Pick 5 meds...
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Hunter
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Goggle isn't giving me straight answer, sorry if this is a dumb quotation. What're austere medicine?
Aidey
Community Leader Emeritus
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It is medicine in an austere environment.
abckidsmom
Dances with Patients
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I'm going to go with phenergan, epi, a broad spectrum antibiotic, albuterol, and something like percocet.
And I'd like to be able to give IV fluids.
ETA: if I was in a tropical environment, I'd bump the albuterol for malaria meds.
And I'd like to be able to give IV fluids.
ETA: if I was in a tropical environment, I'd bump the albuterol for malaria meds.
Clare
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Adrenaline, morphine, ceftriaxone, ondansetron and hmm, the fifth really has me stumped I am torn between GTN, an ACE inhibitor and paracetamol.
Anjel
Forum Angel
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Some sort of antibiotic. Amoxicillin maybe.
Epi
Lisinopril or something of that sort.
Birth control pills
Dilaudid
Epi
Lisinopril or something of that sort.
Birth control pills
Dilaudid
Pick one.
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I like it.
Definitely an antibiotic. Kinda an oddball but I'd choose Ertapenem. TCCC includes it in their guidelines along with Moxifloxacin and Cefotetan. Broad spectrum and effective with limited adverse effects. Easy dosing at 1 gm IV/IM once daily and it's not something the patient has to be able to swallow. Unfortunately it's not effective against pseudomonas aeruginosa though.
Ciprofloxacin would be a good option as well although it has some real nasty side effects. Amoxicillin or penicillin crossed my mind but I see so many patients with allergies to them I'd rather not cause an allergic reaction in a situation that's already bad.
Epinephrine for it's multitude of uses. At the same time if you're using epi that patient is going to probably need more continuous and definitive care than you can provide with your 5 medications in the austere environment but provided MEDEVAC is possible, it could be the one medication you chose to carry that makes the difference.
10/325 oxycodone/apap. Narcotic pain management along with the antipyretic properties and analgesia of the tylenol. Also, it can be argued that it has some anti-inflammatory properties although it's definitely not the best choice if that's what you're looking for.
Combivent (or duoneb, but since o2 is a medication I'm not willing to sacrifice a choice to use nebulized treatments. Plus it's way easier to carry an MDI around than an oxygen tank.) Since it's albuterol and ipratropium does that count as two though? If it does I'll take an albuterol MDI. Reason I'd prefer combivent over albuterol is the synergistic effects of the combination and that in my experience it's been more effective than straight albuterol. Kinda paint yourself into a corner though if your patient has a peanut or soy allergy...
The 5th one is tough. I'm torn between benedryl, aspirin, NS and zofran. Since you're making me pick I'll go with zofran. Phenergan crossed my mind as well but I really don't want to be making my patients sleepy, especially if we are going to have to do any sort of walking to get to a spot where they can be evacuated from. Decided against ASA because there's not a whole lot it'll do that the tylenol wont except in the presence of an AMI, if that's happening in this austere environment, you're in big trouble unless it's real mild...no benedryl because, well see my comment about sleepy people and phenergan. NS would be good but again, tough to carry and the same effect can generally be accomplished with PO fluids. A volume expander like Hextend crossed my mind as well.
So, final answer is Ertapenem, epinephrine, 10/325 percocet, combivent MDI and zofran.
Definitely an antibiotic. Kinda an oddball but I'd choose Ertapenem. TCCC includes it in their guidelines along with Moxifloxacin and Cefotetan. Broad spectrum and effective with limited adverse effects. Easy dosing at 1 gm IV/IM once daily and it's not something the patient has to be able to swallow. Unfortunately it's not effective against pseudomonas aeruginosa though.
Ciprofloxacin would be a good option as well although it has some real nasty side effects. Amoxicillin or penicillin crossed my mind but I see so many patients with allergies to them I'd rather not cause an allergic reaction in a situation that's already bad.
Epinephrine for it's multitude of uses. At the same time if you're using epi that patient is going to probably need more continuous and definitive care than you can provide with your 5 medications in the austere environment but provided MEDEVAC is possible, it could be the one medication you chose to carry that makes the difference.
10/325 oxycodone/apap. Narcotic pain management along with the antipyretic properties and analgesia of the tylenol. Also, it can be argued that it has some anti-inflammatory properties although it's definitely not the best choice if that's what you're looking for.
Combivent (or duoneb, but since o2 is a medication I'm not willing to sacrifice a choice to use nebulized treatments. Plus it's way easier to carry an MDI around than an oxygen tank.) Since it's albuterol and ipratropium does that count as two though? If it does I'll take an albuterol MDI. Reason I'd prefer combivent over albuterol is the synergistic effects of the combination and that in my experience it's been more effective than straight albuterol. Kinda paint yourself into a corner though if your patient has a peanut or soy allergy...
The 5th one is tough. I'm torn between benedryl, aspirin, NS and zofran. Since you're making me pick I'll go with zofran. Phenergan crossed my mind as well but I really don't want to be making my patients sleepy, especially if we are going to have to do any sort of walking to get to a spot where they can be evacuated from. Decided against ASA because there's not a whole lot it'll do that the tylenol wont except in the presence of an AMI, if that's happening in this austere environment, you're in big trouble unless it's real mild...no benedryl because, well see my comment about sleepy people and phenergan. NS would be good but again, tough to carry and the same effect can generally be accomplished with PO fluids. A volume expander like Hextend crossed my mind as well.
