DEALING WITH ALLERGIC AND ANAPHYLAXIS SHOCK

General Overview

The incidence of true anaphylaxis is rare. Most allergic reactions can be managed with over-the-counter anti-histamines. Epinephrine has been given mistakenly to patients for mild allergic reactions, hyperventilation syndrome and panic attacks.

Treatment for Allergic Reactions and Anaphylaxis

1. Remove the allergen or the patient from the offending environment.
2. Administer oral antihistamines (e.g. diphenhydramine 50mg PO every 4-6 hours).
3. If patient shows signs and symptoms of anaphylaxis (Swollen face, lips and tongue; difficulty swallowing; systemic hives; respiratory distress; inability to speak in more than one or two word clusters; signs and symptoms of shock) administer epinephrine .3ml/1:1000 SQ or IM.
4. Ifreaction reoccurs or the epinephrine is ineffective, continue to administer epinephrine.

Evacuation Guidelines for Allergic Reactions and Anaphylaxis

Evacuate Rapidly:

• Any patient who continues to show respiratory compromise or signs and symptoms of shock after treatment with epinephrine and antihistamines.

Evacuate:

• Any patient who has received epinephrine.  Continue to provide anti-histamines during evacuation.

References:

Emergency Medical Technician-Basic: National Standard Curriculum Module 4 Medical/Behavioral Emergencies and Obstetrics/Gynecology.  22 June 1995.  National Highway Traffic Safety Administration United States Department of Transportation.  2 Dec 2004. <www.nhtsa.dot.gov/people/injury/ems/pub/emtbnsc.pd>

“Position Statement 26:The Use of Epinephrine in the Treatment of Anaphylaxis.” American Academy of Allergy Asthma & Immunology.  28 Dec. 2004.  <http://www.aaaai.org/media/resources/position_statements/ps26.stm>;

Schimelpfenig, Tod and Linda Lindsey.  “Poisons, Stings, and Bites.” Wilderness First Aid 3rd ed.  Mechanicsburg, Pennsylvania: Stackpole Books, 2000.  Chapter 11.

Specific Protocols for Wilderness EMS Allergic Reactions.  Version 1.2 May 19, 1994.  The Wilderness Emergency Medical Services Institute.  2 Dec. 2004.  <http://www.wemsi.org/specific.html>;

The Merck Manual 16th Edition.  Rathaway, New Jersey: Merck & Co., Inc., 1992.

Tilton, Buck.  “Allergic Reactions and Anaphylaxis.” Wilderness First Responder 2nd ed.  Guilford, Connecticut: The Globe Pequot Press, 2004.  Chapter 28.

Wilderness Field Protocols Protocol 1 Anaphylaxis.  2001.  Wilderness Medical Associates.  2 Dec. 2004 < http://www.wildmed.com/field_protocols/anaphylaxis_protocol05.01.html#top>;

Wilkerson, James A.  “Allergies.” Medicine for Mountaineering 5th ed.  Seattle, Washington: The Mountaineers Books, 2001. Chapter 20.

DEALING WITH ALTITUDE ILLNESS

General Overview:

Severe altitude illness (HAPE or HACE) is rare in the United States (except Alaska) when proper acclimatization practices are followed.  Mild or moderate altitude sickness (Mild or Moderate AMS) is quite common however and organizations should design programs to allow slow acclimatization in an effort to prevent AMS.

Treatment for Altitude Illness:

1. Do not continue ascending until symptoms have resolved.
2. Maintain adequate hydration and nutrition. Light exercise.
3. Pain medication as needed for headache.
4. Acetazolamide, 250mg PO every 6 to 12 hours, for mild/moderate AMS.
5. If symptoms do not improve over 24-48 hours, descend until symptoms abate. Generally 2000 feet (610m) is adequate.
6. If patient has HAPE or HACE, descent is critical. 2000-4000 feet (610m-1219m) can make a remarkable difference.
7. Oxygen will be helpful, if available, especially for HAPE.
8. Nifedipine, 10-20mg PO every 8 hours (for HAPE) and dexamethasone 8mg PO or 10mg IM followed by 4mg every 6 hours PO or IM (for HACE).
9. Gamov Bag, can make a patient ambulatory for self-evacuation.

Evacuation Guidelines for Altitude Illnesses:

Evacuate Rapidly:

• Any patient with severe altitude illness.

Evacuate Rapidly:

• Any patient unable to acclimatize.

References:

Auerbach, Paul S.  “High-Altitude Medicine.” Wilderness Medicine 4th ed.  St. Louis, Missouri: Mosby, 2001. Chapter 1.

Forgey, William.  “High-Altitude Illness.” Wilderness Medical Society Practice Guidelines for Wilderness Emergency Care 2nd ed. Guilford, Connecticut: The Globe Pequot Press, 2001.  Chapter 10.

Hackett, Peter H.  “The Cerebral Etiology of High-altitude Cerebral Edema and Acute Mountain Sickness.” Wilderness and Environmental Medicine 10 1999: 97-109.

Hackett, Peter H. and Robert C. Roach.  “Medical Therapy of Altitude Illness.” Annals of Emergency Medicine 16, 9 September 1987: 89-95.

Schimelpfenig, Tod and Linda Lindsey.  “Altitude Illness.” Wilderness First Aid 3rd ed.  Mechanicsburg, Pennsylvania: Stackpole Books, 2000.  Chapter 14.

Schoene, Robert B.  “High-Altitude Pulmonary Edema: Pathophysiology and Clinical Review.” Annals of Emergency Medicine 16, 9 September 1987: 99-104.

