Use of analgesics (pain-killing drugs)

The pain-killing medicines carried on board are intended to treat different levels and types of pain likely to occur at sea. Since patients respond differently to medicines, some judgement is required in selecting the correct drug, dosage, or combination of medicines for each case.

It is better not to discuss the choice of medicine with the patient or within his hearing. The person giving treatment should prescribe confidently and reassure the patient that the medicine will relieve the pain.

The pain-killers carried on board include:

For mild to moderate pain:

• Acetylsalicylic acid tablets, 300 mg
• Paracetamol tablets, 500 mg

For severe pain:

• Morphine sulfate injections, 10 mg

Acetylsalicylic acid (Aspirin)

The normal dose for pain relief is 2 tablets, which may be repeated every 6 hours if required.

This medicine acts quickly and is useful for relieving most mild to moderate pain, especially pain affecting muscles and joints. It also helps reduce fever, making it useful for aches and pains associated with feverish illnesses. Side-effects are usually mild and uncommon.

Paracetamol

The usual dose is 2 tablets, repeated every 6 hours if necessary.

Paracetamol is effective for pain relief and is a suitable alternative for patients who cannot tolerate aspirin.

Morphine sulfate

The normal dose is 10–15 mg (1–1½ ampoules).

Morphine is a very strong pain-killer and should only be used in situations specifically mentioned in the guide or when advised by a doctor.

It may be given by subcutaneous injection, which works within about 10–15 minutes, or by intramuscular injection for slightly faster relief.

If the pain is extremely severe, additional doses may sometimes be necessary. However, after three injections have been given, RADIO MEDICAL ADVICE must be obtained before giving further doses.

The guide also warns about precautions and dangers related to morphine use.

Dispensing medicines

Once a diagnosis has been made, check the relevant section of the guide carefully for:

• the name of the medicine,
• the strength,
• the method of administration,
• the amount to give,
• the interval between doses,
• and the total duration of treatment.

Unless otherwise stated, medicines mentioned in the guide should be taken by mouth.

Care must be taken with dosage measurements, especially when doses are given in grams (g) or milligrams (mg).

Some medicines, such as chloroquine, require dosage calculation based on body weight. For example, if the required dose is 5 mg per kg of body weight and the patient weighs 60 kg:

60 kg × 5 mg = 300 mg of chloroquine base.

Since one 250-mg chloroquine phosphate tablet contains only 150 mg of base, the patient would need 2 tablets.

Certain medicines, especially antibiotics like penicillin or erythromycin, must maintain a constant level in the bloodstream. Therefore, they should be administered at regular intervals, such as every 6 hours throughout the day and night.

Some medicines should not be taken during meals, while others should be taken with plenty of fluids, such as sulfamethoxazole + trimethoprim. These instructions should be followed carefully for best results.

When giving standard antibiotic treatment, the full course must always be completed, even if the patient appears cured after a few days. Stopping treatment too early can cause the infection to return.

One responsible person, other than the patient, should supervise and record every dose given. Patients should not normally treat themselves or keep medicines beside their beds.

In malarial regions, one officer should supervise the administration of preventive anti-malarial drugs rather than leaving them for crew members to remember on their own.

If the prescribed treatment is completed and the patient is still not fully recovered, do not simply continue the same treatment. Instead, seek RADIO MEDICAL ADVICE.

Medicines can save lives when used correctly, but careless or unnecessary use can be dangerous. No medicine should ever be taken indiscriminately.

Side-effects and interactions of drugs – Rewritten

Many medicines may cause side-effects, allergic reactions, or hypersensitivity. Before giving any medicine, the caution notes relating to that drug should always be read carefully.

Drug interactions can also be dangerous. A particularly serious example is the combination of two or more central nervous system (CNS) depressants. For instance, combining a tranquillizer such as chlorpromazine with a sedative such as phenobarbital can cause coma, respiratory arrest, cardiac arrest, or death.

Alcohol is also a CNS depressant. Even moderate amounts of alcohol taken together with other CNS depressant medicines can be extremely dangerous or fatal. Patients taking medicines should therefore avoid alcohol or consume it only in strict moderation.

Most patients experience no significant side-effects from medicines. Even when side-effects occur, they are often mild, such as slight nausea, diarrhoea, or minor skin rashes, and usually do not require stopping treatment.

However, severe side-effects must never be ignored. In such cases, a decision may be required to stop or change treatment, and RADIO MEDICAL ADVICE should usually be sought.

Dispensing medicines for children – Rewritten

Whenever possible, RADIO MEDICAL ADVICE should be obtained before giving medicines to children under 16 years of age.

