War Wounds Flashcards
Soft tissue infections must meet at least 1 of the following criteria:
- Patient has organisms cultured from tissue or drainage from affected site.
- Patient has purulent drainage at affected site.
- Patient has an abscess or other evidence of infection seen during an invasive procedure or histopathologic examination.
- Patient has at least 2 of the following signs or symptoms at the affected site with no other recognized cause: localized pain or tenderness, redness, swelling, or heat
When entering Iraq in 2003, things changed for the U.S. as far as what to expect for delivery of pathogens. What were some of the big changes for pathogen access?
– Direct, diffuse inoculation of foreign bodies into tissue
• Clothing, soil, animal/human fecal matter, vegetation
– Prolonged hospitalization increase exposure to nosocomial pathogens
– Often in vehicles
– Desert environment
What wound type gets infected the most frequently?
Gun shot wounds
What was the most concerning pathogen during Operation iraqi fredom?
Acinetobacter due to hot arid climate
What measures do we use to prevent infection in war wounds
Adequate debridement
– Fluid lavage of open wounds
– No consensus on solution (NS/LR), volume (high), method of delivery or pressure (low)
– Repeat washouts critical
• Negative Pressure Wound Therapy appears to promote healing and decrease infection
What antibiotics do we use for:
Soft tissue injury
Cefazolin 2g IV q 6. Alternatively Clindamycin. Do this for 1-3 days
What antibiotics do we use for:
Soft tissue injury with open bone
Cefazolin 2g IV q 6. Alternatively Clindamycin. Do this for 1-3 days
What antibiotics do we use for:
chest injury? With an esophageal tear?
Cefazolin 2g IV q 6. Alternatively Clindamycin. Do this for a day.
Add Metronidazole if there is an esophageal tear
What antibiotics do we use for:
Abdominal with hollow viscus injury
Cefazolin and metro. Alternatively Levo/Cipro and metronidazole.
Do this for 1 day post cleaning.
What antibiotics do we use for: Open maxillofacial fractures?
Cefazolin. Alternatively use Clindamycin. Do this for a day
What antibiotics do we use for: Penetrating brain injuries?
Cefazolin +/- metro. Alternatively you can use ceftriaxone.
Do this 5 days/CSF leak is closed
What antibiotics do we use for: Burns
Mafenide in the morning and silver sulfa in the afternoon. Alternatively you can use silver nitrate solution.
Do this until the wound is grafted.
5 Steps to preventing infection in your hospital:
1) Hand washing
2) ICU cleaning
3) Isolation precautions
4) Cohorting
5) Antibiotic control
When should you consult Infectious Disease?
• What you’re doing isn’t working
• Renal problems or drug allergies limit your selection of antibiotics
• You’re thinking of starting an antibiotic or antifungal you’re not familiar with
– Colistin
– Tigecycline
– Amphotericin B
– Voriconazole