Stewart, Charles E.  “Management of Altitude-Related Emergencies.” Environmental Emergencies.  Baltimore, Maryland: Williams & Wilkins, 1990.  Chapter 6.

Tilton, Buck.  “Altitude Illnesses.” Wilderness First Responder 2nd ed.  Guilford, Connecticut: The Globe Pequot Press, 2004.  Chapter 18.

Wilkerson, James A.  “ Disorders Caused by Altitude.” Medicine for Mountaineering 5th ed.  Seattle, Washington: The Mountaineers Books, 2001. Chapter 21.

Wilkerson, James A.  “ Altitude and Common Medical Conditions.” Medicine for Mountaineering 5th ed.  Seattle, Washington: The Mountaineers Books, 2001. Chapter 22.

DEALING WITH CARDIC EMERGENCIES

General Overview:

Differential diagnosis of non-traumatic chest pain is challenging.  Therefore any patient exhibiting signs and symptoms of chest pain that cannot be attributed to a non-cardiac origin, should be managed as if the origin is cardiac.  Younger people may complain of rapid uncontrolled heart rate without chest pain.

Treatment for Cardiac Emergencies:

1. Reduce anxiety and activity.  Place patient in a position of comfort.  Avoid walking if possible.
2. Administer high-flow/high-concentration oxygen, if available.
3. Assist patient with administration of his or her nitroglycerin, 0.4mg SL spray or tablet, may be repeated every 5 minutes for a total of three doses if the systolic BP remains above 90mmHg.  
4. Administer one-half adult aspirin (160mg) or two baby aspirin (8lmg each) every 24 hours.

Evacuation Guidelines for Cardiac Emergencies:

Evacuate Rapidly:

• Any patient with chest pain that does not relieve within 20 minutes.

Evacuate:

• Any patient with non-traumatic chest pain that subsided with rest or medication.
• Any patient with sustained periods of rapid heart rate.

References:

ACLS Provider Manual.  Dallas, Texas: American Heart Association, 2002.

BLS for Healthcare Providers.  Dallas, Texas: American Heart Association, 2002.

“Cardiac/Circulatory.” United States Special Operations Command.  Special Operations Forces Medical Handbook.  Jackson, Wyoming: Teton NewMedia, 2001. 4-1.

Emergency Medical Technician-Basic: National Standard Curriculum Module 4 Medical/Behavioral Emergencies and Obstetrics/Gynecology.  22 June 1995.  National Highway Traffic Safety Administration United States Department of Transportation.  2 Dec 2004. <www.nhtsa.dot.gov/people/injury/ems/pub/emtbnsc.pd>

Schimelpfenig, Tod and Linda Lindsey.  “Respiratory and Cardiac Emergencies, Seizures, Diabetes and Unconscious States.” Wilderness First Aid 3rd ed.  Mechanicsburg, Pennsylvania: Stackpole Books, 2000.  Chapter 18.

The Merck Manual 16th Edition.  Rathaway, New Jersey: Merck & Co., Inc., 1992.

Tilton, Buck.  “Cardiac Emergencies.” Wilderness First Responder 2nd ed.  Guilford, Connecticut: The Globe Pequot Press, 2004.  Chapter 23.

DEALING WITH CHEST INJURIES

General Overview

Lung injury is a primary concern secondary to a blow to the chest wall.  Specific diagnosis is difficult, but signs and symptoms of dyspnea (difficulty breathing), especially at rest, should trigger an evacuation.  Lung injury can occur spontaneously and outdoor leaders should be attentive to sudden complaints of difficulty breathing.

Treatment for Chest Injuries

1. Place the patient in a position of comfort or on the injured side.
2. Stabilize any injuries. For a fractured rib sling and swathe or tape the affected side. For a flail segment splint with a bulky dressing.
3. For an open chest injury seal the wound with an occlusive dressing secured on three sides.
4. Administer high-flow/high-concentration oxygen if available. Support respirations if necessary.
5. Pain management. Avoid respiratory depressants (e.g. narcotics).
6. Periodically encourage the patient to breathe deeply.
7. Monitor for increasing Shortness of Breath (SOB) at rest and diminishing breath sounds.

Evacuation Guidelines for Chest Injuries

Evacuate Rapidly:

• Any patient with signs and symptoms of serious chest trauma or respiratory distress.
• Any patient exhibiting increasing shortness of breath, especially at rest.
• Any patient with diminished or abnormal lung sounds.

Evacuate:

• Any patient with a suspected rib or clavicle fracture.

References:

Emergency Medical Technician-Basic: National Standard Curriculum Module 5 Trauma.  22 June 1995.  National Highway Traffic Safety Administration United States Department of Transportation.  2 Dec 2004. <www.nhtsa.dot.gov/people/injury/ems/pub/emtbnsc.pd>

“Thoracic Trauma.” PHTLS Basic and Advanced Prehospital Trauma Life Support. St. Louis, Missouri: Mosby, 2003.  Chapter 5.

Schimelpfenig, Tod and Linda Lindsey.  “Chest Injuries.” Wilderness First Aid 3rd ed.  Mechanicsburg, Pennsylvania: Stackpole Books, 2000.  Chapter 7.

Specific Protocols for Wilderness EMS Chest Injury.  Version 1.2 May 19, 1994.  The Wilderness Emergency Medical Services Institute.  2 Dec. 2004.  <http://www.wemsi.org/specific.html>;

Tilton, Buck.  “Chest Injuries.” Wilderness First Responder 2nd ed.  Guilford, Connecticut: The Globe Pequot Press, 2004.  Chapter 10.

