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Old 08-05-2019, 02:25 PM   #21
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City: Bethesda, MD
Country: USA
Vessel Name: Solstice
Vessel Model: Grand Banks 47 Eastbay FB
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Whatever you buy, add a package of DECENT band-aids. The adhesive on most of them is crap. That and be prepared to throw out any portion that has adhesives after about 3 years, tops. The adhesive just dries out, and ends up even less useful than it was from the start. Other stuff like gauze, pads and the like, that'll last a bit longer.

The Band-Aid brand "Flexible Fabric" or "Tru-Stay" ones are about the best. They stick and stay stuck. The fabric ones are more comfortable but the fabric, as you'd expect is a dirt magnet.

That and keep a fresh supply of hydrogen peroxide on hand. I like the spray bottles, as it avoids wasting it for simple cuts & scrapes.

I say this because I've got a 11 year old with friends, and it seems like our house is 'first aid central' for bike, skateboard and other crashes.
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Old 08-05-2019, 05:21 PM   #22
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City: Clearwater, FL
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IM Epi (such as from a typical auto-injector) does wear off in 10-30 minutes. And, it can sometimes take more than one dose to work, even initially. But, that doesn't mean that, if one is at sea (or in the woods, or, or, or...) and away from other medical care, the typical person needs IV Epi to treat anaphylaxis effectively, even potentially definitively.

Instead, one can typically use the initial dose(s) of IM Epi to buy time to fix the root cause of the problem. For example, as soon as the patient is able, a heavy oral dose of Diphenhydramine (Benadryl) or similar old-school antihistamine can be taken to relieve an underlying allergic reaction. If Albuterol (such as by prescription for Asthma) is available, it might be of help in relieving wheezing and other elements of respiratory distress. If a bee sting is causing the problem, removing the stinger might help, as might other measures to slow absorption from the site of the sting (if you happen to be familiar with them). Note: Inducing vomiting doesn't usually work for food allergies, especially after symptoms have started and can lead to //death// by choking, especially when respiratory distress is a concern as it is in the case of anaphylaxis -- so it is not usually recommended.

IV or IM Epi, although essential and lifesaving, does have some potentially deadly or life-changing risks, e.g. MI, CVA, arrhythmia, etc, and, overall, doesn't have nearly as good a safety profile as antihistamines, Albuterol, removing the stinger, etc. So, although Epi should be given as early as needed, and as often as needed, the patient is generally safer if less is needed. (Note: Epi by inhaler, such as the new OTC "Primatine Mist" doesn't seem to work well enough to be of use for anaphylaxis).

IV Epi is generally considered less safe than IM Epi. Of course, when extended treatment is needed, repeated IM injections have their own risks and aren't well tolerated by the patient or practical to manage. And, an IV is often indicated, anyway, to provide fluid to counteract the fluid shift often associated with anaphylaxis and associated risk of hypovolemic shock.

So, I guess all I am saying here is that not being able to give Epi by IV doesn't mean one can't give effective, possibly definitive treatment if it comes down to that (professional help is always way best). Just keep giving IM as needed, for as long as needed, while working to resolve the root cause by removing the allergen (except don't induce vomiting for food allergies), treating the allergy (antihistamine), and using other treatments for specific symptoms, e.g. Albuterol inhaler.

Also, be cognizant of how much IM Epi is available. It can be expensive, but keeping more is always better. I'd rather throw a bunch away than not have one when someone's life depends upon it. But, if it is in short supply, one might have to make decisions I don't envy about when to give the first dose or how long to wait before repeated doses.

(EMT-B, AWLS, WEMT)
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Old 08-05-2019, 06:48 PM   #23
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We vary what we carry by boat, depending on where the boat is likely to cruise. The medical kit for a boat that is never more than 3 hours from shore is much different than one that crosses oceans.

I'm sure we go far beyond what is necessary but we are members of MedAire. It gives us immediate access to doctors and trauma specialists who can advise us as we administer medical treatment. It's a recognition that as well as we've been trained, we're still far from doctors and their training and even doctors are not always expert outside their specialties.

They also advise on health and travel risks and can provide advice on local facilities and medical translators. They've reviewed out medical kit and compared it to our guests and cruising areas. They are primarily in aviation, hence the name.

I know HIPAA was important as persons needed their medical privacy, especially those with certain diseases. They needed protection from employers who would misuse the information. However, I'd encourage everyone to either have a flash drive or have a cloud location with their entire medical history and, if you travel with friends, inform them. We require disclosure from our guests. People show up at ER's all the time with no information. People die from those treating them not being aware of their conditions, sometimes simple things like allergies and drug reactions or being on blood thinners. We have a healthy 22 year old who travels with us, but nearly died from a bee sting years ago, something that most people casually dismiss. She was lucky the school nurse didn't. It's a shame circumstances have led us to feel we need to hide our medical conditions, that people, including employers, will use them negatively. We're primarily a very healthy family and extended family, but many of us have something in our history or profile that is very important to know.
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