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Rx in the Wilderness: The 5 Medications You Need to Stay Alive

by Keith McCafferty

When we talk about survival, it’s the marquee dangers that carry the conversation: snakebite, gunshot, bear attack. Nobody mentions the microscopic bug in your intestines that causes such severe diarrhea that you die from dehydration, or the plaque that dislodges from an arterial wall to stop your heart. Not a word of the bee sting that induces anaphylactic shock, asphyxiating you as mercilessly as the coils of a python.

Such little things can kill you, but other little things can save your life. In a wilderness emergency, the five pharmaceuticals in the chart at right can be very big medicine. Use it as a guide, and consult with your doctor.

Customize It’s smart to modify your medical kit to your environment and medical history. For example, you don’t need to pack epinephrine if you have no history of allergies. Also, if you’ll hike above 8,000 feet, consult your doctor about getting a prescription for acute mountain sickness. Acetazolamide (Diamox) or dexamethasone (Deca­dron) tablets can save a life if the victim is promptly evacuated to a lower altitude.

There’s also a pill you might consider adding: a narcotic pain medication such as oxycodone (Percocet) or hydrocodone (Vicodin). If you break a leg, for example, it could mean the difference between hobbling out under your own power or dying where you are. But narcotics must be used with caution. Because they relieve pain by suppressing the brain’s ability to perceive it, they can affect your thinking. If your companion is injured, a pain pill may calm him enough to help you get him to safety. Self-medication is riskier. Only consider using a specific narcotic if you have taken it before and know that it does not affect your decision-making abilities. Otherwise, substitute ibuprofen (Advil, Motrin), which will attack your pain at the site of the injury, leaving your mind clear to help get you out of trouble.

Asprin
For - Chest pain, aches, and to reduce fever.
Dosage - Chew and swallow four 81mg chewable tablets at the onset of chest pain. For aches and fever, follow label directions.
Warning - If you’re allergic to aspirin, other over-the-counter pain relievers can reduce fever, but they don’t thin blood.

Anti-Diarrheal (Imodium A-D)
For - Relief from severe diarrhea that causes dehydration.
Dosage - Swallow two tablets initially, followed by one tablet after each loose bowel movement, not to exceed four tablets daily.
Warning - Consult a doctor before using other antidiarrheals containing bismuth salicylate (Pepto-Bismol).

AntiEmetic (zofran)
For - Severe nausea and vomiting, leading to dehydration.
Dosage - Place one to two 4mg oral dissolving tablets on the tongue every 4 to 6 hours as needed.
Warning - Phenergan suppositories are cheaper, but side effects include twitchy muscles and restlessness; relieve them with Benadryl.

AntiAllergy (Epinephrine supplemented by Benadryl)
For - Allergic reactions to stings or foods, resulting in anaphylactic shock.
Dosage - Inject medicine using an EpiPen. Supplement with Benadryl at the onset of allergy symptoms, 50mg every four to six hours.
Warning - The effects of epinephrine are temporary. Seek medical assistance as quickly as possible.

Antibiotic (Levaquin)
For - Pneumonia; bronchitis; and skin, soft-tissue, sinus, or urinary infections.
Dosage - Take 750mg once per day.
Warning - Levaquin is not recommended for children or teenagers. Check with your doctor for alternatives.

 

From the June 2012 issue of Field & Stream magazine.

Comments (15)

Top Rated
All Comments
from Proverbs wrote 1 year 44 weeks ago

Interesting. For years I've carried four of the above in a small red RX med bag that goes into whatever backback I'll be using - whether that is for hunting, fishing, or just camping with the family. The RX bag gets checked/refreshed/stocked prior to any and every outdoors trip, or even a road trip.

I carry a few more items in the bag: A)Product containing mink oil for post-bite/sting applications. The mink oil varieties are worth it because beyond ceasing the pain, these products seem to slow the spread of venom (bees, hornets, etc), and I've seen swelling reduced soon after application; B)Product such as Neosporin to prevent small problems from quickly becoming big ones; and C)An asthma inhaler.

The last one is for friends who seem to never have theirs with them when we run into something blooming that triggers an attack, and without it we could be in real trouble. I can think of several episodes where my inhaler saved the day for different people. In one of the cases, a hunting companion started wheezing/heaving when we set up a large army-surplus tent that hadn't been used for several years. Whatever was in the accumlated dust had all of us coughing, but this particular person started turning color. A few minutes after administering the inhaler, he was OK. You just never know.

Good blog.

