Thread: GSW to chest
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Old 01-28-2009, 21:22   #11
Doc Dutch
Trauma Surgeon
 
Join Date: Sep 2007
Posts: 83
Good report, all.

As for antibiotics, it is for prophylaxis strictly. As there is really no infection except to prevent an infection from the skin breakage or dragging clothes through a wound or any other inanimate object with the bullet, antibiotics are just prophylaytic and single dose coverage is adequate. We generally give it IV and during the resuscitation. It is a general broad spectrum antibiotic that has wide covergae and usually we use Ancef 1 gram intravenously. If they have not had a tetanus shot within the last 5 years then they get a new one.

So, shr7 for extremity or soft tissue penetrating trauma, we use Ancef unless they are Pen allergic and then we use Clindamycin and I have also seen Vancomycin used (but heavy handed). This is not for bowel/GI coverage and my next bowel case I will put up on the boards for all to look at and critique and we can discuss antibiotic choice (it is always an appropriate discussion regarding antibiotic stewardship). All antibiotics are given IV because if you give a PO antibiotic and then the patient gets morphine or feels sick due to pain, they could vomit it all up and out, so PO antibiotics are not a good choice!

As for antibiotics versus no antibiotics there is a lot of data in the trauma and surgical literature to give the for open penetrating injuries. Antibiotics are not to be overused in duration and type and they must be discontinued immediately when not needed or when cultures identify that antibiotics can be de-escalated or tailored to the sensitivities of the organism.

RIchLO25 - I must say that "once unstable, always unstable", but in this case we never had a huge blood loss and with the repeat stability of BP and HR, hard to take a patient to the OR and make good better. Now if we go to wash out the wounds and debride them, then I could not argue as the wounds can get washed out better and debrided better. But, they probably don't need such aggressive care as that and can be handled in the ED.

Thanks,

Dutch
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