Wilderness and Rescue Medicine 7th Edition Jeffrey Isaac, PA-C and David E. Johnson, MD

Wilderness and Rescue Medicine 242

Indications . The indication is what the drug is for. In the backcountry, epinephrine is used to treat asthma and anaphylaxis. Ibuprofen reduces pain, inflammation, and fever. Contraindications . A contradiction indicates when a drug should not be used. Ibuprofen, for example, irritates the stomach and therefore should not be used when vomiting is an antici- pated problem, or for anyone with a stomach problem. Side effects . Side effects are the secondary effects of the drug that may or may not be desir- able or acceptable. For example, drowsiness is a side effect of diphenhydramine. This may be useful or dangerous, depending on the situation. Allergies are an undesirable side effect that can occur with any medication. Dosage and route . Dosage answers the question, how much is given, and how often? Medications can be administered by many routes, including by mouth, by injection, absorbed by the mucous membranes of the nose or mouth, absorbed through the skin, or given rectally.

malleable aluminum splint or any rigid object. Add a sling and you can include the elbow, upper arm, and clavicle. Oxygen is administered for almost everything on the ambulance but in the wilderness setting you need a good reason to carry this relatively heavy and bulky equipment. You might choose to leave it behind when responding to an unknown problem at an unknown location. However, oxy- gen is certainly worth packing when respond- ing to a known respiratory system problem at a known location. The automated external defibrillator (AED) falls into the same category. You may choose to carry one when responding to a known cardiac problem. Otherwise, the likelihood of use does not justify its weight and bulk in your pack. On most trips, it makes sense to arrange your kit in modules. Put the materials used for minor maintenance and repair like adhesive bandages and antibiotic ointment in a separate container. This module will have as much to do with pre- venting medical problems as treating them, and it should be easily accessible. It may work best for each member of the team to have his or her own. The more critical but less frequently used supplies can be kept elsewhere. Medications Medications should be repackaged to prevent damage from moisture and movement. A bottle of loose pills will turn into powder after a few hours on the trail or miles at sea. Pack the con- tents tight with cotton or gauze in a waterproof vial and add a few grains of dry rice to absorb any stray moisture. Any prescription medications should be accompanied by documentation from the prescribing practitioner, especially if you will be crossing international borders. Include written instructions for the use of the medication. For each medication, you should know the following: Actions . A drug’s action is how it works. Epinephrine, for example, constricts blood ves- sels and dilates bronchial tubes. Ibuprofen inhibits the chemical mediators of pain and inflammation.

General Principles

You Should Know…

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Indications Contraindications Precautions Dosage Route

Side Effects Interactions

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Fluid Replacement In many cases where dehydration is the primary mechanism, rehydration in the field can make a carry-out evacuation unnecessary. IV fluid replacement is ideal, but not always practical. Oral fluid replacement with electrolyte solutions can be very effective if the patient can swallow safely and is not vomiting.