+4 Good Comment? | | Report
from RES1956 wrote 1 year 44 weeks ago

On my maiden voyage to the great western mountains, I ate some airline chicken that took over my GI tract the next day. Nausea and diarrhea ravaged me and the Ruby Mountains of NW Nevada for the next two days and would have longer had I not been traveling with a fine friend and pharmacist who had a dity bag that would rival most mexican apothecaries and was well stocked with Lomotil, among other things.
I guess the lesson learned was, one, don't eat airline food and always be prepared for the unexpected, if you don't routinely travel with a pharmacist.
Good thread and advice from Mr. McCafferty.

+3 Good Comment? | | Report
from Happy Myles wrote 1 year 44 weeks ago

Keith,
It is interesting how most folks show up in 3d World situations with their normal prescriptions and a kit for horrible injuries yet nothing for things you have mentioned. My doctor and I have worked out a similar list focusing on getting me home as painless, and as healthy as possible. I have spent time in two 3rd World hospitals, not great experiences.

Allergy and insect reactions are two most folks don't prepare for. Diarrhea, and vomiting are serious when even with the best efforts you may be hours and hours from medical care.

As I recall, the use of Diamox begins at home before you head for high altitude. Your doctor is the one to see if it safe for your blood down here at sea level

Am not an expert on medicine, but am pretty experienced in crazy places around the world when the wheels fall off

+2 Good Comment? | | Report
from Happy Myles wrote 1 year 44 weeks ago

Oh, an eye cup and solution can save a lot of unpleasantness.

+2 Good Comment? | | Report
from 1uglymutha wrote 1 year 44 weeks ago

a wprd to the wise concerning prescription medications in the state of colorado: it is unlawful in this state to carry any prescription medication unless it is transported in it's original prescription container. those of you trying to save weight and space by backpacking prescription medications all together in a single container are commiting a misdemeanor violation under colorado law. i found this out the hard way.

+2 Good Comment? | | Report
from wild rice wrote 1 year 44 weeks ago

Did anyone say anything about carrying a good old
plug of chewing tobacco? It sure worked for Marshall
Rooster Cogburn and saved Mattie's life.

+1 Good Comment? | | Report
from mdsulli2 wrote 1 year 43 weeks ago

The chewable packs of Pepto have come in handy more than once. In addition to the Benadryl, Claritan works all day for people with allergies.

+1 Good Comment? | | Report
from Louzianajones wrote 1 year 43 weeks ago

Glad I read this article. I am planning for a road trip soon, and need to update my first aid gear.

0 Good Comment? | | Report
from Trapper Vic wrote 1 year 43 weeks ago

Don't forget poison ivy! Qvel is great stuff and is effective imediately.

0 Good Comment? | | Report
from Roger Spencley wrote 1 year 43 weeks ago

This is all good sound advise, but does a real doctor know you are prescribing medications? Most especially narcotics? Some of this stuff will kill you just as fast as a bear attack, maybe faster. If you think you really need this stuff, CONSULT YOUR OWN FAMILY PHYSICIAN.

-1 Good Comment? | | Report
from chasseur wrote 1 year 42 weeks ago

Generally, Keith has excellent advice on the types of medications that might be needed and would not typically be a part of a wilderness first-aid kit. A few clarifications: Zofran, Percocet(and most other narcotics), Epipen devices, and Levaquin are all prescription medications. As he says, his advice is a guide; you should be getting these or an equivalent appropriate for you) from your doctor.

One addition regarding mountain sickness: a recent study shows that non-prescription ibuprofen (Advil, Motrin, etc.) appears to be as effective in combating altitude sickness as Diamox or Decadron and is far safer. Besides, as recommended, it can do double-duty as a pain reliever.

Again, when in doubt, ask your family doctor for advice.

(And yes, I am an M.D. with wilderness medicine experience.)

0 Good Comment? | | Report
from Semibald wrote 1 year 42 weeks ago

I am an MD, and I agree with Keith's article and chasseur's comments above. However, I think Lomotil (an Rx med) is way better for diarrhea than Imodium AD. Lomotil does a better job of stopping the painful cramping associated with diarrhea. You must get it with an Rx, but if you tell your physician why you want it, I'm sure most would have no problem prescribing it. I don't go anywhere, wilderness or otherwise, without it. (Ask for Zofran Rx while you're at it.) I would add a small tube of neosporin to my kit, also. Epi-Pen + Benadryl is good for severe (and possibly life-threatening) allergies, but Benadryl is very sedating. For poison ivy, chiggers, mosquito bites, etc. I would pack Claritin, Zyrtec, or Allegra - non-sedating anti-histamines.