Wilkerson, James A.  “ Chest Injuries.” Medicine for Mountaineering 5th ed.  Seattle, Washington: The Mountaineers Books, 2001. Chapter 11.

Travel Italy | Emergency Services

FIRST AID | CPR FOR YOUR PET Cardiopulmonary Resuscitation, or CPR, is a combination of chest compression andartificial respiration. It is normally used when you cannot feel or hear the dog’s heart beat. Once the dog stops breathing the heart will go into cardiac arrest and cease beating.Before performing this procedure please keep in mind that Cardiopulmonary Resuscitation is hazardous and can cause physical complications or fatal damage if performed on a healthy dog. It should only be performed when necessary.Cardiopulmonary Resuscitation for puppies/ dogs less than 30 pounds (14 kg): Lay the dog on a flat surface with his/her right side against the surface. Cup your palms and hold the dog with one palm on either side above the heart region. (You can also place your thumb on one side of his chest and keep the fingers on the other side.) Compress the chest for one inch to one-quarter or one-third the width of the chest for a count of one and then let go for a count of one. Carry on at a rate of 100 compressions in a minute. If only one person is available, breathe into the dog’s nose once for every five compressions that are done. If two persons are available, give artificial respiration once every two or three compressions are done. Continue with the CPR and artificial respiration until the dog begins breathing on its own and the pulse becomes steady. Cardiopulmonary Resuscitation for medium/large dogs weighing more than 30 lb (14 kg): Lay the dog on a flat surface with his/her right side against the surface. (You will need to stand towards the dog’s back.) Put one of your palms on the dog’s rib cage, near the heart region, and put your other palm on top of it. Without bending both the elbows, press the rib cage in a downward motion. Compress the chest for one-quarter to one-third the width of the chest for a count of one and then let go for a count of one. Carry on at a rate of 80 compressions per minute. Close the muzzle with your hand before beginning artificial respiration. If only one person is available, breathe into the dog’s nose once for every five compressions that are done. If two persons are available, give artificial respiration once for every two compressions are done. Continue performing CPR until the dog begins to breathe and has a steady pulse. If the dog does not show any signs of improvement after 10 minutes of CPR, you can stop as it has not proven successful.

DEALING WITH ILLNESS AND INJURIES DURING YOUR TRAVEL

Travel is one of the great freedoms in life.  But many times simple illness or minor injury can ruin our day.  When we are in the Outdoors or in a forgein country it is important to have a better understanding of First Aid and Preventive Medicine.  Not knowing the local EMS numbers or even how to procure medicines can create havoc on our travel plans.  As well simple issues can increase quickly into major medical issues that could have been avoided.

Basic Treatment Protocols for possible medical issues in the Outdoors

• Abdominal Illness and Injury
• Allergic and Anaphylaxis Shock
• Altitude Illnesses
• Cardic Emergencies
• Chest Injuries
• First Aid for Burns

FIRST AID FOR BURNS

General Overview

Large burns are uncommon in the backcountry, but even small burns can be debilitating, painful and difficult to keep clean.  Small burns are relatively common backcountry injuries, typically secondary to hot water spills.

Treatment for Burns

1. Ensure the scene is safe.
2. Immediately soak or flush all burns in cold water. Remove clothing and constricting objects (e.g. jewelry, watches, belts).
3. Assess and manage Airway, Breathing and Circulation problems.
4. Gauge the depth, extent and location of the burns.
5. Properly dress the burns with antibiotic ointment, burn gel, Silvadene ® cream or 2nd Skin ® covered loosely with sterile dressings. In extended care situations debride dead skin around blisters that have self-drained and clean several times daily.  Do not drain intact blisters.
6. Pain medication as needed (NSAIDs often recommended).
7. Aggressive hydration.
8. If snow blindness is suspected, provide cool water flushes of the eye and cool compresses.  Rest and avoid sun exposure until symptoms resolve.

Evacuation Guidelines for Burns

Evacuate Rapidly:

• Any patient with signs and symptoms of an airway burn.
• Any patient with partial or full thickness burns covering more than 15% TBSA.
• Any patient with partial or full thickness circumferential burns.

Evacuate:

• Any patient with a full thickness burn.
• Any patient with burns to a special function area: face, neck, hands, feet, armpits, or groin.
• Any patient with a burn that cannot be managed effectively in the backcountry.

References:

“Burns.” United States Special Operations Command.  Special Operations Forces Medical Handbook.  Jackson, Wyoming: Teton NewMedia, 2001. 3-17.

Emergency Medical Technician-Basic: National Standard Curriculum Module 5 Trauma.  22 June 1995.  National Highway Traffic Safety Administration United States Department of Transportation.  2 Dec 2004. <www.nhtsa.dot.gov/people/injury/ems/pub/emtbnsc.pd>

Forgey, William.  “Burn Management.” Wilderness Medical Society Practice Guidelines for Wilderness Emergency Care 2nd ed. Guilford, Connecticut: The Globe Pequot Press, 2001.  Chapter 7.

Schimelpfenig, Tod and Linda Lindsey.  “Burns and Lightning Injuries.” Wilderness First Aid 3rd ed.  Mechanicsburg, Pennsylvania: Stackpole Books, 2000.  Chapter 4.

Specific Protocols for Wilderness EMS Wounds.  Version 1.2 May 19, 1994.  The Wilderness Emergency Medical Services Institute.  2 Dec. 2004.  <http://www.wemsi.org/specific.html>;

Stewart, Charles E.  “Burns.” Environmental Emergencies.  Baltimore, Maryland: Williams & Wilkins, 1990.  Chapter 2.

