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  1. #11

    Re: Medical Supplies On Board

    Basically scrips have to be written for a particular person. However if the supplies are on board and you need them then you use them. The EpiPen should be reserved for use by someone who has a demonstrated history of serious allergy that may need it. The most common allergies for which they are written are peanut allergy (I have seen some horrendous peanut allergy reactions and thank God have had no deaths, but they do occur) and also beestings, which can be any of a variety of stinging insect called Hymenoptera. (wasps, hornets, bees, yellowjackets etc). Note that you should also familiarize yourself with this equipment.
    Please feel free to ask anything else in this line. If I can't answer it or feel I shouldn't I will let you know. None of this stuff is secret, or ought to be.

  2. #12

    Re: Medical Supplies On Board

    Please explain about "Epi-Pens".

    Thanks,

    Doug

  3. #13

    Re: Medical Supplies On Board

    Epi-pens are automatic, intramuscular, injection devices containing a premeasured, single dose of adrenaline. Used for severe allergic reaction. Just remove the syringe cover and drive it into the victims leg.

    My kids have not yet had a bee or jellyfish sting. Would hate to find out they're allergic while visiting some distant island.

    Dr Jim...what do you recommend for relief of jellyfish stings if allergies are not an issue?

  4. #14

    Re: Medical Supplies On Board

    Adolph's meat tenderizer works well for this (believe it or not); the enzymes will dissolve jellyfish venom which is a protein. I also looked this up in Rosen's Textbook of Emergency Medicine; assuming a stable patient who does nor require airway support or any other life-sustaining measures, they advise washing the affected area with seawater (fresh water may cause the remaining stings to "go off"), neutralize the remaining undischarged stings with vinegar, which fixes them, and then covering the affected area with talcum powder or shaving cream which will remove the stings when scraped off. They advise antihistamines, steroid creams, and pain medication. They do not mention Adolphs' but it is well-known to work. They also advise a tetanus booster, which I should have mentioned earlier. Updating tetanus status before the trip is a good idea. Note that even dead tentacles from jellyfish etc can still sting and that you should be wearing gloves when you try to remove them.
    Regarding allergic reactions to venomous marine animals: allergic reactions are more common when a person has been stung before. Most of the really toxic marine venomous animals are not found in our area- they are native to Australia and the Indo-Pacific region. Therefore, if a severe reaction occurs, it is likely to be in someone who has been stung in the past and/or is allergic and does not know it. Also, if a person is stung while in the water and reacts, it can increase their risk of drowning. So- remove the victim from the water, perform basic life support before anything else, glove up, and follow the measures outlined above. After that, the patient should be brought to an ER to complete treatment.

  5. #15

    Re: Medical Supplies On Board

    Quote Originally Posted by jim rosenthal
    The EpiPen should be reserved for use by someone who has a demonstrated history of serious allergy that may need it. .
    Jim,
    Since we have no history of serious allergies, should we forgo an EpiPen script? I always thought they were good to have "just in case".

  6. #16

    Re: Medical Supplies On Board

    Jim, thank you so very much for taking the time to respond to the questions asked in this thread and giving us the benefits of your knowledge. The info will be very useful to me and I’m sure to others as well.

    And Passages, thanks for asking these good questions.

  7. #17

    Re: Medical Supplies On Board

    You have to read the label on the meat tenderizer. The ingredient to look for is papain, an extract of the papaya plant. Papain is an enzyme which, according to the Encyclopedia [does anyone else hear the Mickey Mouse Club song when spelling this?] Britannica, "catalyzes the breakdown of proteins by hydrolysis (addition of a water molecule)." I try to keep papain products on board, but many tenderizers use other ingredients which may not work as well.
    Jim Grove, Fanfare 1966 50MY Hull #22 (Delivered Jan. 7, 1966)

    "LIFE IS JUST ONE DAMNED THING AFTER ANOTHER." Frank Ward O'Malley, Journalist, Playwright 1875-1932

  8. Re: Medical Supplies On Board

    Thing with an epi-pen is that if you need one, and don't have it, someone is likely to die on you.

    In theory anyone who KNOWS they're severely allergic (to anything!) should have one on them. Reality is that many times people don't, or worse, they don't know they're severely allergic - the usual histamine reaction issue is that you don't get "nailed" with your FIRST exposure - its the second and subsequent one that gets you, as the first one sensitizes your system.

    So if you're severely allergic to jellyfish stings, for example, you can get stung once. The SECOND sting, which might happen months or years later, is the one that causes the severe reaction.

    Anyway, if you're going to be a significant distance away from EMS an Epi-Pen is a good thing to have in the med kit. It, like any other sort of actual medication though, has an expiration date if unused and so its another thing to check and renew from time to time.

  9. #19

    Re: Medical Supplies On Board

    That's exactly right, (as my former professor of pathology, John Murphy, would have said). The thing about an Epi-Pen, though, is the last instruction in it: "go immediately to emergency department"...well and good if you're on shore, not so easy if you are on land.
    I think that unless you have a crew member with a documented history of allergy (in which case you should have an Epi-Pen on board) you are going to have a difficult time getting a physician to write a scrip for one. I write them for patients that I have seen who have had a serious allergic reaction, or one that I know has the potential to be serious. Peanut allergy is a great example. No one who has a history of peanut allergy, or beesting allergy, should be without an Epi-Pen. Period. I don't discharge anyone from the ER without a scrip for one, among other things. But if you don't have a person on board with a history of a severe allergic reaction, then your chance of someone having their FIRST serious allergic reaction to anything while on your boat is vanishingly small. Even less is the chance of that reaction, which is slim to begin with, being severe enough to require the use of an Epi-Pen.
    Epi-Pens don't have a lot of downsides, although giving direct injections of adrenaline to people is not for the faint of heart when you see how some of them react to it. (think about how you feel when your adrenalin is way up and you'll get an idea- multiply that a few hundredfold).
    So, to summarize: unless you know you are going to carry someone who you know should have one around, you don't need an Epi-Pen. Sorry for the long-winded post.

  10. #20

    Re: Medical Supplies On Board

    "It's the ennnnn...cyclopedia, E-N-CYC-LO-PEDIA!


    Who's the leader of the club...

    MICKEY MOUSE! donald duck! MICKEY MOUSE! donald duck!

    Sorry - couldn't resist.

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