Austere Anaesthesia by Aebhric OKelly MA, FAWM, Critical Care Paramedic

Austere Anaesthesia  by Aebhric OKelly MA, FAWM, Critical Care Paramedic

Austere Anaesthesia  by Aebhric OKelly MA, FAWM, Critical Care Paramedic

Pain Management with OTC meds. There are a few options out there for pain meds for the non physician. Obviously the best option out there is to have a physician prescribe some heavy hitters. Unfortunately, this is not always an option for Austere Medics.

Ibuprofen has two doses: 400mg will have an analgesic effect and 600-800mg will have an anti-inflammation effect. Ibuprofen is an analgesic and an anti inflammatory. This will benefit any outdoor professional who is in pain from blisters, sprained ankles, or sore muscles. Taking the 800mg dose will address the pain and the inflammation of these injuries.

Paracetamol or Tylenol: 1gm up to 4gm per day. Even the military include this for battlefield casualties. It is also has the highest ratio of success of any analgesic. This means that more people can successfully take Paracetamol without dangerous side effects. Definitely a safe option for the Austere Settings.

Mixing Ibuprofen & Paracetamol: Recent studies have shown that taking 400mg of Ibuprofen and 1gm of Paracetamol/Tylenol together will be have a analgesic effect similar to 2mg of morphine.

Other OTC sedation drugs 

Chlorphenamine (CPM): is used as an anti-histamine. It is great for a runny nose. It can be used for a general analgesic. For Austere Medics who need to debride an infected wound it would help with calming and partially sedating the casualty. Anti-histamines are also quite effective for motion sickness and the prevention of the same. CPM also has an anti nausea effect and can be useful for someone who is suffering from motion sickness or other forms of nausea.

Diphenhydramine (DPH): is used primarily in North America and has the same uses and effect as CPM.

Our Tropical, Travel and Expedition Medicine (TTEMS) graduates get tuition in over-the-counter medications as well as the paramedic formulary. This has been quite useful for their careers as Austere Medics. One of our graduates got a job as the medic for a Mount Kilimanjaro trip for a not-for-profit organisation. As you can imagine they never thought about getting paramedic drugs for the medic. Our graduate quickly grabbed as many drugs as he could from the local chemist before flying to Africa. He had to deal with an ankle fracture with the Paracetamol/ Ibuprofen combination. It worked reasonable well and the casualty was grateful to have pain relief.

Prescription Only Drugs. According to the Pain Ladder, the use of Prescription Only Medications is warranted for moderate to severe pain. IV Paracetamol and Fentanyl are great options. For severe pain there is a need for ketamine with midazolam or possibly higher doses of fentanyl.

Reusing kit. A lot of anaesthetic kit can be reused after sterilisation. For the Austere Medic there are few options available. Having a pressure cooker in the team house is great for sterilising your medical kit. Make sure that your scrub the kit first to remove all of the bits first.

This is blog is for information purposes only. It is imperative that you are a physician or working under the orders of a licensed and registered doctor when using austere anaesthetic skills.

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