Medical Action Sheets by K.B., M.D. Part 4

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We are wrapping up our series on medical action sheets for use when illness or injury strikes in various scenarios that can prevent professional medical access, such as weather extremes (hurricanes, ice storms, blizzards), civil unrest (riots, curfews), EMP, TEOTWAWKI, or pandemics/disasters, which can swamp the medical system. I have given binders of these to my loved ones with the caveat that they use them only in a genuine situation as listed above and if I am unavailable to help them. As you read these lists, remember that I am not prescribing and urge you to review any plans with your medical professional who will tailor medical action sheets to your specific medical needs, conditions, allergies, and abilities.

Last time we studied tick-borne illnesses. However, today we will look at acute sinusitis and how we can deal with them with or without prescription medications.

Acute Sinusitis Overview

Acute sinusitis occurs when the nasal passages become inflamed and swollen. This can be due to viruses, bacteria, or allergies; we will focus on the first two. Often the cause is the common cold, which can cause swelling that blocks sinus drainage with subsequent mucus retention. This mucus retention results in pain located in the forehead, eyes, nose, cheeks, and/or upper teeth and worsens with bending over. Unfortunately, these moist warm passages are a great breeding ground for bacteria. The big question is when or if to use antibiotics. It is best to avoid antibiotics if possible; however, a cloudy or purulent postnasal drainage for over 7 to 10 days, fever over 102 degrees without influenza or other source, or worsening symptoms lean one towards using antibiotics. If the sinusitis was improving and then returns with a vengeance, antibiotics may also be indicated. Again, I am not prescribing and strongly encourage you to see your medical professional.

Home Remedies

When evaluating yourself or another person, be sure to rule out middle ear infection and dental infection. Helpful home remedies include plenty of fluids (no alcohol or caffeine), humidified air (keep the unit clean), saline nasal sprays, over-the-counter (OTC) meds and pain relievers listed below, and sleeping with the head elevated. Inhaling warm water vapor can also help. Some suggest trying herbals, such as inhaling smashed garlic (antibacterial, antifungal, and antiviral) on a cloth under the nose (wait 15 minutes after smashing for the allicin to develop), or inhaling the vapor from thyme tea (2 tsp dried in 8 oz hot water) if not pregnant or allergic to plants in the mint family. By all means, avoid exposure to tobacco smoke, which irritates the sinuses.

Complications

Serious complications of sinus infection includes spread to brain (meningitis), bone (osteomyelitis), or eye socket. Risk of complications rise with conditions such as diabetes, malnutrition, HIV, or other immune suppression.

Medical Action Sheet- Acute Sinusitis

Below is your medical action sheet on adult acute sinusitis, which includes antibiotic information.

Sinus Infection (Sinusitis)

Most are viral (colds or flu) or secondary to allergy/irritants. Swelling results in obstruction, which produces a moist breeding ground for viruses and/or bacteria.

Exam

During an exam, press sinuses. Are they tender? Is there an ear infection?, nasal/throat discharge purulent (containing pus)?, dental tenderness/abscess?, and/or eye swelling/infection?

Treatment

Note: If pregnant, take no herbs or medications (OTC or prescription) without checking with your doctor.

  • Rest.
  • Drink water/juice.
  • Use saline nasal sprays.
  • Use humidified air.
  • Herbal vapors- garlic, thyme (if not pregnant or allergic).
  • Sinus irrigation only if no ear infection and nostril not obstructed. (Read about neti pot usage and the importance of using sterile water and of keeping the pot clean.)
  • Take Guaifenesin (mucus thinner) and decongestants (Sudaphed) if no history of high blood pressure, urinary obstruction, or glaucoma.
  • Afrin nasal spray only for 1 or 2 days or passages will get rebound swelling!
  • Pain reliever, such as acetaminophen or ibuprofen.
  • Avoid irritants, smoke, and medications that dry membranes, such as antihistamines.

