GSW to chest

[frostfire]

Originally Posted by RichL025

A LARGE amount of what we do in medicine is based on decision-making like above... generalizing the results of large studies to individual patients and trying to make rational treatment decisions.

So, in a very long winded way, I probably didn't answer your question as to whether the prophy abx saved the patient from cellulitis... but hopefully I showed you a little of the reason why it's not a straightfoward question...

RL

RichL025,

not at all. That was elaborate and clear actually. I used to view doctors as gods before I entered the healthcare/medical world. Now I understand why it's called "practicing medicine," and that there are treatments used simply based on beneficial empirical result ie. ECT as opposed to well-understood causality.

Thank you for taking the time educating me.

[Doc Dutch]

"Questions:

- Do you expect cellulitis to manifest in a short period of time (minutes, less than 12 hours, I assume the patient is not staying in for days)?
- Can the absence of cellulitis be mosly attributed to the prophylactic intervention?

Thank you for the rationale on IV antibiotics vs. PO. That makes perfect sense.

FF"

So, FF, in answer to your questions, in regards to your first question, cellulitis sets up in days and not hours. If it does come on that fast you must think of Clostridial infections or Necrotizing Fasciitis (as RichL025 stated it is "(aka Necrotizing Soft Tissue Infection) - this is basically cellulitis on steroids and can kill rather rapidly").

The typical pattern for cellulitis development in simple penetrating wounds is for redness, increasing pain, increasing warmth of the skin and swelling and potential pus developing in 72 to 96 hours as that is the typical length of time for the garden variety post-injury wounds to become cellulitic and start draining if they are going to do so. Then the wound may need a debridement or drainage and anibiotics started orally in general. The single prophylatic dose does its job well and keep most infections at bay.

As for the second question, "Can the absence of cellulitis be mosly attributed to the prophylactic intervention?", the answer is yes. But we do other things to supplement the antibiotics like, cleaning the wound, bandaging the wound, if necessary irrigating the wounds, debriding dead tissue from the wound, leave the wound open to drain, a tetanus shot if not in the last 5 years and have the patient return in 4 to 7 days to examine the injury.

I do not generally prescribe oral antibiotics at discharge. I do prescribe keeping the wound clean, pain medications, and fresh bandages every 12 hours or so. Overuse of antibiotics is not healthy for the patient and can often be over-prescibed by medical practitioners in general leading to multidrug resistence.

I hope this helps. Have a Happy Superbowl Day!

Dutch

[frostfire]

Originally Posted by Doc Dutch

I hope this helps. Have a Happy Superbowl Day!

Dutch

Sure does, Doc. Thank you