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

Examples of Operational Need Stimulating Scientific Innovation Antibiotics and Pain Control 1 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. ” 2 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” 3 4 5 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… . 6 Increased Risk of Infection in Trauma Patients • Disruption of Mechanical Barriers • Bacterial Contamination • Local Wound Factors • Invasive Interventions • Impaired Resistance 7 • Adequate and Timely Resuscitation • Early Wound Care • Antibiotics • Tetanus Immune Prophylaxis 8 General Preventive Measures Adequate and Timely Resuscitation • A,B,C’s • * Need to maintain a “nearly normal” arterial oxygen tension. • Volume Expansion Considerations 9 • Eliminate Dead Space – fluid, blood • Delayed Primary Closure (DPC) – 4 - 6 days • Early Immobilizatio n of Fractures – Soft tissue damage • Sterile Dressing – contamination, desiccation • Debridement – excise devitalized tissue • Irrigation – high pressure, solution Early Wound Care 10 • Finite period of time in which infection can be prevented. – Miles, Burke. • How early, not how long. – Fullen, et al. • Both the timing and the choice are important. – Thadepalli, et al. 11 Antibiotics What Bugs? • Yom Kippur War – P