The Merck Manual 16th Edition.  Rathaway, New Jersey: Merck & Co., Inc., 1992.

Tilton, Buck.  “Wilderness Wound Mangament.” Wilderness First Responder 2nd ed.  Guilford, Connecticut: The Globe Pequot Press, 2004.  Chapter 15.

Wilkerson, James A.  “Burns.” Medicine for Mountaineering 5th ed.  Seattle, Washington: The Mountaineers Books, 2001. Chapter 8.

First Aid Kit Checklist

Basic care: Prepackaged first-aid kits typically contain many of the following items:

• Antiseptic wipes (BZK-based wipes preferred; alcohol-based OK)
• Antibacterial ointment (e.g., bacitracin)
• Tincture of benzoin (bandage adhesive)
• Assorted adhesive bandages (fabric preferred)
• Butterfly bandages/adhesive wound-closure strips
• Gauze pads (various sizes)
• Nonstick sterile pads
• Medical adhesive tape (10-yd. roll, min. 1" width)
• Blister treatment (e.g., Moleskin, 2nd Skin, Glacier Gel
• Ibuprofen/other pain-relief medication
• Insect-sting relief treatment (e.g., AfterBite)
• Antihistamine to treat allergic reactionsSplinter (fine-point) tweezers
• Safety pins
• Comprehensive first-aid manual or information cards

Comprehensive care: Carry all of the basic items listed above; add items below based on anticipated needs.

Note: The list below is intentionally extensive; rarely will a single kit include every item shown here.

• Wound coverings
• Rolled gauze
• Rolled, stretch-to-conform bandages
• Elastic wrap
• Hydrogel-based pads
• First-aid cleansing pads with topical anesthetic
• Hemostatic (blood-stopping) gauze
• Liquid bandages
• Oval eye pads
• Medications/treatments
• Hand sanitizer (BKZ- or alcohol-based)
• Aloe vera gel (sun exposure relief)
• Aspirin (primarily for response to a heart attack)
• Antacid tablets
• Throat lozenges
• Lubricating eye drops
• Loperamide tablets (for diarrhea symptoms)
• Poison ivy/poison oak preventative
• Poison ivy/poison oak treatment
• Glucose or other sugar to treat hypoglycemia
• Oral rehydration salts (e.g., CeraLyte)
• Antifungal foot powder
• Prescription medications (e.g., antibiotics)
• Injectable epinephrine to treat allergic reactions (e.g., EpiPen, Twinject)

First-aid Tools

• Knife (or multi-tool with knife)
• Paramedic shears (blunt-tip scissors)
• Safety razor blade (or scalpel w/#15 or #12 blade)
• Finger splint(s)
• SAM splint(s)
• Cotton-tipped swabs
• Standard oral thermometer
• Low-reading (hypothermia) thermometer
• Irrigation syringe with 18 gauge catheter
• Magnifying glass
• Small mirror
• Medical/surgical gloves (nitrile preferred; avoid latex)
• Triangular cravat bandage
• Steel sewing needle with heavy-duty thread
• Needle-nose pliers with wire cutter
• Headlamp (preferred) or flashlight
• Whistle (pealess preferred)
• Duct tape (small roll)
• Small notepad with waterproof pencil or pen
• Medical waste bag (plus box for sharp items)
• Waterproof container to hold supplies and meds
• Emergency heat-reflecting blanket

Personal care, other items

• Sunscreen
• Lip balm
• Insect repellent (plus headnet, if needed)
• Biodegradable soap
• Water-disinfection system
• Collapsible water sink or basin

Remember that First Aid supplies expire and make sure you know how to use everything in your kit.  If you take something out REPLACE as soon as possible

WHAT MEDICINES SHOULD BE IN YOUR FIRST AID KIT DURING TRAVEL

You should always have verbal orders or written protocols from your Medical Director to administer prescription medications in the field. You should have verbal orders or written protocols from your Medical Director to administer over-the-counter medications to minors.  Without these protocols, you are potentially practicing medicine without a license, which is illegal.  In addition to having medication administration protocols, you should obtain informed consent for medication administration, even non-prescription medication.  Inform the recipient of the indications, contraindications and possible side effects of the medication and obtain consent to administer.

Before administering any medication read the protocols, confirm the dosage, read the label and confirm the medication, ask the patient about previous history with this medication and any known allergies, ask the patient if they are currently on any medication and if so, review the protocols for contraindications.Please note that the following medication information is for medication available in the United States.  Outside of the Unites States medication may carry different trade names.  Some medication available only by prescription in the United States may be available without a prescription in other countries and may be prepared in different dosing.  If you purchase medication outside of the United States you should confirm classification, dose, indication, contraindication and possible side effects before administering it. 

All dosing is indicated for adults. Pediatric dosing should be dictated by your Medical Director.ATC medical advisor represents that the information provided was developed utilizing current resources and standards.  Medication administration is a complex decision that requires consultation with a Physician.  The information below is not a substitute for a Medical Director, nor should it be used without authorization and approval by a Physician.  Italiaoutdoors does not endorse or recommend specific medications.

