5 Medications

[MonkeyArrow]

If your company was building a compact, robust medical backpack to take in as a single provider for extended extrication scenarios (SAR, hiking trails, etc.), what are the five medications that you would want to be included in the kit? Why?

Here are my five:

• Ketamine. It can be used for pain relief as well as for sedation if you have to intubate. Of course, there will be no paralytics but it will definitely help.
• Epinephrine. Can treat anaphylaxis, increase HR, increase BP. Front line drug for cardiac arrest (yes, the literature supports it IF properly dosed at the right intervals).
• Adenosine. Can help show underlying rhythms and can convert certain AV node pathway SVTs.
• Atropine. Helps to treat bradycardias and heart blocks. If you carry enough of it, a antidote for organophosphate poisoning.
• Nitro and/or ASA.

Edit: Maybe I would replace Nitro/ASA for a calcium channel blocker such as verapamil for the treatment of Afib. Oh, and a tube of insta-glucose.

 

[STXmedic]

Real quick off the top of my head.

Ketamine for pain and asthma

Epi for anaphylaxis and asthma

Benadryl for allergic reaction and mild nausea

ASA for CP

Saline/Hextend for fluid replacement

 

[DesertMedic66]

Real quick off the top of my head.

Ketamine for pain and asthma

Epi for anaphylaxis and asthma

Benadryl for allergic reaction and mild nausea

ASA for CP

Saline/Hextend for fluid replacement

This would pretty much be my list as well

 

[TransportJockey]

Real quick off the top of my head.

Ketamine for pain and asthma

Epi for anaphylaxis and asthma

Benadryl for allergic reaction and mild nausea

ASA for CP

Saline/Hextend for fluid replacement

That list looks about perfect. I'd say a 30ml vial of epi 1:1000 with some flushes so it's good for all situations

 

[Ewok Jerky]

I have 0 experience in SAR but I hike a lot. I don't know if I would want to indicate somebody in this hypothetical scenario of single provider in the woods. In addition if my patient had a simple sprain or fracture but was otherwise ambulatory I don't know if ketamine would be my go-to. Anyways my point is maybe switch that out for an NSAID maybe 800 of motrin. I def agree with benedryl, epi, maybe a CCB for hypertensive emergencies, not perfect for all cardiac conditions but... and I would round it out with glucose. That's a tough call for a cardiac med, nitro, ASA or CCB.

 

[Tigger]

If your company was building a compact, robust medical backpack to take in as a single provider for extended extrication scenarios (SAR, hiking trails, etc.), what are the five medications that you would want to be included in the kit? Why?

Here are my five:

• Ketamine. It can be used for pain relief as well as for sedation if you have to intubate. Of course, there will be no paralytics but it will definitely help.
• Epinephrine. Can treat anaphylaxis, increase HR, increase BP. Front line drug for cardiac arrest (yes, the literature supports it IF properly dosed at the right intervals).
• Adenosine. Can help show underlying rhythms and can convert certain AV node pathway SVTs.
• Atropine. Helps to treat bradycardias and heart blocks. If you carry enough of it, a antidote for organophosphate poisoning.
• Nitro and/or ASA.

Edit: Maybe I would replace Nitro/ASA for a calcium channel blocker such as verapamil for the treatment of Afib. Oh, and a tube of insta-glucose.

We don't carry cardiac medication aside from ASA in our a backcountry kit as we aren't going to bringing a monitor with us. That's not a good use of weight in that setting unless I was given a very good reason to do so based on dispatch information. It's also just not a likely call in that setting, and we run a fair number of these calls.

Currently the wilderness bag has:

3 Epi 1:1000
2 Benadryl
1 Solu-Medrol
4 Albuterol
1 Atrovent
1 Zofran
1 Narcan
1 ASA
1 D50
1L NS

We also bring the narcotic pouch with 400 of fent, 20 of MS, 20 of vallium, 20 of versed, and 500 of ketamine.

That's more than five of course. If we had to cut it down to just five...

Epi 1:000 has a variety of uses, anaphylaxis and reactive airway primarily. I doubt we will be working a code in the backcountry but you never know.
Albuterol certainly stays as it's a common wilderness call at altitude.
A liter bag, while heavy, is much lighter than a dehyrdated patient in a litter.
Fentanyl is probably the most versatile pain medication of the three and is the least likely to hinder someone from walking. We can also use it to assist with joint reductions, which is something we cannot do with Ketamine
Benadryl for symptom relief.

Realistically there is no reason to arbitrarily limit what you want to carry. Unlike the ambulance we usually only have one patient on these calls so we aren't bring in absurd quantities of these medications with us. The "med box" is a 1x5x3 tackle box, it's the smallest kit in the whole bag.

