疼痛科中抗生素使用（英文PPT）Antibiotics and Pain Control课件.pptVIP

Pain Management on the Battlefield Kevin C.OConnor, D.O. Examplesof Operational Need Stimulating Scientific Innovation Antibiotics and Pain Control WW II Poole, 1944: “The greatest lesson learned from World War II may have been the benefit of the use of penicillin prophylactically in the surgical units close to the front.” Korea Scott, 1954: “In any tactical situation where the casualty cannot reach the aid station until 4-5 hours or longer after wounding, antibiotic therapy by the aidman in the field is most desirable” Vietnam Kell, 1991: “A single injection of a broad-spectrum antibiotic with a long half-life should be given prophylactically to personnel on the battlefield to provide bactericidal coverage from the earliest moment after injury occurs.” Somalia Mabry, 2000: 4 of 5 open fractures of the tibia from gunshot wounds became infected. 2 of 2 open fractures of the femur became infected. In all, 15 wound infections in 58 casualties. 15 hour delay to definitive care, “Current US Army doctrine on prehospital care does not call for antibiotic administration by medics in the field…”. Why not?! Antibiotics not routinely given in the field by civilian pre-hospital personnel (EMT/paramedic model for medic training). Combat medics don’t typically see wound infections during the time they care for them – may not appreciate their devastating effect. Not a “sexy” topic. Ivory Tower arrogance…. Increased Risk of Infectionin Trauma Patients Disruption of Mechanical Barriers Bacterial Contamination Local Wound Factors Invasive Interventions Impaired Resistance General Preventive Measures Adequate and Timely Resuscitation Early Wound Care Antibiotics Tetanus Immune Prophylaxis Adequate and Timely Resuscitation A,B,C’s * Need to maintain a “nearly normal” arterial oxygen tension. Volume Expansion Considerations Early Wound Care Sterile Dressing contamination, desiccation Debridement excise devitalized tissue Irrigation hig