Abbreviations

:PO:  Oral
SQ:  Subcutaneous injection
IM:  Intramuscular injection

Drug Information Provided OnAnalgesic (Painkillers)-Over-The-Counter
    Acetaminophen (e.g. Tylenol)
    Aspirin (e.g. Bayer, Ecotrin)
    Ibuprofen (e.g. Advil, Motrin)
    Ketoprofen (e.g. Orudis KT)
    Naproxen (e.g. Aleve)
    Phenazopyridine hydrochloride (e.g. Pyridium, Uristat)
Analgesics (Painkillers)-Prescription
    Hydrocodone bitartrate/acetominophen (e.g. Vicodin)
    Oxycodone/acetominophen (e.g. Percocet, Roxicet)
Anti-Allergy-Over-The-Counter
    Phenylephrine (e.g. Neo-Synephrine)
    Hydrocortisone acetate (e.g. Cortaid)
    Diphenhydramine hydrochloride (e.g. Benadryl)
    Pseudoephedrine hydrochloride (e.g. Sudafed)
Anti-Allergy-Prescription
    Albuterol
    Epinephrine (e.g. Adrenalin or EpiPen)
Antibiotic-Over-The-Counter
    Polymyxin B sulfate/bacitracin (e.g. Polysporin)
Antibiotic-Prescription
    Erythromycin
    Trimethoprim Sulfamethoxazole (e.g. Septra or Bactrim)
    Cephalexin (e.g. Keflex)
    Ciprofloxacin hydrochloride (e.g. Cipro)
Anti-Fungal-Over-The-Counter
    Tolnaftate (e.g. Tinactin)
    Miconazole nitrate (e.g. Monistat 3)
Anti-Fungal-Prescription
    Fluconazole (e.g. Diflucan)
Anti-Emetics (Anti-Vomiting) and Anti-Acids-Over-The-Counter
    Calcium carbonate (e.g. Tums, Maalox)
    Bismuth subsalicylate (e.g. Pepto-Bismol)
Anti-Emetics (Anti-Vomiting) and Anti-Acids-Prescription
    Prochlorperazine (e.g. Compazine)
    Promethazine (e.g. Phenergan)
Anti-Vertigo (Anti-Motion Sickness)-Over-The-Counter
    Meclizine (e.g. Antivert, Bonine)
Anti-Vertigo (Anti-Motion Sickness)-Prescription
    Scopolamine (e.g. Trans-Derm Scop)
Anti-Diarrheal-Over-The-Counter
    Loperamide hydrochloride (e.g. Imodium)
Anti-Diarrheal-Prescription
    Diphenoxylate hydrochloride with atropine sulfate (e.g. Lomotil)
Anti-Altitude-Prescription
    Acetazolamide (e.g. Diamox)
    Dexamethasone (e.g. Decadron)
    Nifedipine (e.g. Procardia)Analgesics (Painkillers)-Over-The-CounterAcetaminophen (e.g. Tylenol)

Classification: Non-narcotic analgesic, antipyretic
Dose: 650mg/4-6 hours PO (Regular strength), 1000mg/6 hours PO (Extra strength).  Maximum dose 4g/24 hours PO.
Indications: For relief of pain due to headache, cold and flu discomfort, minor muscle and joint discomfort and menstrual cramps. For reduction of fever. Especially useful for those allergic to aspirin or aspirin-containing products. Does not control inflammation.
Contraindications: Hypersensitivity, active alcoholism, liver disease, hepatitis.  Acetaminophen is a common ingredient in over-the-counter pain, cold and flu medicine.  Be careful of accidental overdose in combination with other products.
Side Effects: Hypersensitivity is rare.Aspirin (e.g. Bayer, Ecotrin)

Classification: Analgesic, Non-Steroidal Anti-Inflammatory Drug (NSAID), antipyretic, anticoagulant.
Dose: 325-650 mg/4 hours PO (Regular strength), 500-1000mg/4-6 hours PO (Extra strength), 162-325mg/24 hours PO for cardiac chest pain.  Maximum dose 4g/24 hours PO.
Indications: For relief of pain due to headache, cold and flu discomfort, minor muscle and joint discomfort and menstrual cramps. For reduction of fever. Controls inflammation. Can be used to “cauterize” exposed tooth pulp. For use
with cardiac chest pain.
Contraindications: Allergic sensitivity.  Gastrointestinal bleeding, bleeding disorders, impaired liver function.  Do not give to children under 12.
Side Effects:  Gastrointestinal distress, allergic reaction.Ibuprofen (e.g. Advil, Motrin)

Classification: Analgesic, Non-Steroidal Anti-Inflammatory Drug (NSAID), antipyretic.
Dose: 400-800mg/4-8 hours PO
Indications: For symptomatic relief of pain associated with headache, colds, flu, frostbite, toothache, arthritis, burns and menstrual cramps. May be used to reduce fever. For pain of inflammation and reduction of inflammation associated with muscle, joint and over-use injuries.
Contraindications: Active peptic or gastrointestinal ulcer, gastrointestinal bleeding disorder, history of hypersensitivity to aspirin or other NSAIDs.
Side Effects:  Nausea, epigastric pain, dizziness and rash.  Ketoprofen (e.g. Orudis KT)

Classification: Analgesic, Non-Steroidal Anti-Inflammatory Drug (NSAID).
Dose: 75mg/8 hrs PO
Indications: For symptomatic relief of pain associated with headache, colds, flu, frostbite, toothache, arthritis, burns and menstrual cramps. May be used to reduce fever. For pain of inflammation and reduction of inflammation associated with muscle, joint and over-use injuries.  
Contraindications: Active peptic or gastrointestinal ulcer, gastrointestinal bleeding disorder, history of hypersensitivity to aspirin or other NSAIDs.
Side Effects: Nausea, diarrhea and epigastric pain.Naproxen (e.g. Aleve)

