Jan 18, 2008 at 3:29 am #1226796
I'm a doctor about to hike the PCT. I feet it'd be pretty dumb of me not to carry a pretty decent kit. I'll bring the standard stuff, some antibiotics, antiseptic, a little sewing thread etc., but I want to pack light. Any good hints out there?Jan 18, 2008 at 5:20 am #1416603
@ryanfLocale: Mid atlantic, No. Cal
My goal was to keep my med kit under one ounce, I used to carry a .4oz kit, but i am more comfortable with my 1oz set up.
I carry the basics.
-2x 3"x3" gauze pads
-2x antiseptic towlettes
-6x medium sized bandaids
-2x large adhesive bandages
-5x butterfly wound clouser strips
-2x small packet of triple antibiotic ointment
-1x antihistamine tablet
-5x Ibuprofen tablets
-5x acetaminophen tablets
-1x safety pin
I also carry duct tape, superglue and a needle and thread in my repair kit, which can all be used to close wounds.
For foot care, I carry hydropel and leukotape.
but you are the doctor.. tell me what i am missingJan 18, 2008 at 11:54 am #1416653
Closure strips are great (better than trying to sew stitches yourself). The other thing I would add is a little syringe (without the needle) to use as an irrigator. It is my understanding that you should wash out a dirty wound with water (before putting a bandaid on it) as opposed to trying to use an antiseptic (like alcohol, which would tend to aggravate the wound).Jan 18, 2008 at 1:04 pm #1416669Jan 18, 2008 at 1:50 pm #1416674Jan 18, 2008 at 2:02 pm #1416677
WFA courses from both WMI and WMS both teach the above advice of cleaning wounds by forceful irrigation with clean water.
I would add that they define clean water as water that is safe to drink, they suggest using a LOT of water (depends on size of the wound but use a liter for "not large" wounds or more if it's a nasty wound) and they define forceful as more force than you get from squeeze bulb syringes or a zip lock bag. If you don't have a good syringe, then by all means improvise but if you intend to plan to be able to do a good job cleaning a wound, pack the real thing … they are not heavy in the UL sense … perhaps they are in the SUL sense.Jan 18, 2008 at 2:33 pm #1416680
1. Read two articles below
2. ABC kit- triangular bandage, pressure bandage, nitrile gloves (2 pr.), CPR mask, blunt tip scissors, ziplock for biohazard waste
3. Wound/blister kit- Bactroban antibiotic ointment, 10 cc irrigation syringe, athletic tape, sterile gauze, tegaderm, bandaids, tincture of benzoin, alcohol pads
5. Other- tweezers, safety pins
6. Medical forms, safety/evacuation plan
Realize the worst-case scenario can happen to anyone. A friend nearly died of toxic shock syndrome from a foot blister…trailname Sandals.Jan 18, 2008 at 5:47 pm #1416706
> WFA courses from both WMI and WMS both teach the above advice of cleaning wounds by forceful irrigation with clean water.
Curiously, I have never done this. I rely on letting the small wound bleed a bit – the amount of blood loss is trivial, and the blood flushes out any nasties. There are very few nasties in the wild in fact.
And none of the many occasions when i have done this have given any problems at all.
> they suggest using a LOT of water (depends on size of the wound but use a liter for "not large" wounds or more if it's a nasty wound)
Of which 99% will flow past the wound and do absolutely nothing useful – apart from looking good to the novice.
cheersJan 18, 2008 at 7:35 pm #1416713Jan 18, 2008 at 8:25 pm #1416718
They weren't talking about treating small clean wounds.
Oh rats, Dave beat me to it.Jan 18, 2008 at 11:05 pm #1416731
> They weren't talking about treating small clean wounds.
I was responding to your comment thus:
> (depends on size of the wound but use a liter for "not large" wounds
I repeat: I have never really bothered washing out a wound with lots of water as described. 99% of the Liter would be wasted.
I have carefully brushed the gravel out with a handkerchief, and encouraged the blood to flow to help clean the wound. This has worked fine. Note that for the first 5 – 10 minutes the patient will not feel anything in the wound – shock kills the nerves for a little while. Just get him to look the other way. :-)
This includes a cut up to 2" wide and right through the skin to the underlying tendons – he slashed his palm open when descending a schist gully and slipped.
It also includes a surface abrasion several inches in diameter over the shin bone but not quite through the skin. Similar problem – went for a slide down a gully on schist.
Both cases healed just fine.
But note: after cleaning the wound was dusted with Bismuth Formic Iodide powder (BFI). This is a surgical dusting powder of great power – but it should be readily available. Then the wound was dressed and the dressing was left untouched for several days.
