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1、ExamplesofOperationalNeedStimulatingScientificInnovationAntibioticsandPainControlWWIIPoole,1944:“ThegreatestlessonlearnedfromWorldWarIImayhavebeenthebenefitoftheuseofpenicillinprophylacticallyinthesurgicalunitsclosetothefront.”KoreaScott,1954:“Inanyta
2、cticalsituationwherethecasualtycannotreachtheaidstationuntil4-5hoursorlongerafterwounding,antibiotictherapybytheaidmaninthefieldismostdesirable”VietnamKell,1991:“Asingleinjectionofabroad-spectrumantibioticwithalonghalf-lifeshouldbegivenprophylacticall
3、ytopersonnelonthebattlefieldtoprovidebactericidalcoveragefromtheearliestmomentafterinjuryoccurs.”SomaliaMabry,2000:4of5openfracturesofthetibiafromgunshotwoundsbecameinfected.2of2openfracturesofthefemurbecameinfected.Inall,15woundinfectionsin58casualti
4、es.15hourdelaytodefinitivecare,“CurrentUSArmydoctrineonprehospitalcaredoesnotcallforantibioticadministrationbymedicsinthefield…”.Whynot?!Antibioticsnotroutinelygiveninthefieldbycivilianpre-hospitalpersonnel(EMT/paramedicmodelformedictraining).Combatme
5、dicsdon’ttypicallyseewoundinfectionsduringthetimetheycareforthem–maynotappreciatetheirdevastatingeffect.Nota“sexy”topic.IvoryTowerarrogance….IncreasedRiskofInfection inTraumaPatientsDisruptionofMechanicalBarriersBacterialContaminationLocalWoundFactors
6、InvasiveInterventionsImpairedResistanceGeneralPreventiveMeasuresAdequateandTimelyResuscitationEarlyWoundCareAntibioticsTetanusImmuneProphylaxisAdequateandTimelyResuscitationA,B,C’s*Needtomaintaina“nearlynormal”arterialoxygentension.VolumeExpansionCons
7、iderationsEarlyWoundCareEliminateDeadSpacefluid,bloodDelayedPrimaryClosure(DPC)4-6daysEarlyImmobilizationofFracturesSofttissuedamageSterileDressingcontamination,desiccationDebridementexcisedevitalizedtissueIrrigationhighpressure,solutionAntibioticsFin
8、iteperiodoftimeinwhichinfectioncanbeprevented.Miles,Burke.Howearly,nothowlong.Fullen,etal.Boththetimingandthechoiceareimportant.Thadepalli,etal.WhatBugs?YomKippurWarPseudomonas–25.6%isolatesGmNegbacilli–70%isolatesoverallUsedpenicillinsSomalia
