Dealing with medical emergencies at sea.
Part TWO: What medicines do we need to take?
By Major Henry Chandler MBChB, MRCS, DMCC And Dr Chris Chandler FRCOG
What medicines do we need to take?
This month we consider the medicines you should consider taking with you on a significant ocean passage.
Be realistic in what you take. Hopefully, you will never need any of these, but if you stock it make sure you know what it is for, what else it can be used for, and when it goes out of date.
Most seasickness tablets will cause drowsiness. In general, seasickness is a self-limiting condition as the inner ear adjusts. Remember it used to take Nelson three days at sea before he felt ok! An alternative to tablets is Hyoscine patches (Scopaderm) available without prescription. The only remedy that works immediatly on all people is to sit under a tree.
Chlorphenamine, Cetirizine, Loratidine. Invariably the more beautiful a part of the world is, the more likely you are to encounter biting or stinging beasts. These drugs work by reducing the bodies reaction to an assault such as a bite or sting, and form part of the treatment for anaphylaxis (shock).
An effective anti-inflammatory medication. Take 400mgs three times a day with or after food (as it can cause stomach ulcers/bleeding).
Carrying them on board is always a matter of great debate. They are certainly not a ‘cure-all’ for infections. Rinsing a superficial wound in copious amounts of seawater will be far more effective at removing bacteria than any antibiotic. That said, having a two week supply of a few broad-spectrum antibiotics could be (and has been) the difference between somebody surviving an infection or not.
As always, qualified medical aid should be used if at all possible, but as we know, that’s not so easy in remote parts of the world or when crossing an ocean. It is worth considering that with the sat comm links we are discussing in this edition of Ocean Sailor, assistance can always be found by satellite link.
Flucloxacillin (Penicillin based): Skin and soft tissue infections – 500mgs every 6 hours x 7(minimum) -14 days.
Co-Amoxiclav (Penicillin based): Abdominal, urinary tract, tooth, ear and eye pain with fever – 625mgs every 8 hours x 7-14 days.
Clarithromycin (Non Penicillin based): Abdominal, urinary tract, tooth, ear, eye, skin and soft tissue infections – 500mgs every 12 hours x 7-14 days.
Doxycycline (Non Penicillin based): Fever/Infection with no clear focus – 200mgs (first day) then 100mgs daily x 7-14 days.
The actual antibiotic you give may vary, but if you are a long way from help and somebody is unwell with a fever, give whatever antibiotics you have whilst planning the shortest route to safety.
Effective over the counter treatment for diarrhoea.
A pain killer, anti-inflammatory and anti-platelet (blood thinner) medication. A multi-purpose drug like this should be in every med-kit. The 300mg tablet can be taken at a dose of 300-600mgs 4 hourly for pain. Always take with or just after eating as Aspirin can cause stomach ulcers and bleeding, especially at maximum dose. Aspirin should also be given in a suspected heart attack and continued at 300mgs twice a day until medical care is sought. Not to be used on the under 16s.
Codeine is a weak opiate-based painkiller, as such, it is subject to legislation based on strength and preparation. Check the regulations specific to countries you are in/travelling to as improper possession can attract heavy penalties. Tends to be more effective in treating visceral (internal organs) pain than headaches etc. Take 30-60mgs four times a day. At maximum dose side effects are likely, particularly in those who have never taken it before. These include nausea, vomiting, drowsiness and constipation. It often comes in combined preparations with paracetamol (CoCodamol 30/500 is 30mg of codeine with 500mg of paracetamol in one tablet). Never exceed the stated dose of paracetamol (4g in 24hrs).
A strong anti-inflammatory, effective in the treatment for musculoskeletal pains and other inflammatory conditions eg sinusitis, dental pain etc. Usually only available via a pharmacy. Take 50mg three times a day with or after food (as it can cause stomach ulcers/bleeding).
Oral Rehydration Salts Dioralyte, ORT, ORS
A combination of salts and sugar designed for ease of absorption to treat dehydration.
Diarrhoea, vomiting and fevers can quickly lead to dehydration which increases the severity and duration of many illnesses. Flat Coca-Cola is a good alternative if none of the other preparations are available.
Paracetamol Acetominophen in US
An effective painkiller, anti-inflammatory and anti-pyrexial (fever-reducing) medication. Two things should not be underestimated about paracetamol: It is one of the most effective drugs at reducing pain (not eradicating) and also one of the most dangerous in overdose. It is best used in combination with other painkillers. Take 1g (2 x 500mg tablets) four times a day no closer than 4 hours apart.
Tramadol is a controlled drug in many countries and isn’t available over the counter. If you speak to your doctor and explain you are travelling to a remote location without easy access to medical support, they will probably prescribe you some medications including Tramadol, for a fee. This is because Tramadol is available as an intramuscular preparation but is less tightly regulated than other powerful analgesics e.g Morphine. That said as a strong synthetic opiate painkiller it will be subject to strict legislation and possession without a valid prescription will likely incur a penalty. The dose is 50-100mg every 4-6 hours to a maximum of 400mg in 24 hrs. Side effects are as with other opiates and commonly include drowsiness, nausea, vomiting, constipation, dizziness, low blood pressure etc.
Some of the drugs listed above, not only Tramadol, may be on controlled drugs list in your country of arrival. You may need to declare them on arrival at customs. Check with the customs department by email before you arrive.
Talk to your GP. They may be willing to help with the antibiotics and painkillers requiring prescriptions. They will probably charge a fee.
There are now a number of “online pharmacies” available, some of which specialise in providing meds for travel/expeditions.
Your best bet is to invite a sea-loving medical friend to join you on the trip. We can be available at short notice!