  Triangular bandage 1
Decongestants Dristan Nasal Mist pheniramine/phenylephrine 4 x 3 ml
  Sudafed pseudoephedrine 60 x 30 mg
Dressings Abdo. Pads, 5" x 9" 3
  Abdo. Pads, 6" x 8" 8
  Abdo. Pads, 8" x 10" 5
  Bactigras - 10cm x 10 cm chlorhexidine acetate 5
  Bactigras - 5cm x 5cm chlorhexidine acetate 4
  Gauze - 4" x 4" 80
  Gauze - 5 cm x 5 cm 10
  Kling, nonsterile 4, 2" rolls
  Kling, nonsterile 4, 3" rolls
  Kling, nonsterile 4, 4" rolls
  Kling, sterile 4" x 4.5 m - 4 rolls
  Large fingertip dressing 10
  Sofra-Tulle - 10cm x 10 cm framycetin sulfate 15
  Telfa - 3" x 4" 18
Ears Garasone ear drops betamethasone/gentamicin 4 x 2.5 ml
Eyes Eye pads 12
  Eye patch tape 4 x 1" roll
  Opticrom drops cromoglycate 2 x 10 ml
  Sodium Sulamyd 10 % drops sulfacetamide 2 x 8 ml
  Sofracort drops framycetin/gramicidin/dexamethasone 2 x 8 ml
  Tetracaine drops tetracaine 5 ml
  Vasocon-A antazoline/naphazoline 10 ml
  Visine 1 x 15 ml
Hemorrhoid treatment Anusol - HC ointment hydrocortisone/zinc sulfate 15 g
Miscellaneous alcohol swabs-disposable 80
  EpiPen epinephrine 1
  Gastrolyte sachets dextrose/electrolytes 10
  Vaseline petroleum jelly 3 x 50 g
  Vaseline nasal packing 2 of 1" x 36"
Muscle Relaxant Robaxacet acetaminophen/methacarbamol 12
  Robaxisal ASA/methacarbamol 12
Muscle Relaxant - oral Flexeril cyclobenbenzaprine 40 x 10 mg
  Robaxisal ASA/methocarbamol 28 x 325mg/400mg
Needles IV Quik-caths:22G & 18G 2
  needles-18G, 1 1/2" 6
  needles-19G, 1 1/2" 2
  needles-22G, 1 1/2" 2
  needles-23G, 1" 5
  needles-25G, 5/8" 8
  needles-25G, 5/8" 2
  needles-27G, 1/2" 14
  scalpels-disposable 3 sterile
  syringes-1cc w 27G 1" needle 4
  syringes-20cc w/o needles 2 sterile
  syringes-3 cc w 21G 1 1/2" needle 7
  syringes-3 cc w 25G 1" needle 9
  syringes-3 cc w 25G 1/2" needle 3
  syringes-3cc w 22G 1 1/2" needle 2
  syringes-3cc w 25G 5/8" needle 3
  syringes-6 cc w/o needle 1 sterile
Other absorbent cotton balls, sterile 4 balls/pk, 5 pks.
  blood pressure cuff sphygmomanometer 1
  cautery - disposable 1
  chemstrips 35
  Gloves, latex - nonsterile 1 box
  Gloves, latex - sterile 4 pairs
  Gloves, vinyl - sterile 1 pair
  Instant Cold Packs 3
  Instrument - Coker clamp 1
  Instrument - hemostat, curved 1
  Instrument - hemostats, straight 1 large, 1 small
  Instrument - tissue forceps 1
  Instrument - towel clamp 1
  Iodide tablets 50
  IV Administration Set 1
  magnifying glass 1
  measuring tape 1
  Minor Laceration Trays - sterile 2
  moleskin 16" x 7"
  moleskin 3" x 2"
  ophthalmoscope 1
  otoscope 1
  pregnancy kits 3
  Q-tips 1 large box
  Splints for fingers 2 med,1 long
  splints-malleable 2
  stethoscope 1
  surgical scissors 2 pair
  surgical tubing 1 lg. piece
  thermometer 1
  tongue depressors, nonsterile 40
Packing 5% iodoform packing - 1 jar, sterile 1.2cm x 4.5cm
  plain packing - 1 jar, sterile 1.2cm x 4.5cm
Steroids - topical Hydrocortisone cream hydrocortisone 0.5 % 30 g
  Hydrocortisone cream hydrocortisone 1 % 30 g
  Kenacomb cream gramicidin/neomycin/nystatin/triamcinolone 30 g
  Kenalog cream triamcinolone acetonide 0.1 % 120 g
  Topicort cream desoximetasone 0.25 % 30 g
  Topicort Mild 120 g
  Westcort cream hydrocortisone-17-valerate 0.2 % 45 g
  Prednisone prednisone 200 x 5 mg
Sutures steri-"suture"-strips 40 x 1/4"x3"
  steri-strips 40 x 1/8"x3"
  sutures-abs. Dexon ll 2 x 4-0
  sutures-abs. plain gut 1 x 2-0
  sutures-Dermalon 12 x 6-0
  sutures-Dermalon 4 x 4-0
  sutures-Dermalon, lg. needle 8 x 5-0
  sutures-Dermalon, sm. needle 7 x 5-0
  sutures-Novafil 6 x 4-0
Tape Cloth tape 2 x 2" rolls
  Cloth tape 1 x 1" roll
  Dressing tape - Curasilk 3 x 1" rolls
  Heavy duty stretch tape 1 x 4" roll
  Heavy duty stretch tape 2 x 3" rolls
  Leukoplast waterproof 5.5 yds x 1"  - 2 rolls
  Paper tape 1 x 2" roll
  Transpore 1/2" roll 2