antibiotics

[usalsfyre]

www.survivingsepsis.org

Their reccomendations are pretty much THE last word on sepsis care.

[Dustdevil]

A rural service I spent years with in the 80s carried Kefzol for open fractures and penetrating trauma, which would usually be airlifted into Dallas. Administration was at the discretion of the medic or nurse in charge of that patient. There was no cookbook protocol. I believe they stopped using field abx in the 90s, when the hospital stopped running the service, and the county started hiring trailer trash medics and EMTs.

The above is pretty well how we functioned in military field medicine too, although 3G cephalosporins have now become the standard.

As already mentioned, obviously a C&S is neither necessary nor practical for prophylaxis.

[Doczilla]

Antibiotics may be useful in prophylaxis of wound infections in environments far removed from medical care. 39% of wounds sustained by US troops during the Battle for Mogadishu sustained wound infections, which was only 18 hours from beginning to arrival at medical care. For most EMS systems, they are not looking at this kind of interval to care outside of a disaster situation, so I don't believe it would be necessary.

Regarding sepsis, blood cultures change antibiotic treatment rarely, and culture results will not return for several days. One reason we don't see abx in the prehospital environment often for meningitis/encephalitis is that the diagnosis is so hard to make, and once made, it is recommended to give a dose of steroids prior to administration of the antibiotic.

I carry ceftriaxone (Rocephin) in my kit for care provided outside the normal environments. It's inexpensive, has good broad spectrum coverage, penetrates CSF well for head wounds, has decent gram negative coverage for abdominal wounds, and covers pneumonia and UTI rather well.

'zilla

[Kiwiology]

...when the hospital stopped running the service, and the county started hiring trailer trash medics and EMTs.

Hey, at least they didn't come from the same place the Houston Fire Department gets their Paramedics

[BushyFromOz]

All our ambulances carry ceftriaxone, for what I'm not sure...

Meningococcal septiceamia and ICP's will give it for sepsis. Have used it as a prophylactic for open fractures (the last wound was full of horse manure)

On the topic of sepsis, im amazed at how many ambo's dont recognise septic shock until it starts to bite them in the ass.

[DwayneEMTP]

Wait, is this like, I have a "Friend" that just came back from Thailand and has...say, a "burn" what antibiotics would you use for that? :-)

Thanks to my friends I've had a broad range of antibiotics on most of the gigs I've worked since becoming a medic. But most often they've been used for STDs or toothaches...Hard to imagine unless your contact time would be 12hrs or more that it would be a good idea for most medics. Are there some? Yeah, likely, but not most I think.

Dwayne

[chbare]

Meningococcal septiceamia and ICP's will give it for sepsis. Have used it as a prophylactic for open fractures (the last wound was full of horse manure)

On the topic of sepsis, im amazed at how many ambo's dont recognise septic shock until it starts to bite them in the ass.

Septic shock when defining it with proper criteria will likely be exceedingly difficult to diagnose by point of care EMS crews. To actually say somebody is in "septic shock," you must identify a constellation of findings to include a sepsis related SIRS response, multiple organ dysfunction and the presence of refractory hypotension. I want to stress the term "refractory. This means you need to perform initial fluid resuscitation first, and only after fluid resuscitation has failed can you think about septic shock proper. Remember, not every hypotensive patient with sepsis will be in septic shock.

Take care,

chbare.

[BushyFromOz]

Septic shock when defining it with proper criteria will likely be exceedingly difficult to diagnose by point of care EMS crews. To actually say somebody is in "septic shock," you must identify a constellation of findings to include a sepsis related SIRS response, multiple organ dysfunction and the presence of refractory hypotension. I want to stress the term "refractory. This means you need to perform initial fluid resuscitation first, and only after fluid resuscitation has failed can you think about septic shock proper. Remember, not every hypotensive patient with sepsis will be in septic shock.

Take care,

chbare.

Yeah, i over simplified the statement, i meant to say that people generally are not prepared to manage sepsis or septic shock until it bites them.