So, final answer is Ertapenem, epinephrine, 10/325 percocet, combivent MDI and zofran.
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Summit
Critical Crazy
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I cannot answer without knowing the patient population.
Aconcagua?
Moab desert?
Jungles of Papau?
Antarctic research base?
Transantlantic on a small ship?
Alaskan wilderness?
Aconcagua?
Moab desert?
Jungles of Papau?
Antarctic research base?
Transantlantic on a small ship?
Alaskan wilderness?
abckidsmom
Dances with Patients
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I will take ceftriaxone.
I think you have, in a very smart way...
One of the first things I would do is research what common illnesses in the area are. Based on that and common problems for all locations would play a significant role in my choice.
I thought it was an interesting challenge. Obviously only 5 medications are not going to suffice for any reasonable level of care, but if you really had to pick it is a tough decision isn't it?
Onle thing I have noticed though, epi seems to be a very popular choice in the emergency population. It is usually in the first 3, and even my friend picked it first.
When I told him why it would not be one of my choices and why, he decided he would also give up on it.
I'll let you guys play a little longer before I give up my answers.
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Achilles
Forum Moron
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See you all have these nice drugs, when the only drug you need is O2 :lol: lol
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If this is truly austere, and I can not get the patient out to a higher level for an extended period of time, I am not going to waste room in my drug box with epi. It has no real proven benefit, and the likelihood of being able to manage a patient post arrest in such an austere environment for an extended period of time with the 5 meds I have is slim. In this environment, anything more than good strong BLS in a full arrest is a luxury.
Normal Saline (If I have to include this as a med)
Albuterol inhaler
Acetaminophen (might consider switching out for ASA depending on the patient population)
Phenergan
Morphine
I guess I am kind of treating this as the "if you were on a desert island" scenario. If I was in an environment were certain diseases were endemic (like malaria, dengue fever, etc.) I would do my best to get prophylaxis for myself prior to deploying and try to manage the patient population with good education and prevention.
This is a tough question to say the least. It is the type of situation where you give us five, and I would like to take ten, if you give us ten, I would like to take fifteen, etc.
Normal Saline (If I have to include this as a med)
Albuterol inhaler
Acetaminophen (might consider switching out for ASA depending on the patient population)
Phenergan
Morphine
I guess I am kind of treating this as the "if you were on a desert island" scenario. If I was in an environment were certain diseases were endemic (like malaria, dengue fever, etc.) I would do my best to get prophylaxis for myself prior to deploying and try to manage the patient population with good education and prevention.
This is a tough question to say the least. It is the type of situation where you give us five, and I would like to take ten, if you give us ten, I would like to take fifteen, etc.
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mycrofft
Still crazy but elsewhere
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Do you have dependable refrigeration or at least a way to keep things at a temperature, at LEAST under 80 deg F? What about resupply times?
Yeah, find out what the prevalent diseases and injuries are first if you can.
Define austere also. Are we talking NO hospitalization, or delayed transport and arrival at hospital, or do you have any sort of infrastructure besides people's bedrooms in a cottage or hut somewhere to treat in place?
Without the ability to store or maintain certain treatment regiments over time, some medicines are going to be sitting unused, or rapidly used up, or ordered and stored in quantities which crowd out other medicines without a corresponding benefit to your patient cohort.
If I was a nurse with vague or no standing orders, packing a GO bag for an unknown stay at a disaster scene in, say, Iowa in April, and ignoring topical preparations, I'd bring the following:
1. Aspirin,oral
2. Benedryl, injectable
3. A short-acting beta-agonist in MDI form.
4. Injectable PCN with a local anesthetic built-in.
5. Tetanus toxoids and diluent, single-use ampuoles.
I would want some topicals to combat infections and promote healing.
Yeah, find out what the prevalent diseases and injuries are first if you can.
Define austere also. Are we talking NO hospitalization, or delayed transport and arrival at hospital, or do you have any sort of infrastructure besides people's bedrooms in a cottage or hut somewhere to treat in place?
Without the ability to store or maintain certain treatment regiments over time, some medicines are going to be sitting unused, or rapidly used up, or ordered and stored in quantities which crowd out other medicines without a corresponding benefit to your patient cohort.
If I was a nurse with vague or no standing orders, packing a GO bag for an unknown stay at a disaster scene in, say, Iowa in April, and ignoring topical preparations, I'd bring the following:
1. Aspirin,oral
2. Benedryl, injectable
3. A short-acting beta-agonist in MDI form.
4. Injectable PCN with a local anesthetic built-in.
5. Tetanus toxoids and diluent, single-use ampuoles.
I would want some topicals to combat infections and promote healing.
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Summit
Critical Crazy
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I forgot to add: am I treating my expedition or the local populace?
Agreed on the epi. I'm considering my list... but skiing first.
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You are correct. I replace benadryl with morphine.
I do remember that promethazine can be used in allergic reaction now that you mention it, when I posted I didn't even consider it. My mind went immediately to anti-emetic.
I do remember that promethazine can be used in allergic reaction now that you mention it, when I posted I didn't even consider it. My mind went immediately to anti-emetic.
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And thanks to my premium member status...that post is gone forever!!!
All we have to look back on now is our memories...
All we have to look back on now is our memories...
Pick the 5 best you will think works best anywhere for anyone.
Don't overcomplicate it.