Medical Bag'-8

Table 1. BASIC EQUIPMENT FOR A PHYSICIAN'S MEDICAL BAG'-8 medical bag GF,RRY KENEFICK, MID he general practitioner's when the family physician treats pa- "black bag" has long tients in the home and saves any hos- been the symbol of com- pital use, either in the emergency de- petence and dedication. partment or by admission. As the For years most people lived in small population becomes older and conse- towns, and the general practitioner quently more housebound, the house- had one of the few cars in town. He call becomes more important. or she was more mobile than the pa- For about 3 years I worked for a tients, so often it was easier for the replacement service and gained con- physician to go see the patient than siderable experience doing house- for the patient to see the physician. calls. This article is designed to serve Nothing was more reassuring than to as a useful guide for the family physi- see the local general practitioner ar- cian who isjust starting his or her own rive with his or her little black bag. It practice and also for the "old hands." was usually a Gladstone bag and was suitably dignified of its purpose. The black bag Times changed, however, and the There are a number ofdifferent kinds public became more mobile; hos- of black bags.'-3 Each has a different pital emergency departments became appeal. The bag chosen must reflect more commonplace; and ambulance the personality and needs of the user. services became more sophisticated. The old Gladstone bag lacks com- As a result, the housecall fell into dis- partments and organization, and of- repute. In fact to this day it is a widely ten one is searching through a pile of held misconception that family physi- vials at the bottom of the bag. This cians no longer make housecalls, but method often causes the labels ofvials nothing could be further from the and bottles to wear off. truth. A newer Gladstone bag has many The housecall is once again a use- compartments and drawers. There is ful method for the family physician also the "attache case" style, which dealing with a patient's problem. The opens flat. This often contains foam housecall is a cost-effective method rubber or styrofoam, (bad for the en- vironment), with cutouts for your sup- Dr Kenefick on Active Staff Rqyal plies. The type I prefer to use is the Columbian Hospital, St Magyl Hospial, fishing tackle box style. This style Queenl Park Hospital, New JVWesbninste, BC. comes in various sizes and colors. 1496 Canadian Family Physician \o01 38: June 1992 Table 2. DRUGS'4: Each physician might want more or less ofthefollowing items in his or her medical bag. Inhaled Antihistamnes * Nitroglycerin spray * Dimenhydrinate * Salbutamol inhaler * Pramethazine * Adrenalineoerosol * Astemizole Anupesks * Terfnadine * Acetylsalicylic ocid (eg, Entrophen 10) * Omelidine * Meperidine, 50-mg tablets Cardiac medations * Regulor acetaminophen, No. 1, No. 2, No. 3, or pediatrk drops * Digoxin, 0.25-mg tablets * Morphine * Isasorbiedinitrate, 5mg * Non-steroidal anti-inflommatory drugs (NSAIDs) as a substitute * Nitroglycerin, 0.6 mg (spray is preferobe becouse of a longershelf-life) (ensure a of and AntibiotKs variety type dosage according to pradice) * Nifedipine capsules * Amoxicillintrihydrate * Tetracychine Cough nueidne - triprolidine tables * Erythromycin Minor tranquiizers - lorazepam, 1 mg * Trimethoprim-sulfamethoxazole Antiperistaitk agent - loperamide Ancid of choice - tblets are easier to carry,a sme are packaged in rol Sterod - prednisone, 5 mg Antiemetics * Dimenhydrinate (tablets, suppositores) Hypnotic Temazepam, 15 or 30 mg * Prochorperazine (capsules, supposiories; alo used for anxiety and pychosis) * Triazoam, 0.25mg Antiastima * Theophylline Emtic, eg, Ipecac * Aerodhamber Adrenalin, 1 mg/ml Prochlorperazine, 12.5 mg/ml Bcitrhdn,ihc Aminophylline, 250 mg/10 ml Dimenhydrimte, S0 mg/mL Zinc sulate Atropine sulate, 0.6 mg/l mL Diazepm, 10 mg/ml Poyyxin B eye mad er solution Furosemlde, 20 mg/2 mL Idocalne, I% or 2% Antipyrine drops Hydrocortisone sodium sucdnote, Glucugon indton, I mg Proparacone 100 mg/2 mL (eye anesthetics can be used to Promazine, 100 mg/2 m, freeze lcerations, especially in children, Morphine sulhte, 1S mg/I ml or chlorpromazine, 25 mg/mL to make the use of an injected local anesthetic easier) Mepeiine, 50 mg/mL Injectdale dextrose, 25 g 1498 Canadian Family Physician VOL 38: June 1992 The fold-out trays have many guide one's path in the dark. While * Use a small aluminum or plastic small compartments. Many of the filling in for other physicians, I container to dispose of used compartments can be adjusted by used