Antibiotic Use

It’s best to avoid antibiotic use, but in some cases of bacterial infection they may be necessary. When might it be bacterial?

  1. Face or dental pain + Fever over 102 and not a cold or flu,
  2. Got better and then got worse,
  3. Cloudy nasal drainage more than 7 days + pain or sore throat.

Which Antibiotics

Which antibiotics do you use for adults? Amoxicillin 500mg three times daily for at least 10-14 days and possibly up to 21 days.

If not improving after 48 or 72 hours, switch to Augmentin. Augmentin is hard on the GI system and can result in diarrhea. Try eating yogurt to ease the side effects.

If penicillin allergic, try azithromycin (3-5 days), ciprofloxacin, or trimethoprim-sulfamethoxazole. Beware of the risk of tendonitis or tendon rupture with ciprofloxacin, especially in patients over age 60. Avoid using ciprofloxacin, if possible.

N.B., if dental cause for sinusitis or foul-smelling anaerobic bacteria, treat with clindamycin 300 mg 3x/day. Clindamycin can result in dangerous colitis. Alternatively, treat with amoxicillin 500 mg 3x/day plus metronidazole 500mg 3x/day. Don’t use metronidazole without true need, as it may be carcinogenic.

See Also:

SurvivalBlog Writing Contest

This has been part four of a four part entry for Round 80 of the SurvivalBlog non-fiction writing contest. The nearly $11,000 worth of prizes for this round include:

First Prize:

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  2. A Gunsite Academy Three Day Course Certificate. This can be used for any one, two, or three day course (a $1,095 value),
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Third Prize:

  1. A Royal Berkey water filter, courtesy of Directive 21 (a $275 value),
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Round 80 ends on January 31st, so get busy writing and e-mail us your entry. Remember that there is a 1,500-word minimum, and that articles on practical “how to” skills for survival have an advantage in the judging.

Hope They Help

May you never need these medical action sheets and accompanying information. Though, if you do, my hope is that they help you in your time of need.


21 Comments

  1. The sheets are very very nice and I have learned from reading them. But a dose of reality, most of my medical books are thousands of pages long. The List of things that can go wrong with us humans is just incredibly huge. We kid ourselves if we think we can learn it in an hour, a day, a week, or a month, or put it in a binder of only eight or 900 pages. The patients I see in the indigent clinic present me with issues most of which have not been covered in these sheets, and they are real patients. That’s not to say the sheets aren’t useful it’s just to say humans are incredibly complex. There’s a reason I spent four years in medical school and years after that in residency. And I don’t even come close to really knowing more than just one tiny specialty. The surgeons with whom I work have such vast knowledge it is amazing. Secondly, I have worked in a enormous healthcare centers, and in dirt floored missionary clinics. Most problems that are truly serious you simply can’t solve in a dirt floor clinic even with years and years of professional training. At most trauma centers, after intubation and life-saving fluids, the trauma patient immediately goes into a possibly head to toe CT scanner!!! And for a very good reason too! If we get into an end of the world situation, it’s going to be like Puerto Rico. Where thousands and thousands of people in each community are going to die because of lack of real medical care. My conclusion? Spend more time figuring out how YOU are going to keep the incredible systems that we have, STILL WORKING to keep us alive, functioning in some semblance even with cataclysmic events trying to tear them apart. If those systems quit, you’re going to live like you were in a cave, medically speaking. And then you’ll wish you had years and years of experience. Good luck treating your first brain bleed Consider Venezuela where the mortality rate is probably many many times higher now, And envision how you could have prevented that.

  2. And I thought the sheets were extremely well done. When I started my residency I used a book we called the Washington manual, and things like this remind me of it. They can be life-saving.

  3. In a TEOTWAWKI situation, some knowledge can be better than total ignorance and perhaps save some lives. There will be a great deal of suffering and death, sad to say.
    As for me personally, I spent 4 years in an excellent medical school, 5 years of specialization, and many years in practice. I totally agree that medical care is extremely complex. I *am* doing what I can to try to help others in spite of now being handicapped and retired disabled. God bless you for your work in missionary clinics and with the indigent, for that is where my heart is too.

