Letter Re: The Core Kit: First Aid and Beyond

Tuesday, Nov 13, 2012

Dear Mr. Rawles,
As a pharmacist of more years than I like to admit, I would like to make a few comments and additions regarding Jason J.'s recent excellent post on "The Core Kit - First Aid and Beyond". First, I must thank Jason for his time, knowledge, and insight, as well as for his service to our country. His sense of humor was well-received as well! My comments are minor, but may clarify/enhance an issue or two.

First, as Jason suggests, it is wise to follow "Universal Precautions" whenever you are dealing with the blood or bodily fluids of someone else. In the health care field, these precautions simply mean to protect yourself as if the unknown person has a blood-borne disease, whether you know it to be true or not. However, thankfully, Jason's statement: "Realize that every person has unique blood. This includes pathogens. We all have something in our blood we should not pass around" is a bit of an overstatement. The blood of a healthy person is sterile, except for the living blood cells that are a natural component of human blood.

With regard to the analgesic (pain med) section, I fear that a few typos may result in a misunderstanding of the intended points. First, ibuprofen should not be the long term choice of analgesic if you have stomach problems (especially if you're prone to ulcers). As a side-effect of it's pharmacological action, it inhibits the formation of the essential mucous layer which protects the lining of the stomach from the extreme acidity of the gastric juices. Using ibuprofen regularly, and long-term, is a sure recipe for ulcers and the inevitable G.I. bleed. Perhaps acetaminophen would be a better choice in people with stomach problems. While on the subject of ibuprofen (including its longer-acting sister, naproxen), it must be noted that it does indeed possess anti-inflammatory properties which are very useful in suppression of pain involving inflammation, such as rheumatoid arthritis (an auto-immune, inflammatory disease). In contrast, osteoarthritis (the general "wearing out" of joints which eventually manifests in most of us old geezers) is not considered an inflammatory condition (though acute flare-ups happen!). In this case, acetaminophen may relieve the pain without the stomach and kidney side-effects of ibuprofen.

Speaking of acetaminophen, though it is excellent for reducing fevers and helping to relieve some non-inflammatory pain, I would be remiss in not reminding everyone that it is the second most common cause of liver failure in the U.S. (anyone care to guess the first most common cause?...I'll drink to that!). To dramatically reduce the risk of this toxic phenomenon, many experts are now recommending that acetaminophen should be restricted to no more than 3 grams daily. Since a regular strength acetaminophen (i.e., Tylenol) tablet contains 325 mg, the maximum would be 9 tablets per day. Beware that "extra strength" tabs contain 500mg, and some sustained release products contain 650mg per tab. Also, be alert to other combination analgesics, often containing acetaminophen in a dose of 300-500mg per tab (e.g., Norco, Vicodin, Lortab, Lorcet, Percocet, etc.). If you're taking any of these drugs, this acetaminophen should be figured into your total daily dose count.

Finally, many medical folks (especially dermatologists) recommend the routine use of "double antibiotic ointment" (bacitracin and polymyxin) in the place of "triple antibiotic ointment" (bacitracin, polymyxin, neomycin) because many people develop a sensitivity (allergy) to neomycin - usually resulting in a local skin reaction which may confound assessment of the severity and healing progress of the wound. I haven't studied the data on this phenomenon, but many hospitals have changed to the double antibiotic ointment as the standard. Having said that, whichever you can get is far better than having none! Also, with regard to antibiotics and their appropriate uses, I would recommend a copy of "The Sanford Guide to Antimicrobial Therapy" to keep handy with whatever antibiotics you can store. This is a small paperback "pocket reference" published annually which summarizes the clinical use of antibiotics. Much of it is more detailed than most non-medical folks would need, but the first chapter addresses common infections by affected body system, and recommends empiric (i.e., "best guess without cultures") antibiotic choices based on the most likely involved pathogen. If you know a doctor, nurse practitioner, or hospital pharmacist, ask them if you can have their last year's edition. We usually throw them away when we get the new one, and the bulk of the recommendations rarely changes. You may also need to get a good magnifying glass. If the information is condensed much more, we're going to need a microscope to read it!

Thanks again, Jason, for your post, and, as always, thank you to Mr. Rawles for all that you do!

Best Regards, - S.H. in Texas


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