 

[DesertMedic66]

We don't carry cardiac medication aside from ASA in our a backcountry kit as we aren't going to bringing a monitor with us. That's not a good use of weight in that setting unless I was given a very good reason to do so based on dispatch information. It's also just not a likely call in that setting, and we run a fair number of these calls.

Currently the wilderness bag has:

3 Epi 1:1000
2 Benadryl
1 Solu-Medrol
4 Albuterol
1 Atrovent
1 Zofran
1 Narcan
1 ASA
1 D50
1L NS

We also bring the narcotic pouch with 400 of fent, 20 of MS, 20 of vallium, 20 of versed, and 500 of ketamine.

That's more than five of course. If we had to cut it down to just five...

Epi 1:000 has a variety of uses, anaphylaxis and reactive airway primarily. I doubt we will be working a code in the backcountry but you never know.
Albuterol certainly stays as it's a common wilderness call at altitude.
A liter bag, while heavy, is much lighter than a dehyrdated patient in a litter.
Fentanyl is probably the most versatile pain medication of the three and is the least likely to hinder someone from walking. We can also use it to assist with joint reductions, which is something we cannot do with Ketamine
Benadryl for symptom relief.

Realistically there is no reason to arbitrarily limit what you want to carry. Unlike the ambulance we usually only have one patient on these calls so we aren't bring in absurd quantities of these medications with us. The "med box" is a 1x5x3 tackle box, it's the smallest kit in the whole bag.

I'm going to also assume you carry an O2 bottle for the Atrovent and Albuterol?

 

[Tigger]

I'm going to also assume you carry an O2 bottle for the Atrovent and Albuterol?

Yes, we have a small bottle in the bottom the bag. SAR brings in carbon cyclinders if we need to keep them on O2.

 

[irishboxer384]

For remote settings there is no reason to limit your amps as they are small/light, easy to mass pack.

Knowing how much food, water, spare batteries for comms equipment and cold weather clothing, shelter/sleeping system depending on remoteness... is the more tricky side of planning for remote extrication. Fluids and oxygen and how much you are able to carry is a factor....

In putting together packs for various environments I've worked as a single provider in non-hostile situations (Antarctica, Sierra Leone etc.), the equipment required to be self-sustainable has taken up much much more of the room in my kit than amps/medication.

 

[Carlos Danger]

This question is always an interesting thought experiment, but in reality I would never want to be limited to just 5. And as was pointed out, there's really no reason to be, since vials and syringes are very compact and lightweight compared to the other stuff you need in order to use the meds (oxygen cylinders, monitor/defib, IV bags).

But I'll take a stab and say:

• ibuprofen
• hydromorphone
• cefazolin
• diphenhydramine
• epinephrine

All can be given IM, SL, or PO. I would not bring IVF, but plenty of water for PO replacement.

 

[Av8or007]

1. EPInephrine 1 mg/ml (1:1000). This is the first line treatment for anaphylaxis, and asthma refractory to salbutamol when the patient is in respiratory failure. Can also be diluted down to 0.1 mg/mL for arrests (although you don't have a monitor, so this is likely not very useful) or to 0.02 mg/mL as a push dose pressor and ionotrope.

2. Ketamine, lots and lots of ketamine. Can be used both for analgesia, sedation and general anaesthesia depending on the dose.

3. Ceftriaxone. Broad Spectrum antibiotic (3'rd gen cephalosporin) with excellent gram negative and gram positive coverage.

4. Ibuprofen, PO and IV. PO is used for the majority of cases, and is highly effective when given in adequate dosing.

5. Diphenhydramine. Antihistamine for anaphylaxis (IM/IV) or PO for mild to moderate allergic reactions. Can also be used as an antiemetic or mild sedative.

Saline would also be brought along (500 mL bags, simply to allow the same amount of weight in gear to be used to treat multiple patients if nessecary), and it is not considered a medication per se in Canada.

If I could add on another 5 medications (given that the space they take up is minimal compared to the benefit they provide):

6. Droperidol. Useful as an antiemetic, antipsychotic or sedative agent depending on dose.

7. Fentanyl (lots and lots of fentanyl) - opioid for pain control, can be given IV, IM or IN

8. Methylprednisolone, both the IV/IM formulation and a medrol dose pack. Used for anaphylaxis, asthma exacerbation requiring steroids or any steroid responsive condition.

9. Levofloxacin, both the PO tabs and IV formulation. Both in enough quantities to complete at least one course of treatment, for the PO tablets, two to three 10 day courses. This is a fluroquinolone with excellent gram negative coverage; extremely useful for treating respiratory and urinary tract infections, skin and soft tissue infections, among many other things.

10. Lidocaine 1% - local anaesthetic for procedures and wound management.