06-22-2007, 02:33 PM
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most of us, in a desperate emergency, would use outdated drugs in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.)
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.)