Works for me. Ymmv
cheersJan 18, 2008 at 11:47 pm #1416736Jan 19, 2008 at 1:22 am #1416738Jan 20, 2008 at 1:46 pm #1416884
Turns out I'm an ER doctor, so wounds are what I deal with. I originally wrote this as I've always eschewed anything but the makeshift med kit from stuff in my cabinets. Anyway, all besides the point.
Here's some advice on wounds:
1. Make sure your tetanus is up to date before you go out. Tetanus is a spore former and most likely to be contracted with dirty wounds. specifically, rust and dirt. Yes, regular old hiking trail dirt has lots o' tetanus. And odds are you may have some dirt in your wounds. The recs, if you've had a fully vaccination series in the past (and if you're from the US you have), are for a tetanus within 5 years for wounds at high risk (dirty wounds, deep wounds, improperly irrigated wounds), and 10 years for other wounds. So, 5 years.
2. Studies have looked at all of the aforementioned issues and the only thing that has really been shown to help wounds is irrigation, irrigation, irrigation. I don't really know much about the bloodletting approach, but hey, knock yourself out. Wound infection rates are inversely proportional to the volume of irrigation AND THE PRESSURE WITH WHICH IT IS APPLIED. That's key, thus the shouting. a little 3 cc syringe is pretty crappy. You can get pretty decent pressure with 10 cc. In the ED I use a 20 or 50 cc syringe for dirty wounds. Don't drip water into the wound, spray it in. If you are near a sink a faucet opened all the way does a pretty good job. Making a pressure bag with a big ziplock, or spraying through pressure using a hose from your water filtration device can be useful too.
3. You gotta get out foreign bodies. Leaving a rock or gravel or glass etc. in a wound will highly increase your risk of infection. If you need to use tweezers or more irrigation or your finger, then sterilize the best you can and JUST DO IT! swoosh. If you think there is stuff in it, don't close it.
4. If the wound is deep, then get out the gunk, wash it, then wash it again, wrap it, and be hesitant to close it. We will leave dirty dirty wounds open a few days and then perform a appropriately named delayed closure 3 or 4 days later if it doesn't look infected.
5. Don't use alcohol, or hydrogen peroxide, or iodine or whatever on your wounds. It can be helpful to use a little hydrogen peroxide on a really dirty wound if you can't immediately wash it. It also MIGHT be helpful to mix in a small amount of iodine with your irrigation water. Be sure to rinse the iodine water out prior to closure. i say might because studies are inconclusive. Since the water may be out of a bag you've been sucking on for 10 miles, I imagine the iodine technique might be a good idea. Don't use hydrogen peroxide, alcohol, iodine etc after you've washed. These things work by creating an environment that kills bacteria. That being said, they also kill healing tissue.
6. Irrigation is key. Whether you close something with steri strips, stitches, duct tape, superglue, etc., it's never been shown to affect healing. I would hesitate to close any deep wound (like a 2 inch deep thigh wound) where there might be a potential space left underneath. In other words, where the top is closed and there is a big unsutured deep cut that isn't pulled together. That is a big space that bacteria love. Warm, deep, with pools of protein. You should also not close deep punctures (stab wounds and gunshot wounds in the er are not sewn up). Of note, did you know that superglue was originally made by the military as a wound closure for field use in Vietnam? It works pretty well for small wounds.
7; After you've closed something, wash with simple soap and water. I would cover with a antistaph/antistrep antibiotic. Bactroban is a good choice.
8. If you are close to society and get cut, typically wounds can be closed on the body for up to 12 hours. They can be closed on the face for up to 24 hours. If you show up later, they will be washed and then possibly sewn up in 2 or 3 days if there are no signs of infection.
9. Prophylactic antibiotics are not a good idea unless a wound is highly contaminated.
10. If you close a wound and it gets infected, open it up. Let the pus get out, and irrigate it. Staph makes little pockets of pus in a wound that need broken up. Pop those vicodins you carry, open the wound, wash like hell, and try to break up the walls very gently with your washed and alcohol cleaned finger. Don't ignore your big pus filled wound. See a doc fast. And start up some antibiotics! Pus is usually staph. You should have strep coverage too.
11. Wounds you obtain in water are another beast. As are punctures through your shoe. Those are high risk and need antibiotics, but you have to know which ones as they are special situations.As are a lot of other situations.