If this is not possible, the following guidance should be followed carefully. During the hour after giving medicine, observe the child closely. Monitor the child’s general condition, pulse rate, and breathing rate. If the child becomes faint or the pulse or breathing becomes unusually fast or slow, seek RADIO MEDICAL ADVICE before giving another dose.

For small children, tablets or capsules may be crushed and mixed with honey, jam, milk, or a little orange juice to make administration easier.

Morphine for children – Rewritten

Morphine must not be given to children under 10 years of age.

For children aged 10–15 years, the dose should not exceed 10 mg unless a radio medical doctor specifically advises a higher dose.

Erythromycin tablets, 250 mg – Rewritten

• Under 2 years: ½ tablet every 6 hours
• 2–8 years: 1 tablet every 6 hours
• 8 years and above: adult dose

Tetracycline hydrochloride capsules, 250 mg – Rewritten

Tetracycline must not be given to children under 12 years of age.

Children aged 12 years and above may receive the adult dose.

Phenoxymethyl penicillin potassium tablets, 250 mg – Rewritten

For children under 2 years:

• ¼ tablet every 6 hours when adult dose is 1 tablet every 6 hours
• ½ tablet every 6 hours when adult dose is 2 tablets every 6 hours

For children aged 2–13 years:

• ½ tablet every 6 hours when adult dose is 1 tablet every 6 hours
• 1 tablet every 6 hours when adult dose is 2 tablets every 6 hours

For children aged 13 years and above:

• Adult dosage

Procaine benzylpenicillin injection, 600,000 units/ml – Rewritten

• Under 2 years: 150,000 units (¼ ml) every 12 hours
• 2–8 years: 300,000 units (½ ml) every 12 hours
• 8 years and above: adult dose

Cyclizine hydrochloride tablets, 50 mg – Rewritten

• Under 6 years: ¼ tablet
• 6–13 years: ½ tablet
• 13–16 years: ¾ tablet

Sulfamethoxazole + trimethoprim tablets, 480 mg – Rewritten

This medicine must not be given to infants below 6 months of age.

• 6 months to under 6 years: 240 mg (½ tablet) every 12 hours
• 6–13 years: 1 tablet every 12 hours
• 13 years and above: adult dose

Lotions, creams, ointments, and drops – Rewritten

Follow the instructions given on the container. Otherwise, treat the child similarly to an adult, but do not apply excessive amounts, especially in children under 4 years of age.

Other medicines – Rewritten

If no dosage instructions are provided:

• Up to 1 year: 1/10 of adult dose
• 1–4 years: ¼ of adult dose
• 4–10 years: ½ of adult dose
• 10–15 years: ½ of adult dose

Standard antibiotic treatment – Rewritten

The guide often refers to “standard antibiotic treatment” for convenience.

For patients who are not allergic to penicillin:

If the patient can swallow tablets:

• Phenoxymethyl penicillin potassium (250 mg tablets): 2 tablets initially, followed by 1 tablet every 6 hours for 5 days.

If the patient cannot swallow tablets:

• Procaine benzylpenicillin 600,000 units by intramuscular injection once daily for 5 days.

For patients allergic to penicillin – Rewritten

If tablets can be taken:

• Erythromycin 500 mg initially,
• followed by erythromycin 250 mg every 6 hours for 5 days.

If vomiting occurs:

• Give one 50-mg cyclizine hydrochloride tablet 30 minutes before erythromycin.
• Children aged 1–10 years should receive half a tablet.
• Children above 10 years may receive one full tablet.

Note on the use of penicillin – Rewritten

Penicillin is a powerful medicine capable of destroying many harmful germs, but it should be used carefully because some people are sensitive or allergic to it.

Mild allergic reactions may include itching, skin rashes, swelling, or weals. Severe reactions may cause fainting, collapse, or even death, although such severe cases are rare.

If collapse occurs after giving penicillin, inject 1 ml of epinephrine subcutaneously immediately.

Whenever penicillin injections are administered, a sterile syringe and an ampoule of epinephrine should always be kept nearby.

Before giving penicillin, always ask the patient whether he has ever had any allergic reaction to it. If there is any history or suspicion of allergy, do not give penicillin either by mouth or injection. Use erythromycin instead.

Any patient who has received penicillin and is later sent ashore to hospital should carry a written note stating:

• how much penicillin was given,
• how it was given,
• and when it was administered.

Penicillin is particularly effective in treating acute infections such as:

• boils,
• abscesses,
• carbuncles,
• cellulitis,
• erysipelas,
• infected wounds,
• infected burns,
• ear infections,
• tonsillitis,
• quinsy (peritonsillar abscess),
• and pneumonia.