Classification: Analgesic, Non-Steroidal Anti-Inflammatory Drug (NSAID).
Dose: 550mg/12 hrs PO
Indications: For symptomatic relief of pain associated with headache, colds, flu, frostbite, toothache, arthritis, burns and menstrual cramps. May be used to reduce fever. For pain of inflammation and reduction of inflammation associated with muscle, joint and over-use injuries. .
Contraindications: Hypersensitivity to aspirin or other NSAIDs.
Side Effects: Nausea, constipation, abdominal pain, headache, dizziness and drowsiness.Phenazopyridine hydrochloride (e.g. Pyridium, Uristat)

Classification: Urinary tract analgesic
Dose: 100-200mg/6-8 hrs PO
Indications: For symptomatic relief of burning, pain, urgency and frequency associated with urinary tract/bladder infections. Should be used concurrently with an antibiotic.
Contraindications: Hypersensitivity. Renal/liver insufficiency.
Side Effects:  Headache, gastrointestinal disturbance and rash.  Dye stains clothing.Analgesics (Painkillers)-PrescriptionHydrocodone bitartrate/acetominophen (e.g. Vicodin)

Classification: Narcotic analgesic, antitussive.
Dose: 5-10mg/4-6 hours PO
Indications: For moderate to severe pain. Narcotic. Good for musculoskeletal
and dental pain. Good for people allergic to codeine.  Suppresses cough reflex.
Contraindications: Hypersensitivity.
Side Effects: Sedation, decrease in blood pressure, sweating and flushed face, drowsiness and dizziness.Oxycodone/acetominophen (e.g. Percocet, Roxicet)

Classification: Narcotic analgesic.
Dose: 5-10mg/ 4 hours PO
Indications: For severe pain.
Contraindications: Hypersensitivity.  Caution with CNS depression, respiratory depression, seizures and shock.
Side Effects:  Drowsiness, dizziness, hypotension, anorexia, nausea,vomiting and constipation.Anti-Allergy-Over-The-CounterPhenylephrine (e.g. Neo-Synephrine)

Classification: Nasal decongestant
Dose: Blow nose before medication is administered, tilt head back, apply 2-3 drops or 1-2 sprays in each nostril.  Wait 5 minutes between nostrils.
Indications: For relief of nasal congestion that accompanies colds and allergies. May be useful to help stop nosebleed. May be useful to relieve sinus “squeeze” associated with diving.
Contraindications: Severe hypertension, ventricular tachycardia, pancreatitis, hepatitis, thrombosis, heart disease, narrow angle glaucoma.
Side Effects:  Rebound nasal congestion due to overuse (>3 days), stinging, burning, drying of nasal mucosa.Hydrocortisone acetate (e.g. Cortaid)

Classification: Glucocorticoid
Dose: Topical 1% cream, 2-4 times/day
Indications: For relief of pain and itching of nematocyst stings, poison ivy, oak and sumac, insect bites and other allergic skin reactions. May help dry up oozing rash of allergic skin reactions.
Contraindications: Serious infections, viral, fungal or tubercular skin lesions.
Side Effects: Itching, redness and irritation.Diphenhydramine hydrochloride (e.g. Benadryl)

Classification: Antihistamine
Dose: 25-50mg per 4-6 hours
Indications: For temporary relief of respiratory allergy symptoms and cold symptoms. Helps relieve the itching of allergic skin reactions. Useful in treatment of moderate allergic and anaphylactic reactions. May be used as a mild sedative and for insomnia. May help alleviate seasickness.  Can be used to treat distonic reations.
Contraindications: Hypersensitivity, acute asthma attack, glaucoma, peptic ulcer, hypertension and COPD.
Side Effects: Drowsiness, dizziness, weakness, hypotension, dry mouth, thickening bronchial secretions and urinary retention.Pseudoephedrine hydrochloride (e.g. Sudafed)

Classification: Nasal decongestant
Dose: 60mg per 4-6 hours
Indications: Decongestant useful in treating upper airway sinuses and nasal passages. Use of more that 5 days may cause reverse effects.
Contraindications:  Severe hypertension, coronary artery disease, lactating women, MAO inhibitor therapy.
Side Effects: Nervousness restlessness, insomnia, trembling and headache.Anti-Allergy-PrescriptionAlbuterol

Classification: Bronchodilator
Dose: Two puffs of metered dose inhaler (MDI) with use of a spacer every 4 hours and as needed.
Indications: Shortness of breath or respiratory difficulty thought to be secondary to reactive airway dysfunction (asthma) or HAPE.
Contrainidications: Tachycardia secondary to underlying heart condition.
Side Effects: Palpitations, tachycardia and tremor.Epinephrine (e.g. Adrenalin or EpiPen)

Classification: Bronchodilator, antiallergenic, cardiac stimulant.
Dose: .3ml 1:1000 SQ or IM. Repeat as necessary.
Indications: For severe allergic reactions including anaphylaxis and status asthmaticus.
Contraindications: No true contraindications with anaphylaxis.  Hypertension, cardiac disease, glaucoma and shock.
Side Effects: Increased heart rate, nervousness, dizziness, lightheadedness, nausea and headache.Antibiotic-Over-The-CounterPolymyxin B sulfate/bacitracin (e.g. Polysporin)

Classification: Antibiotic
Dose: Topical
Indications: Contains ingredients for prevention of infection in minor wounds. Works as a lubricant, offers some relief from itching.
Contraindications:   Hypersensitivity.
Side Effects: Hypersensitivity reactions-burning, itching, inflammation, contact dermatitis.Antibiotic-PrescriptionErythromycin