a hand-held spotlight that needles and blades.4 moving the "walls." The one I use is plugged into the cigarette lighter * Don't leave your bag in the car. If 40 cm x 20 cm x 23 cm. It opens flat in the car to find house numbers. you have to, lock it in the trunk. and contains three trays, which fold I found this saved me more time Beware of theft.3 out so they can all be seen at a glance. than anything else in my car. * Be sure you protect your bag from It has a large compartment at the bot- * Use drugs that have more than freezing and overheating.2'3 It tom for such items as a sphygmome- one use, eg, diazepam for status could be embarrassing to try to ter, a diagnostic kit, and dressings. epilepticus, anxiety, and muscle re- draw up frozen furosemide into laxation. your syringe. Maintaining your Items in the black bag * Drug vials can be protected by us- physician's bag is quite a responsi- The contents of the medical bag de- ing the plastic containers supplied bility. D pend on where the practice is located. by the manufacturer or cotton For most physicians the medical bag balls.4 Requests for reprints to: Dr Geriy combines for equipment diagnosis * Label pill bottles with adhesive Kenefick, 100-713 Columbia St, New West- and initial therapy when making a tape and felt pen marker. minster; BC V3M 1B2 housecall.4 In some rural areas where travel by boat or aircraft might be * Many physicians do not like to References necessary to get to the patient, a carry narcotics for various reasons, 1. Buckley G. 'Fhe doctor's bag. In: and therefore alternatives must be CormackJ, Marinker M, Morrell D, edi- ''mini" intensive care unit might be tors; 'Ihompsoni WVA, executive editor. Prac- needed. Table 1 8 lists the basic equip- chosen. tice: a handbook ofprimary medical care. Lon- ment that a family physician might * Use as small a list ofdrugs as possi- don, Engi: Kluwer-Harrap Handbooks, need in an urban or rural area, where ble; know them well; know about 1980:chap 6. there is also access to well-equipped drug interaction in the drugs you 2. Jernigan JA. What's in your bag doctor? ] use. Fla Aled Assoc 1982;69:298-301. hospitals and an ambulance service. 3. Shires DB. Office organization. In: Shires Try to use equipment and drugs that * Check for drug allergies, idiosyn- DB, Hennen BK, Rice DI, editors. Family have more than one use.2 crasies, or contraindications be- medicine: a guidebookfor practitioners of the art. It is important to be aware of the fore administering drugs. 2nd ed. New York, NY: McGraw-Hill Book Co, 1987:546-73. indications and uses of the various * Be sure you know the pediatric and the 4. Sheldon JH. The doctor's bag. Catn Fam drugs interactions between and geriatric doses of the various Physician 1980;26: 1349-51. them. The list of medication drugs. 5. Burkett GE Jr. The doctor's bag. Rational (Table 2 i-8) to include in the medical * The physician on a housecall is a Drug 7lher 1976;l0(Dec):1-5. bag is by no means exhaustive and is potential victim of addicts and 6. Carson NE, Murtagh JE. The doctor's left up to the individual physician. criminals.2 Many of my bag. Aust Fam Physician 1981; 10:966-8. experi- 7. Moulds A, Martin PB, Bouchier Hayes Usually the physician should carry ences have taught me to counsel enough oral medication to keep the TA. The doctor's bag. CFPC Update caution. 1983;26: 1028-30. patient going until he or she can fill * 8. WNittes R. Another doctor's bag [letter]. a prescription. Take the time to make notes about your housecall. It is as important Can Fam Physician 1981;27:22-3, 25. Conclusion as an office visit. It is impossible to assemble the con- * Have a method of replenishing tents of the physician's bag to suit all your bag supplies, eg, have your physicians in all situations, even un- office staff check the bag once a der the simplest of definitions, ie, the month for expired medications, basic necessities. Each physician has and after each housecall, make a to choose the items according to his note of supplies used, and have of- or her need. Some will use less, some fice staff replace them. It is impor- will use more, eg, oxytocics in post- tant to keep your bag supplies partum hemorrhage. The following up-to-date.3 rules might be helpful when deciding * A map might be useful. what items are needed. * Tape a copy ofthe page on resusci- * Try to use smaller diagnostic tation from the Washington Man- kits - the rechargeable type. They ual on Medical Therapeutics in- can also double as a flashlight to side the lid of your bag. 1500 Canadian Family Physician VOL 38: June 1992.

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