  4. Recurring (almost every few months) sinus and bronchial infections may also be caused by an allergy to dairy products. I had them for years when a new friend told me about his same problem. His tests showed him to be allergic to dairy products including milk, butter, cream, cheese – all of it. I went off of dairy and had no more infections for months. Then one weekend in the summer I went on an ice cream bender. Two days later I had a serious sinus infection! That was over 10 years ago and I have only had a couple of minor infections since. My only hold out is a little butter on my toast and a little half and half in my coffee. I miss pizza and ice cream the most!

  5. I have to agree with prepperdoc. Many health issues would be best treated by our current medical system. But this is Survivalblog. So another alternate idea for sinus issues is to place 1-2 drops of oregano oil in a cup of boiling water. Cover your eyes with a towel and breathe in your nose and exhale out your mouth , then reverse the process. Do this as many times as you can . then repeat throughout the day. You can reheat the cup of liquid a few times and reuse. This has worked for me a few times. It’s surely worth a try.

  7. Long ago I was an Infantry men and then a combat medic, in a Light infantry Div. I humped my ruck and my M-5 bag and did both jobs. For 12 of my 18 years in the service, I learned how to treat emergency medical conditions with just what we had in the filed. Sterile fields were only dreamed about. We did the best we could and helped a lot of injured, wounded or sick soldiers. No we did not have modern medical care of a ER. we did not have much of anything. Solders were transported to the rear for better medical treatment. My point is we are heading in to a new reality where the level of medical care people can hope to get after “The Crunch” may not be much better then I could give as a combat medic in the filed. That is what we need to think about and plan as well as train for. Learning how to grow plants that can be used treat our medical problems seems to be of great value to me. Thank You K.B., M.D. for posting your work. Besides even if the unimaginable happened and the country and world keep from falling over the cliff. The cost of medical care in this country will soon price itself out of the reach of the working class. I expect that my grandchildren will see Doctors with home offices and making house calls once more like my parents talked about. Most of the fancy tests they now order to cover themselves from malpractice lawsuits will be out of range of the common folk and we will return to a reality that many more people will die, from things that are easily prevented today. How large is your medical first aid kit? What KB., M.D. is doing is of great value to me. Thank You. If he keeps posting the Sheets I hope they saved in a format that we can copy them easily and put them in a notebook on the medical shelf of our libraries.

  8. I understand the reasons behind not prescribing an antibiotic until it is known/proven that the infection is bacterial. But it ignores two realities:
    1. While you wait to decide if it’s bacterial the patient suffers and suffers and gets worse and what was first a sinus infection becomes a lower respiratory infection, possibly pneumonia and in older or unhealthy patients this could be a death sentence.
    2. The concept is to reduce use of antibiotics so that there is less chance of germs becoming antibiotic resistant. Good thought but in the entire 3rd world (about 80%) of the population people who get sick can buy antibiotics without a pre4scription or seeing a doctor and they do all the time. So does it make sense to restrict a sick person in the West from antibiotics in some vain attempt to save the world while the entire 3rd world does whatever they want to with antibiotics?

    In the old days, a doctor would evaluate your condition and general health and prescribe antibiotics just in case your infection was bacterial and didn’t wait till you were at deaths door to try to save you. Why not now???

  9. My guess is that sinus infections will be a leading cause of death after the world as we know it now has befallen us. It might be a good idea to buy as many fish antibiotics as you think you might use and then by double that amount again.