0 Good Comment? | | Report
from Richard Hubbell wrote 1 year 26 weeks ago

I am a Vanderbilt-trained physician who received his emergency medicine training from Paul Auerbach, and I just have to say that this is the best, most common-sense article on pharmacologic preparedness I have ever read. EVERYONE heading to the Great Outdoors should clip'n'save this article and get every medicine mentioned. I would recommend hydrocodone over oxycodone due to the increased risk of nausea with oxy (alleviated by food, but this cuts into your rations). I would also recommend adding Cipro (500 mg twice a day) to go with the Levaquin (which was an inspired choice!), especially for women, who are more prone to urinary tract infections. In my experience, it is the best for UTIs. One 150 mg pill of Diflucan is handy, as it knocks out the yeast infections caused by antibiotics (another must for females). Dramamine for dizziness/nausea, Neosporin as mentioned above, and OTC Prilosec are also appreciated. As funny as it sounds, severe heartburn can really take away the enjoyment of a day's hike, plus, in severe cases it can be mistaken for a heart attack. One a day and you can eat whatever you like with near impunity. I like to have muscle relaxants such as Soma or Baclofen, as a lot of pain is from muscle strain. They require a bit more care, so make sure you know what you are doing. Last but not least...our lady hikers need to remember to pack their birth control pills. Again, this is an excellent article. Well done!

0 Good Comment? | | Report
from BassCanuck wrote 1 year 22 weeks ago

You forgot to mention an antacid like tums or pepto bismol

0 Good Comment? | | Report
from Debra Wiggins S... wrote 48 weeks 13 hours ago

Poison ivy/oak is tough if you are highly allergic(as I am) Burts Bees make a great soap for ivy/oak plus benedryl, claritan and calamine lotion. Good old bleach can come in handy as can tea tree oil and citronella oil. Remember to boil your water which is why old timers drank so much coffee and soap should be rinsed thoroughly when doing dishing(boiled water again) or you may get diarrhea. Also cayenne pepper stops bleeding and helps with shock and comes as an herb or capsules or tincture and I have found it irreplaceable.

0 Good Comment? | | Report

Post a Comment

from Proverbs wrote 1 year 44 weeks ago

Interesting. For years I've carried four of the above in a small red RX med bag that goes into whatever backback I'll be using - whether that is for hunting, fishing, or just camping with the family. The RX bag gets checked/refreshed/stocked prior to any and every outdoors trip, or even a road trip.

I carry a few more items in the bag: A)Product containing mink oil for post-bite/sting applications. The mink oil varieties are worth it because beyond ceasing the pain, these products seem to slow the spread of venom (bees, hornets, etc), and I've seen swelling reduced soon after application; B)Product such as Neosporin to prevent small problems from quickly becoming big ones; and C)An asthma inhaler.

The last one is for friends who seem to never have theirs with them when we run into something blooming that triggers an attack, and without it we could be in real trouble. I can think of several episodes where my inhaler saved the day for different people. In one of the cases, a hunting companion started wheezing/heaving when we set up a large army-surplus tent that hadn't been used for several years. Whatever was in the accumlated dust had all of us coughing, but this particular person started turning color. A few minutes after administering the inhaler, he was OK. You just never know.

Good blog.

+4 Good Comment? | | Report
from RES1956 wrote 1 year 44 weeks ago

On my maiden voyage to the great western mountains, I ate some airline chicken that took over my GI tract the next day. Nausea and diarrhea ravaged me and the Ruby Mountains of NW Nevada for the next two days and would have longer had I not been traveling with a fine friend and pharmacist who had a dity bag that would rival most mexican apothecaries and was well stocked with Lomotil, among other things.
I guess the lesson learned was, one, don't eat airline food and always be prepared for the unexpected, if you don't routinely travel with a pharmacist.
Good thread and advice from Mr. McCafferty.

+3 Good Comment? | | Report
from Happy Myles wrote 1 year 44 weeks ago

Keith,
It is interesting how most folks show up in 3d World situations with their normal prescriptions and a kit for horrible injuries yet nothing for things you have mentioned. My doctor and I have worked out a similar list focusing on getting me home as painless, and as healthy as possible. I have spent time in two 3rd World hospitals, not great experiences.

Allergy and insect reactions are two most folks don't prepare for. Diarrhea, and vomiting are serious when even with the best efforts you may be hours and hours from medical care.

As I recall, the use of Diamox begins at home before you head for high altitude. Your doctor is the one to see if it safe for your blood down here at sea level

Am not an expert on medicine, but am pretty experienced in crazy places around the world when the wheels fall off

+2 Good Comment? | | Report
from Happy Myles wrote 1 year 44 weeks ago

Oh, an eye cup and solution can save a lot of unpleasantness.

+2 Good Comment? | | Report
from 1uglymutha wrote 1 year 44 weeks ago

a wprd to the wise concerning prescription medications in the state of colorado: it is unlawful in this state to carry any prescription medication unless it is transported in it's original prescription container. those of you trying to save weight and space by backpacking prescription medications all together in a single container are commiting a misdemeanor violation under colorado law. i found this out the hard way.