Classification: Antibiotic
Dose: 250mg/6 hrs for 5 days.  Take with food.
Indications: For sinus, pulmonary, ear, eye, respiratory and soft tissue infections.
Contraindications: Hypersensitivity, liver disease, hepatitis.
Side Effects: Abdominal discomfort and cramping, nausea, vomiting, diarrhea and rash.Trimethoprim Sulfamethoxazole (e.g. Septra or Bactrim)

Classification: Antibiotic
Dose: Single strength tablet contains 80mg trimethoprim and 400mg sulfamethoxazole.  Double strength tablet contains 160mg trimethoprim and 800mg sulfamethoxazole.  Dose is 2 single strength tablets or 1 double strength tablet/12 hours PO.  Recommended length, 5 days for UTI and infectious diarrhea, 10-14 days for  kidney infection.
Indications: For marine wounds, kidney, ear, sinus and some respiratory infections. Best for urinary tract infections. Works with infectious diarrhea if ciprofloxacin unavailable.
Contraindications:  Hypersensitivity, anemia.
Side Effects: Nausea, vomiting, diarrhea, decreased appetite, stomach cramps, headache.Cephalexin (e.g. Keflex)

Classification: Antibiotic
Dose: 250-500mg per 6 hours for at least 5 days.
Indications: For skin, bone, pnuemonia and urinary tract infections.
Contraindications: Hypersensitivity. Sensitivity to penicillins.
Side Effects:  Oral and vaginal fungal infections, diarrhea and abdominal cramping.Ciprofloxacin hydrochloride (e.g. Cipro)

Classification: Antibiotic
Dose: 250mg/12 hours PO for UTI.  500mg/12 hours PO for kidney infection, infectious diarrhea, bone and joint infection.  See Physician for length of course.
Indications: Best for infectious diarrhea. Okay for bone and urinary
tract infections.
Contraindications: Hypersensitivity.
Side Effects:  Nausea, diarrhea, vomiting and constipation.Anti-Fungal-Over-The-CounterTolnaftate (e.g. Tinactin)

Classification: Antifungal
Dose: Topical, 2 applications/day
Indications: For treatment of superficial skin fungi such as ringworm, jock itch and athlete’s foot.
Contraindications: Hypersensitivity.
Side Effects:  Mild irritation.Miconazole nitrate (e.g. Monistat 3)

Classification: Antifungal
Dose: 200mg vaginal suppositories nightly for three nights or topical cream as needed.
Indications: Vaginal candidiasis.
Contraindications: Hypersensitivity, first trimester of pregnancy.
Side Effects:  Itching, burning and stinging.Anti-Fungal-PrescriptionFluconazole (e.g. Diflucan)

Classification: Antifungal
 Dose: 150mg once.
Indications: Vaginal candidiasis.
Contraindications: Hypersensitivity.
Side Effects: Fever, chills, dizziness, drowsiness, headache, constipation, diarrhea, nausea, vomiting, abdominal pain.Anti-Emetics (Anti-Vomiting) and Anti-Acids-Over-The-CounterCalcium carbonate (e.g. Tums, Maalox)

Classification:  Antacid
Dose: 500mg tablet as needed
Indications: For symptomatic relief of heartburn, acid indigestion, sour stomach and other conditions related to an upset stomach, including intestinal gas problems.
Contraindications: Hypersensitivity.
Side Effects: Swelling of legs and feet, fecal impaction, metabolic alkalosis.Bismuth subsalicylate (e.g. Pepto-Bismol)

Classification:  Antidiarrheal, antinauseant.
Dose:
Indications: For use in the control of diarrhea, nausea and upset
stomach. May help prevent “traveler’s diarrhea.”
Contraindications: Bleeding ulcers, hemophilia, kidney impairment.  Should not be taken by the aspirin allergic.
Side Effects: May turn tongue and stool black.Anti-Emetics (Anti-Vomiting) and Anti-Acids-PrescriptionProchlorperazine (e.g. Compazine)

Classification: Antiemetic
Dose: 5-10mg/6-8 hours PO or 10mg/12 hours PO (Extended release) or 25mg/12 hours rectal suppository.
Indications: Nausea and vomiting.
Contraindications: Hypersensitivity.  Glaucoma, bone marrow suppression, liver or cardiac impairment, blood pressure problems, CNS depression.
Side Effects: Muscle spasms of the neck are a common side effect, but are treatable with diphenhydramine.Promethazine (e.g. Phenergan)

Classification: Antihistamine, antiemetic.
Dose: 12.5-25mg/4-6 hours rectal suppository
Indications: Nausea and vomiting, motion sickness.
Contraindications: Glaucoma, CNS depression, intestinal or urinary tract obstruction.
Side Effects: Drowsiness, disorientation, hypotension and syncope.  Muscle spasms of the neck are a common side effect, but are treatable with diphenhydramine.Anti-Vertigo (Anti-Motion Sickness)-Over-The-CounterMeclizine (e.g. Antivert, Bonine)

Classification: Antiemetic, antivertigo
Dose: 25-50mg PO per day, I hour before exposure to motion.
Indications: Prevention and treatment of motion sickness, vertigo.
Contraindications: Hypersensitivity.
Side Effects: Drowsiness.Anti-Vertigo (Anti-Motion Sickness)-Prescription Scopolamine (e.g. Trans-Derm Scop)