  10. One Guy –

    “Why not now” is exactly the reason we have so many resistant diseases. The majority of common respiratory infections are viral, in 30 years I have seen very few non-medical people really understand this concept (and I don’t mean to sound harsh). People go to the doctor, spend their hard earned money and expect to leave with an instant cure, (meaning at least one antibiotic, no matter how many times you explain an antibiotic will not cure a viral syndrome)! Working in the ER last year I actually had a guy come in and tell me he better get what he paid for because he has tickets to the Spurs game that night and he expected to be cured. The guy had a cold, I really wanted to be able to say…good luck with that! And on top of that he ER visit probably cost him somewhere in the neighborhood of $1000.00. I personally think colds are horrible, and when I get one I fell terrible for about 3 weeks, but I have never taken an antibiotic for one. Just because the rest of the world does it does not make it right. We are not coming up with new antibiotics fast enough to keep up with more and more resistant bacteria that are becoming common place. I fear in the future we will see people dying frequently of things that were easily treated in the past. The CDC and the WHO and other agencies have been trying to persuade doctors to not over prescribe antibiotics just because they feel pressured to do so, and believe me some people become completely unglued when told they will not be getting an RX for antibiotics. There really needs to be a more concerted effort to educate the public on this. I know I do not want to see my children or their children die of a once treatable disease just because most people can’t handle common ailments. We are way to spoiled!!

    1. As I said I do understand the reason for this policy. What do you do about the free use of antibiotics in the 3rd world? What do you do about the use of anti-biotics in the meat raising industry? What do you do about the use of antibiotics in the pet industry? Nothing. We only “punish” sick people in the West.

      Some years back I got strep. I felt ill that day but until I got home and sat around a little I didn’t feel the full effects of strep. So I went to the doctors/clinic at about 9 pm on Friday night. The doctor was pretty unhappy that he had to deal with a patient after hours so he told me to go home, take aspirins and sit in a tub of cold water to lower my temp. So by Monday morning I was sick as a dog simply because the doctor didn’t want to treat me or prescribe antibiotics. So that winter I got strep numerous times, my wife and son got strep to. BUT there is good news!!! The doctor was saving the world from overuse of antibiotics.

      SO what is the purpose of requiring patients to suffer for a couple of days and to get substantially sicker and THEN prescribe antibiotics? Is this “healthcare”?

      1. I don’t think the third world has completely gone wild with antibiotics, first, many in the third world do not have access to doctors and antibiotics or the funds for this, I think this might be a slight exaggeration on your part. And again, just because others do it does not make it right or beneficial to the world in general. Newer research suggests in many cases it is not even necessary to prescribe adults antibiotics for strep throat. Complications for an adult are rare. Even for children complications are rare, although I believe a child’s risk for complications such as rheumatic fever are not worth that risk.
        As for the meat industry, I believe they are finally waking up to the facts that animals who are routinely given antibiotics are more of a danger to the health of humans and the fact that this hastens resistance to common diseases, and many are starting to go antibiotic free. It’s a start at least.
        I truly am not trying to upset anyone or you with my beliefs, and I do believe we may never agree on this subject, but I can tell you in 30 years of critical care nursing I have seen way too much pain, suffering and dying. The fact that most cannot accept some discomfort with common ailments, and will not be cured with an antibiotic for what usually is a viral syndrome, is not helpful to the future of medicine. Again I state I do not want my children and grandchildren, nor anyone else’s to die from diseases that use to be easily treated, but are already becoming resistant due to the over use of antibiotics.

        1. In the 3rd world you can buy antibiotics without a prescription. Your point that many in the 3rd world can’t afford to buy antibiotics doesn’t change that simple fact.

          But you missed my original point. IF someone presents themselves to a doctor and they are quite ill, could be upper respiratory or pneumonia or whatever, Should they suffer (i.e. be turned away without treatment) or should they be given antibiotics? This is especially critical for older people, people with compromised immune systems and the very young. SO should we “save the world” or treat the patient? AND if saving the world from misuse of antibiotics is SO important that the patient be damned why not first stop the use of antibiotics for animals and non-prescription use?

          I have four bottles of 100 each of the best choice antibiotics for SHTF in my refrigerator. I bought them online as they are intended for animals. BUT just to save the world if I show up at the doctors with severe pneumonia I should be denied antibiotics. Does this make sense???

