Most people that know me are well aware that I use my iPOD for most everything in my life. This includes my schedule, music, movies and medical applications. I have been in the habit of making my own word documents with important notes and information since medical school. A lot of these are used often and even more now that there is the Adventure Doc Clinic and I see more travelers. A few of my friends have asked about getting copies of some relevant “adventure doc” documents and how I am running them on my iPOD.
I use a document reader called “Documents to Go” which can be found at the DataViz website. Here are a few of the documents I am referring to more frequently:
ADULTS:
chloroquine phosphate (Aralen)
250mg, 2 tabs/wk – 500mg/wk
ok for long term(6yrs) use (risk of retinopathy) and ok for preg.
hydroxychloroquine (Plaquenil) check retinas
200 mg, 2 tabs/wk
Mefloquine (Lariam) dreams, $
250mg/wk (1 tab) best for resistent
Doxycycline sun exposure, food
100mg, 1 tab/day (second to mefloquine for resist areas)
Atovaquone/proguanil (Malarone)
250/100mg, 1 tab/day
Primaquine (used as radical cure)
30mg base/day
Proguanil (Paludrine) with chloroquine weekly
100mg, 2 tabs/day
Fansidar (folate metabolism) (pyrimethamine/sulfadoxine)
1 tab weekly
Maloprim (folate metabolism)
(pyrimethamine/dapsone)
may cause anemia/neutropenia with >1 month of use, check cbc
CHILDREN:
chloroquine phosphate
8.3 mg/kg PO
Mefloquine (Lariam)
15-19 kg – 1/4 tab per wk PO
20-30kg – 1/2 tab per wk PO
31-40kg – 3/4 tab per wk PO
Proguanil (Paludrine) with chloroquine weekly
<2 years old – 50mg/day PO
2-6 y/o – 100mg/day PO
7-10 y/o – 150mg/day PO
>10 y/o – 200mg/day PO
Atovaquone/proguanil (Malarone pediatric) 62.5mg/25mg
11-20 kg – 1 tab daily
21-30 kg – 2 tabs daily
31-40 kg – 3 tabs daily
>40 kg – 4 tabs daily (same as adult 250/100 mg tab)
Malaria treatment
CHLOROQUINE SENSIT
chloroquine 600mg base initial then 300 mg base at 6,24, 48 hrs
PEDS- 10mg/kg base then 5mg/kg at same hours
MDR
mefloquine 15mg/kg stat dose
peds-same (not for those <15kg)
MDR/mefloquine resistant
quinine sulfate 10mg/kg TID plus tetracycline 4mg/kg qid or doxy 1.5mg/kg qday for 7 days OR artesunate 200mg stat then 100mg daily plus mefloquine
if at rural facility/no PO by patient
chloroquine 3.5mg base/kg q6 IM or sub-q until PO tolerated
quinidine 20mg salt/kg by IM to thigh (split dose into each thigh) then 10mg/kg q8
Radical cure for vivax and ovale
primaquine at last dose of chloroquine (exoerythocytic stage)
mefloquine safe in pregnancy
STAND BY
quinine plus:
650mg po tid for 7 days quinine
250mg po qid for 7 days tetracycline
n/v/headache, tinitus
doxy 100 bid 7 days
halofantrine
And for our paramedics in the field I have a list of medications that have been slightly modified from the following list and are the basics of the advanced medical kits carried by Adventure Doc Paramedics:
Proficient and Always Carried:
Acetaminophen (Tylenol) 325-650 mg PO q 4-6 hours max 4 gr/day
Dexamethasone 0.25-4 mg BID-QID 8-16 mg IM/IV q 1-3 weeks
Diphenhydramine (Benadryl) 25-50 mg IV/IM/PO q 4-6 hours
Epinephrine 0.1-0.5 mL SC/IM q 10-15 min (1:1000 soln = 1mg/ml)
Ertapenem (Invanz) 1 gram IV/IM q 24 hours
Fentanyl Oral Lozenges (Actiq) 400-800 mcg (max 1600 mcg/day)
Gatifloxacin (Tequine) 400 mg IV/PO daily
Hetastarch (Hextend) 500-1000 ml IV
Ibuprofen (Motrin, Advil) 400-800 mg PO TID/QID (max 3200 mg/day)
Ketorolac (Toradol) 15-30 mg IV/IM q 6 hours
Lidocaine (Xylocaine) 0.5% – 2%
Meloxicam (Mobic) 7.5-15 mg PO daily
Morphine Sulfate 5-15 mg slow IV push
Moxifloxicin 400 mg PO/IV daily
Naloxone (Narcan) 0.4-2.0 mg IV repeat q 2-3 minutes up to 10 mg PRN
Promethazine (Phenergan) 12.5-25 mg PO/IM/IV q 4-6 hours PRN
Sodium Chloride 0.9% 500-1000 ml IV; 5-50 ml IV for med dilution or flush
Acetazolamide (Diamox) 125-250 mg PO BID (1-2 days prior ascent)
ASA 325-650 mg PO/PR q 4 hours
Albuterol (Proventil) MDI 2 puffs q 4-6 hours
Bacitracin topical ointment
Benzonatate (Tessalon Perles) 100-200 mg PO TID/PRN
Ceftriaxone (Rocephin) 1-2 grams IV/IM q 12-24 hours (max 4 grams/day)
Cetrizine (Zyrtec) 5-10 mg PO q day
Cimetidine (Tagamet) 300 mg IV/IM/PO q 6-8 hours or 400mg PO BID
Clindamycin (Cleocin) 150-450 mg PO q 6 hours or 600-900mg IV/IM q 6-8 hours
Dextromethomorphan (Robitussin DM) 10-20 mg PO q 4 hours
Dextrose (D50) 0.5-1 gram/kg up to 25 grams
Doxycycline 100 mg PO qday
Fexofenadine (Allegra) 60 mg PO BID or 120 mg q day
Guaifenesin 100-400 mg PO q 4-6 hours
Hydrocortisone topically q day to qid
Hydromorphone (Dilaudid) 1-4 mg PO/SC/IM/IV q 4-6 hours
Lactate Ringers (LR) 500-1000 ml
Lovofloxacin (Levaquin) 250-750 mg PO/IV q day
Loperamide (Immodium) 4 mg PO then 2 mg with each loose BM (max 16 mg/day)
Loratadine (Claratin) 10 mg PO q day
Meclizine (Antivert) 25-50 mg PO 1 hour before travel
Mefloquine (Larium) 250 mg PO once/week from 1 week prior to travel and 4 weeks after
Ondanstron (Zofran) 8-16 mg PO q 8 hours or 4 mg slow IVP or IM q 8 hours
Primaquine 30 mg base PO daily for 14 days after malaria exposure
Psuedoephedrine (Sudafed) 30-60