+2 Good Comment? | | Report
from wild rice wrote 1 year 44 weeks ago

Did anyone say anything about carrying a good old
plug of chewing tobacco? It sure worked for Marshall
Rooster Cogburn and saved Mattie's life.

+1 Good Comment? | | Report
from mdsulli2 wrote 1 year 43 weeks ago

The chewable packs of Pepto have come in handy more than once. In addition to the Benadryl, Claritan works all day for people with allergies.

+1 Good Comment? | | Report
from Louzianajones wrote 1 year 43 weeks ago

Glad I read this article. I am planning for a road trip soon, and need to update my first aid gear.

0 Good Comment? | | Report
from Trapper Vic wrote 1 year 43 weeks ago

Don't forget poison ivy! Qvel is great stuff and is effective imediately.

0 Good Comment? | | Report
from chasseur wrote 1 year 42 weeks ago

Generally, Keith has excellent advice on the types of medications that might be needed and would not typically be a part of a wilderness first-aid kit. A few clarifications: Zofran, Percocet(and most other narcotics), Epipen devices, and Levaquin are all prescription medications. As he says, his advice is a guide; you should be getting these or an equivalent appropriate for you) from your doctor.

One addition regarding mountain sickness: a recent study shows that non-prescription ibuprofen (Advil, Motrin, etc.) appears to be as effective in combating altitude sickness as Diamox or Decadron and is far safer. Besides, as recommended, it can do double-duty as a pain reliever.

Again, when in doubt, ask your family doctor for advice.

(And yes, I am an M.D. with wilderness medicine experience.)

0 Good Comment? | | Report
from Semibald wrote 1 year 42 weeks ago

I am an MD, and I agree with Keith's article and chasseur's comments above. However, I think Lomotil (an Rx med) is way better for diarrhea than Imodium AD. Lomotil does a better job of stopping the painful cramping associated with diarrhea. You must get it with an Rx, but if you tell your physician why you want it, I'm sure most would have no problem prescribing it. I don't go anywhere, wilderness or otherwise, without it. (Ask for Zofran Rx while you're at it.) I would add a small tube of neosporin to my kit, also. Epi-Pen + Benadryl is good for severe (and possibly life-threatening) allergies, but Benadryl is very sedating. For poison ivy, chiggers, mosquito bites, etc. I would pack Claritin, Zyrtec, or Allegra - non-sedating anti-histamines.

0 Good Comment? | | Report
from Richard Hubbell wrote 1 year 26 weeks ago

I am a Vanderbilt-trained physician who received his emergency medicine training from Paul Auerbach, and I just have to say that this is the best, most common-sense article on pharmacologic preparedness I have ever read. EVERYONE heading to the Great Outdoors should clip'n'save this article and get every medicine mentioned. I would recommend hydrocodone over oxycodone due to the increased risk of nausea with oxy (alleviated by food, but this cuts into your rations). I would also recommend adding Cipro (500 mg twice a day) to go with the Levaquin (which was an inspired choice!), especially for women, who are more prone to urinary tract infections. In my experience, it is the best for UTIs. One 150 mg pill of Diflucan is handy, as it knocks out the yeast infections caused by antibiotics (another must for females). Dramamine for dizziness/nausea, Neosporin as mentioned above, and OTC Prilosec are also appreciated. As funny as it sounds, severe heartburn can really take away the enjoyment of a day's hike, plus, in severe cases it can be mistaken for a heart attack. One a day and you can eat whatever you like with near impunity. I like to have muscle relaxants such as Soma or Baclofen, as a lot of pain is from muscle strain. They require a bit more care, so make sure you know what you are doing. Last but not least...our lady hikers need to remember to pack their birth control pills. Again, this is an excellent article. Well done!

0 Good Comment? | | Report
from BassCanuck wrote 1 year 22 weeks ago

You forgot to mention an antacid like tums or pepto bismol

0 Good Comment? | | Report
from Debra Wiggins S... wrote 48 weeks 13 hours ago

Poison ivy/oak is tough if you are highly allergic(as I am) Burts Bees make a great soap for ivy/oak plus benedryl, claritan and calamine lotion. Good old bleach can come in handy as can tea tree oil and citronella oil. Remember to boil your water which is why old timers drank so much coffee and soap should be rinsed thoroughly when doing dishing(boiled water again) or you may get diarrhea. Also cayenne pepper stops bleeding and helps with shock and comes as an herb or capsules or tincture and I have found it irreplaceable.

0 Good Comment? | | Report
from Roger Spencley wrote 1 year 43 weeks ago

This is all good sound advise, but does a real doctor know you are prescribing medications? Most especially narcotics? Some of this stuff will kill you just as fast as a bear attack, maybe faster. If you think you really need this stuff, CONSULT YOUR OWN FAMILY PHYSICIAN.

-1 Good Comment? | | Report

Post a Comment

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