          Keep in mind I an NOT talking about those cases where you KNOW that antibiotics won’t help I am talking about those cases where you DON’T know.

          1. ONE GUY

            I will not go round and round with you on this…..you will never get it.
            I will however give you a piece of advice to help you save the antibiotics you have, you should not store most antibiotics (pill form) in the fridge, you may be cutting down on their life expectancy. Pill form antibiotics should be stored in a cool, dry place. Like in a drawer in your bedroom, shelf of a closet, or a box. Not in your bathroom, kitchen, fridge or freezer. Most antibiotics last much longer than their expiration date, with a few exceptions like epinephrine or doxycycline. Research each particular drug you have for best results.
            I wish you good luck.

          2. It does not make sense to me to think you can save the world at the expense of your patients. If someone comes to you for health care and your choice is to wait a few days to see if it gets worse or they die I don’t want you as a health care provider.

            If the goal is to reduce misuse of antibiotics and you do not try to get the low hanging fruit first, i.e. drugs used on animals and free use of antibiotics in the 3rd world without a doctors consult. Then you do not have a plan that can or will work. Your plan will simply cause more hardship and suffering for sick people in your care.

            If you KNOW that someone has a viral infection then I see no problem with not prescribing antibiotics. If on the other hand you do not know but deny antibiotics for no better reason than your theory on saving the world then you are guilty of malpractice. It saddens me that you don’t understand that and it saddens me that there are others in our medical community who agree with you.

  12. -TXnurse

    Thanks for the link, that looks like a great website! And thank you as well OP for the series. I haven’t given anywhere near as much thought as I should have to medical stuff. Time to get crackin’.

  13. Warm Sterile water (99F-104F) and fine salt solution in a neti pot can work wonders if the cause is allergens or bacterial. Doesn’t seem to be long lasting with cold/flu, but is a welcome 30 minutes of breathing bliss a few times a day. I’ve found it superior, though strange until you’re accustomed to it, to saline sprays other than portability. Needs to be warm to help break up mucus and clear the passages, and is more comfortable when at the right temperature.

  14. Agreed, TXNurse! Just to add a bit in answer to Anonymous’s question – the point is well-taken that antibiotics are misused all over the world, but thankfully, there is evidence that bacterial resistance is a bit of a local affair. As a matter of fact, hospital microbiology labs publish the resistance patterns seen in hospital bacterial isolates each year – it’s called the “antibiogram”, and it varies from hospital to hospital, even within the same city! The antibiogram helps us to tailor initial antibiotic choices to the local flora. Perhaps if we can get a handle on unnecessary use of antibiotics in America (yes, including agricultural veterinary medicine) WE can benefit, and avoid, or delay a quick jump back to 1920 in terms of infectious disease deaths.

    A short illustrative story of what we may face: I was privileged to know my maternal grandfather for the first 14 years of my life. He was born in 1880, and was always VERY concerned that I should clean every cut and scrap ASAP. “You’ll get blood poisoning” was his mantra. It was only much later in my medical career when his perspective finally became clear: He was 66 years old before penicillin was made available to the public. Though basic sulfonamides had been around for a decade or so, the introduction of penicillin was the turning point in our war against bacterial disease. What he called “blood poisoning” is what we call sepsis, and when allowed to progress to septic shock, the mortality rate is quoted as high as 50%. My Grandaddy had spent most of his adult life seeing children and otherwise-healthy adults DIE from infections resulting from minor injuries. I, for one, would not like to return to this time!

    Though all antibiotics carry the risk of side-effects, they are basically a very safe class of drugs. Sometimes I think this is a curse. If they carried the same side-effects as classical cancer chemotherapy, you can be sure that they would be used only when absolutely necessary, and we wouldn’t be in a race against the brutal past!

    Just a little food for thought….

    Happy New Year everyone!!

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