open fracture antibiotics prophylaxis
DESCRIPTION
Antibiotics prophylaxis for different types of bone fractures pre-opTRANSCRIPT
Dr. Richard ChmielewskiDr. Abdul Hamid Alraiyes
80 years old CF
Chief Complain
Fall
Pain on the Lt elbow
Transferred from another ER with a diagnosis of:
Fracture of the Lt proximal ulna
Open fracture type I.
ID consult : POD # 1 For ABx prophylaxis because of the open fracture type I.
PMHx: Hypertension
Hyperlipidemia
PSHx: Lt THR (3 years)
Lt Fibula # with plate and I.M nailing. (8 years )
NKDA
No blood transfusion
Meds: Tenormine 50 mg PO QD
Social Hx:
No Hx Of smoking / ETOH/ elicit drugs
Physical Exam:
V/S : 36.8 - 120/76 - 67 – 17
HEENT: Broses on the chin
Chest: CTA bil.
CVS: S1 + S2 + PSM III/VI
ABD: soft, Lax and no tenderness
EXT: no edema , good pulse , Lt upper arm dressed with a cast.
Labs: WBC = 10.4 , Hb= 12.4, Ht= 37, Plt= 241
Na= 140, K= 4, Cl= 104, CO2= 28, BUN= 15, Cr= 0.5, Glu= 110
Dose the patient need Abx prophylaxis? If yes, what Abx should be used & for how long? What else should be considered apart from Abx prophylaxis?
The Abx prophylaxis depends on the type of the open fracture
• Wound less than 1 cm,• without contamination • minimal injury of soft
tissue.
• Wound between 1 -10 cm• mild contamination• extensive soft tissue damage and
moderate crushing component.
• Wound larger than 10 cm• severe contamination • severe crushing component.
antibiotics “Gram Positive coverage” should be started as soon as possible after injury and continued for 3 days*
*J Am Acad Orthop Surg. 2006 Oct;14(10 Suppl):S98-S100
antibiotics “Gram Positive coverage” should be started as soon as possible after injury and continued for 3 days*
*J Am Acad Orthop Surg. 2006 Oct;14(10 Suppl):S98-S100
antibiotics “Gram Positive coverage” should be started as soon as possible after injury and continued for 5 days*
combined with local therapy consisting of antibiotic-impregnated polymethylmethacrylate beads
*J Am Acad Orthop Surg. 2006 Oct;14(10 Suppl):S98-S100
Tetanus vaccination history .