Anyway, I hope that helps!Jan 20, 2008 at 2:52 pm #1416892
Thanks for the info Patrick!Jan 20, 2008 at 2:57 pm #1416893
Although it might be light by this sites standards this is what I usually take for a 2 week wilderness canoe trip days from civilization:
Ibuprofen 400 mg #24
Loperamide 2 mg #10
Levofloxacin 500 mg #5
Diphenhydramine 50 mg #10
Neosporin ointment packets #4
Safety pins #3
butterfly closures #3
knuckle adhesive bandage #2
alcohol pads #4
alcohol from fuel bottle (must dilute to 70% conc)
small conforming gauze #1
large conforming gauze #1
2×2 sterile dressing #1
3×3 sterile dressing #1
3×3 non-stick dressing #1
3×4 non-stick dressing #1
self adhering elastic bandage #1
duct tape from repair kit
Cravats #2 (I wear one as a bandana)
CalStat hand wash 4 oz from mess kit
Zip-lock bag from mess kit
AquaMira from mess kitJan 20, 2008 at 3:34 pm #1416900
Looking at your kit, I might include the following:
you have one antibiotic, which is Levofloxacin. This is useful for traveler's diarrhea, although Campylobacter is resistant to it (one of the 4 or 5 common bacterial causes of traveler's diarrhea). A good choice for foreign travel. It also will cover UTI's for females, both typical and atypical pneumonia, and is good for foot puncture wounds through a shoe. It is not good for staph. It was okay before Methicillin Resistant Staph Aureus came to predominate, but is not good now. i would add some staph coverage. Bactrim is the best (but be careful as it is a sulfa med and people can have bad allergic reactions to it). Clindamycin is a good choice as it covers strep too. Doxycycline is good as well.
I would also consider adding Tinidazole for Giardia if you have a longer trip. The incubation period for giardia is 1-3 weeks so most the time you would get it on return from society. A 2 gram dose has a 95% cure rate for giardia. Metronidazole/Flagyl is an old choice and only 80% effective now and has to be taken for 7 days.
I would also add a steroid cream. Something potent from your doc would be good, but hydrocortisone would be okay.Jan 20, 2008 at 3:51 pm #1416906
@hechoendetroitLocale: South Kak
Curved tip syringes are great for cleaning out wounds (esp. deep ones). The curved tip tapers to a smaller point, providing great water pressure. You can always cut the tip to reduce the pressure and increase the flow, if need be.Jan 20, 2008 at 8:36 pm #1416948
> Roger – the nasties aren't in the wild they are on your skin!
I am sorry to have to disagree – and strongly too.
The bugs on your skin are part of you. They will not do you any harm at all. (Assuming no faecal matter etc.) Humans (and our precedents) have been living with them for … many hundreds of thousands of years.
Remove them with an antibiotic wipe and you risk getting far worse bugs which will cause you harm.
Do you know where the biggest source – in fact far and away THE biggest source, of staph infections is (especially MRSA) ? Hospitals. Too many miss-applied antibiotics floating around breeding resistance, too many people walking around from patient to patient carrying bugs (these people are called nurses and doctors), and too many sick people.
Sure, irrigate the wound if you have the water. But don't panic if you can't.
cheersJan 20, 2008 at 10:19 pm #1416962
@hechoendetroitLocale: South Kak
"The bugs on your skin are part of you."
—Yes, staph has been shown to colonize ~30-50% of humans.
"They will not do you any harm at all."
—Normally this is true but given the proper environment (wet/warm), bacteria can reproduce rapidly. Combine that with a foot wound (or even a crack in the skin) and a weak immune system response = infection.
"THE biggest source, of staph infections is (especially MRSA) ? Hospitals."
—For MRSA, yes. "Regular" staph is much more common elsewhere (air, dust, sewage, water, milk, food or on food equipment, surfaces, humans, animals).
"Remove them with an antibiotic wipe and you risk getting far worse bugs which will cause you harm."
—It is true that an antibiotic treatment may kill off beneficial microbes and disturb the balance. That being said, the balance is likely already disturbed somewhat. Use judiciously.Jan 20, 2008 at 11:21 pm #1416965Jan 21, 2008 at 8:39 pm #1417105
Patrick, good observation. This pharmacist had not given it much thought lately. Matter of fact, I had Trovan in my kit even after it had been pulled off the market.
Doxycycline may be advantageous if one is traveling in high-risk areas for Lyme Disease. If taking clindamycin one does not need to worry about photosensitivity reactions unlike Bactrim and doxycycline.
Last summer I did bring some clobetasol cream with me when we were in the tundra due to a psoriasis like rash. I have often questioned if I should add an opiate to my kit and have mixed emotions.Jan 22, 2008 at 9:51 am #1417175
If I didn't get cut by rusted metal I'm fine. Abcesses do suck though.Jan 22, 2008 at 10:49 am #1417191
@mowLocale: Minnesota, USA
Is there a medication one could take along that treats both Giardia and cryptosporidia? Or does the aforementioned Tinidazole work for each?Jan 22, 2008 at 3:13 pm #1417239
Nitazoxamide is used to treat both giardia and cryptosporidia in immune compromised patients. Otherwise, it is loperamide and hydration.
I suspect it may be difficult to find a pharmacy stocking nitazoxamide. It will probably cost you $100 if you do not have insurance.
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