(精选)ANTIBIOTICS IN TACTICAL COMBAT CASUALTY CARE (TCCC)教学课件.pptVIP

ANTIBIOTICS IN TACTICAL COMBAT CASUALTY CARE (TCCC) Infections and sepsis are a late cause of morbidity and mortality in combat trauma patients. Recommendations for and commentary on early administration of antibiotics in the combat casualty have been recorded since WWII. ANTIBIOTICS IN TCCC All wounds sustained on the battlefield should receive antibiotics. But at a minimum, any patient presenting with penetrating abdominal trauma, massive soft tissue damage, a grossly contaminated wound, open fracture, or a long delay in CASEVAC/MEDVAC should receive prophylactic antibiotics. ANTIBIOTICS IN TCCC War wound antibiotics need to be simple, practical, effective, have a good safety profile, and a broad spectrum of activity. Treatment should start immediately and continue at least until surgical debridement has occurred. Coverage should be appropriate for the organisms implicated in combat wound infections. ANTIBIOTICS IN TCCC Consideration should be made as to how far forward the BN PA/MD want to push antibiotic supplies and release authority. This will depend on several factors: Supply/Re-supply Education and training level of Medics, Combat Life Savers, and Laymen Mission and Unit priority PILL AND PARENTAL PACKS Pill Packs may be available thru the hospital Pharmacy/MedLog, or if stocks are plentiful can be assembled and packaged at the BAS. Parental Packs could also be assembled and used by the medics as directed; particularly if their CASEVAC may by-pass the BAS en-route to the FST. PAs/MDs must educate and emphasize judicious use particularly of p.o. antibiotics to decrease development of resistant organisms. ORAL PROPHYLAXIS Decrease the logistical burden of carrying, reconstitution and injection of parental medications Simple, light, durable, and easily administered Single agent DOC is #1Gatifloxacin followed by #2Moxifloxacin More realistic choices would be Levofloxacin or Ciprofloxacin alone or in combination with Metronidazole or Clindamycin PAR