Classification: Antinausea, antiemetic
Dose: 1.5 mg transdermal patch. Keep out of eyes. Put one patch behind ear 4-5 hours before needed.  Remove after 72 hours.
Indications: Prevention of motion sickness.
Contraindications: Glaucoma, urinary or intestinal obstruction, tachycardia.
Side Effects: Dry mouth, drowsiness, blurred vision, hallucinations, confusion.
Anti-Diarrheal-Over-The-CounterLoperamide hydrochloride (e.g. Imodium)

Classification: Antidiarrheal
Dose: 4mg PO initially followed by 2mg PO after each loose stool
Indications: For use in the control of diarrhea. Thought to limit peristalsis. Helpful in evacuating someone with severe diarrhea.
Contraindications:  Hypersensitivity.  Diarrhea secondary to certain bacteria (e.g., E.Coli)
Side Effects:  Dry mouth, dizziness, abdominal discomfort.Anti-Diarrheal-PrescriptionDiphenoxylate hydrochloride with atropine sulfate (e.g. Lomotil)

Classification: Antidiarrheal
Dose: 5mg/6 hours PO
Indications: For severe diarrhea.  Evacuate after 24 hours with no improvement.
Contraindications:  Liver disease, dehydration, glaucoma.
Side Effects:  Drowsiness, lightheadedness, dizziness, nausea.Anti-Altitude-PrescriptionAcetazolamide (e.g. Diamox)

Classification: Diuretic.
Dose: 250mg/6 to 12 hours PO (prevention dose = 125mg/12 hours PO)
Indications: For prevention and treatment of mild to moderate acute mountain sickness.
Contraindications: Sulfa-allergies, pregnancy, dehydration or renal disease.
Side Effects: Dehydration, tiredness, altered taste, nausea, numbness in extremities and lips. Dexamethasone (e.g. Decadron)

Classification: Corticosteroid.
Dose: 8mg PO or 10mg IM initially then 4mg/6 hours PO or IM during evacuation.
Indications: For treatment of High Altitude Cerebral Edema and increasing ICP from head trauma.
Contraindications: No absolute contraindications for short-term emergency use except hypersensitivity.
Side Effects: Cough, dry mouth, throat irritation, blurred vision, indigestion, personality and behavioral changes, muscle weakness.Nifedipine (e.g. Procardia)

Classification:  Antihypertensive
Dose:  10mg/8 hours PO or 30-60mg/24 hours PO (Extended release).
Indications: High Altitude Pulmonary Edema (HAPE).
Contraindications:  Hypersensitivity. Hypotension.
Side Effects:  Peripheral edema, headache flushed skin, dizziness.

Referenes: Mosby’s 2005 Drug Consult for Nurses.  Elsevier Mosby, St. Louis, MO.  2005.  ISBN 0-323-02847-0.Ogden MD, Herb and Tod Schimelpfenig.  Edited by Drew Leemon.  NOLS Field Medical Protocols and Drug Orders 2004.  Unpublished document.Saunders Nursing Drug Handbook 2004.  Saunders, St. Louis, MO.  2004.  ISBN 0-7216-0300-9.

Travel Italy | Emergency Services

DRUGSTORES AND PHARMACY'S IN ITALY The Italian pharmacy, or Farmacia, doesn't deal in many non-medical items, but they do have a monopoly on over-the-counter medications like aspirin and decongestants--and those medications may also include alcoholic "elixors." Learn about Italian pharmacies here. Italian Pharmacy General Information The number and opening hours of Italian Pharmacies are regulated by law. Pharmacies operate on a "rota" system designed to ensure an open pharmacy (or one which can be opened in a medical emergency) in each general area at night, holidays and Sundays. Each Pharmacy displays a card with its own opening hours, emergency telephone number, and where to go outside of those opening hours for emergency services. Pharmacists in Italy are allowed more leeway in dispensing health advice and selling pharmaceuticals than in the US. If you can describe your condition well, you may be able to procure a prescription directly from a pharmacist in Italy. Likewise, if you need a prescription filled on an emergency basis, you may be able to do so--if you know the scientific or generic name of the medicine you need and can make a good case for the pharmacist to dispense it. When to go to the Italian Pharmacy For minor aches and pains, cold or flu, and "little" non-critical emergencies, your best bet may be to head over to your local Farmacia. You'll go to a Farmacia for aspirin and even vitamins. Italian pharmacies will often carry homeopathic and herbal remedies as well. Many Italian pharmacists speak at least a little English, but if you are staying in Italy a while, you might want to learn some handy Italian at the Italian Language Audio Phrasebook: Pharmacy. The list will give you some idea of what you can purchase in an Italian Pharmacy. If you are suffering something more serious, or have had an injury not likely to be helped by aspirin, you can go to the 24-hour casualty departments, or pronto soccorso, at any hospital. If you are unable to transport yourself, the toll-free medical emergency telephone number in Italy is 118. You may get an ambulance by calling this number, or if you do not require transport to a hospital, the First Aid Service (Guardia Medica) will be sent. Finding Your Medicines in Italy Before you leave on your Italian vacation, you'll want to make sure you have enough of your prescription medicines for the duration of your trip. In addition, to avoid problems down the line, you'll want to carry the following:    •    Carry the medications in their original container.    •    Carry all medicines with you in your carry-on bag    •    Accompany each medication with a physician's written description of the medical problem    •    Know the generic or scientific name of the medicine The latter advice is crucial if you need to replenish a medicine during your trip. American pharmaceutical firms often give proprietary names to their version of common medicines and these names are not always recognized overseas. The information you carry above should be typewritten for clarity.