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1、Click to edit Master title style,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,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 e

2、arly 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

3、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 s

4、urgical 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:,Su

5、pply/Re-supply,Education and training level of Medics,Combat Life Savers,and Laymen,Mission and Unit priority,ORAL PROPHYLAXIS,Decrease the logistical burden of carrying,reconstitution and injection of parental medications,Simple,light,durable,and easily administered,Single agent DOC is#1Gatifloxaci

6、n followed by#2Moxifloxacin,More realistic choices would be Levofloxacin or Ciprofloxacin alone or in combination with Metronidazole or Clindamycin,PARENTAL ANTIBIOTICS,Should be used in unconscious casualties,patients in shock,and penetrating abdominal trauma,Does not lessen the importance of rapid

7、 transit to definitive care and surgical treatment,Successful regimes include:,Single Agents#1Cefoxitin 1-2 Gms TID IV/IM.If IV push over 3-5 minutes.#2.Ertapenum 1Gm qd IV/IM.If IV,it must be given over 30 minutes.If IM,it should be mixed with 3.2cc of 1%Lidocaine without Epinephrine.,Combinations:

8、#1Gentamicin and Clindamycin,#2Tobramycin and Clindamycin.,What youll probably have and use most will be Cefazolin and Ciprofloxacin.,MES SICKCALL,P.O.Antibiotics,Pen VK,Clindamycin,Cephalexin,Doxycycline,Augmentin,Metronidazole,Ciprofloxacin,Azithromycin,Gatifloxacin,Sulfamethoxazole,Parental Antib

9、iotics,Ceftriaxone,Cefazolin,AS SOON AS YOU ARRIVE,Perform an inventory.,Differentiate NEED and“nice to have”,Speak with:Div Surgeon/PA,Pharmacy Chief,MEDLOG,Returning or Sister Units,and Inter-theater MEDLOG via email to determine what is available,possible,impossible,and surplus to guide you on yo

10、ur request,Be prepared to barter,do favors,and kiss-up to get what you want,PRIOR TO MISSION,Request and or prepare Pill Packs and Parental Packs for the BAS,Platoon Medics,Combat Life Savers,and Laymen as supplies,training,mission,and confidence dictate.,Pre-think drug protocols and combinations.,Place orders to MEDLOG/Pharmacy ASAP!,Dont break the bank on“Pet Drugs”.,QUESTIONS?,POC:Shon Compton,W#(210)221-4734,C#(210)488-8695,Email,shon.,