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ID:19853191
大小:5.51 MB
页数:69页
时间:2018-10-07
《抗生素ppt课件(英文精品)antibiotics and pain 》由会员上传分享,免费在线阅读,更多相关内容在教育资源-天天文库。
1、ExamplesofOperationalNeedStimulatingScientificInnovationAntibioticsandPainControlWWIIPoole,1944:“ThegreatestlessonlearnedfromWorldWarIImayhavebeenthebenefitoftheuseofpenicillinprophylacticallyinthesurgicalunitsclosetothefront.”KoreaScott,1954:“Inanytacticalsituationwherethecasualtyc
2、annotreachtheaidstationuntil4-5hoursorlongerafterwounding,antibiotictherapybytheaidmaninthefieldismostdesirable”VietnamKell,1991:“Asingleinjectionofabroad-spectrumantibioticwithalonghalf-lifeshouldbegivenprophylacticallytopersonnelonthebattlefieldtoprovidebactericidalcoveragefromthe
3、earliestmomentafterinjuryoccurs.”SomaliaMabry,2000:4of5openfracturesofthetibiafromgunshotwoundsbecameinfected.2of2openfracturesofthefemurbecameinfected.Inall,15woundinfectionsin58casualties.15hourdelaytodefinitivecare,“CurrentUSArmydoctrineonprehospitalcaredoesnotcallforantibioticad
4、ministrationbymedicsinthefield…”.Whynot?!Antibioticsnotroutinelygiveninthefieldbycivilianpre-hospitalpersonnel(EMT/paramedicmodelformedictraining).Combatmedicsdon’ttypicallyseewoundinfectionsduringthetimetheycareforthem–maynotappreciatetheirdevastatingeffect.Nota“sexy”topic.IvoryTow
5、erarrogance….IncreasedRiskofInfectioninTraumaPatientsDisruptionofMechanicalBarriersBacterialContaminationLocalWoundFactorsInvasiveInterventionsImpairedResistanceGeneralPreventiveMeasuresAdequateandTimelyResuscitationEarlyWoundCareAntibioticsTetanusImmuneProphylaxisAdequateandTimely
6、ResuscitationA,B,C’s*Needtomaintaina“nearlynormal”arterialoxygentension.VolumeExpansionConsiderationsEarlyWoundCareEliminateDeadSpacefluid,bloodDelayedPrimaryClosure(DPC)4-6daysEarlyImmobilizationofFracturesSofttissuedamageSterileDressingcontamination,desiccationDebridementexcisedev
7、italizedtissueIrrigationhighpressure,solutionAntibioticsFiniteperiodoftimeinwhichinfectioncanbeprevented.Miles,Burke.Howearly,nothowlong.Fullen,etal.Boththetimingandthechoiceareimportant.Thadepalli,etal.WhatBugs?YomKippurWarPseudomonas–25.6%isolatesGmNegbacilli–70%isolatesoverallUse
8、dpenicillinsSomalia
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