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Link Posted: 10/5/2010 7:37:09 PM EDT
Great thread. Subscribed.
Link Posted: 10/5/2010 8:45:41 PM EDT
I'd like to know if anyone has any real data on whether freezing will improve or hurt the shelf life. It seems to me that an ultra cold
freezer like they use in medical research would certainly keep the chemicals stable. But does anyone have any actual reference on what the stability of common antibiotics is when stored in a regular freezer with defrost cycle vs a refrigerator vs
cool dark shelf?
Link Posted: 10/5/2010 8:46:19 PM EDT
Taggus Maximus
Link Posted: 10/5/2010 9:19:21 PM EDT
Originally Posted By TheGrayMan:
Originally Posted By monkeyman:
I would like to thank everyone who contributed.   I am a dumbass when it comes to seeking medical attention (high pain tolerance and a no give up/tough it out disposition) I was on a business trip one time traveling from place to place when I came down with badly infected tooth. Too busy to seek medical attention on the road and too dumb to go when I first got home on Friday night. I suffered all day Saturday and came down with a fever.  Too stubborn to go to the ER ( I hate ERs) but knew I was in trouble. Found some Amoxycillin that my daughter (Acne) had forgotten to take back to college and started self medicating. Went to the dentist on Monday and he said that since I had a knee replacement in the last year I was lucky that I started on the antibiotics when I did. Knee replacements and oral infections are bad ju-ju.  He prescribed the same thing.

I learned a couple things

First-don't be a dumb ass when it comes to your health
Second-It is good to have back up meds just in case.


Coincidentally, you picked an excellent drug for a tooth infection.

People with artificial joints need to be extra careful... if you seed that joint with bacteria through your bloodstream, you're going to think you're on the ninth circle of hell before it's all over.  You'll have to have another surgery to open up your knee joint, remove the infected hardware, wait for the infection to clear up, and then have a re-do of your joint replacement.

That's a big-ball-o-bullsh*t you don't need.


I did a little internet searching before I decided to take it.  Was lucky I had the right stuff available.
Link Posted: 10/7/2010 9:28:54 AM EDT
Originally Posted By AJ_Dual:
Just FYI, Flagyl (Metronidazole ) is really good for knocking down tooth abscesses, which is one of the kinds of post-SHTF things you may come across.

And considering it acts against a wide variety of non bacterial protozoan GI parasites, (which are waterborne, hence it's use in aquariums), it's obvious it should be on a SHTF short-list.

Although as a treatment for anaerobic bacterial infections, it's generally not indicated for superficial skin infections or wound infections.


Clindamycin is another option for anaerobe coverage, and has decent gram positive coverage for folks allergic to penicillin.
Link Posted: 10/7/2010 2:02:24 PM EDT



Originally Posted By TheGrayMan:



Originally Posted By MK262:

I apologize if this has already been asked and answered... I do plan on reading the whole thread... but what is the typical course of anti-biotics prescribed following a gunshot wound? Does the course of anti-biotics change depending on where a person is shot (Extremity vs. Abdomen)?



Thanks!




If you're gutshot, antibiotics are not going to help you.  You'll still get peritoneal soilage and peritonitis... and antibiotics don't fix that.



As for the rest, the average rule-of-thumb treatment course is ten days, though that can be greatly extended depending on how the patient responds, and the type of infection.


I understand that gut shot + no surgical intervention = almost certain dirt nap, but how about a "flesh wound" gun shot or deep penetrating wound of some sort with no arterial or organ damage.



Would you consider a prophylactic course of abx if advanced medical care was not available and which one(s) would you choose either from your list or the commonly available fish abx?



Thank you



 
Link Posted: 10/7/2010 2:58:11 PM EDT
Originally Posted By Justin-Kase:

Originally Posted By TheGrayMan:
Originally Posted By MK262:
I apologize if this has already been asked and answered... I do plan on reading the whole thread... but what is the typical course of anti-biotics prescribed following a gunshot wound? Does the course of anti-biotics change depending on where a person is shot (Extremity vs. Abdomen)?

Thanks!


If you're gutshot, antibiotics are not going to help you.  You'll still get peritoneal soilage and peritonitis... and antibiotics don't fix that.

As for the rest, the average rule-of-thumb treatment course is ten days, though that can be greatly extended depending on how the patient responds, and the type of infection.

I understand that gut shot + no surgical intervention = almost certain dirt nap, but how about a "flesh wound" gun shot or deep penetrating wound of some sort with no arterial or organ damage.

Would you consider a prophylactic course of abx if advanced medical care was not available and which one(s) would you choose either from your list or the commonly available fish abx?

Thank you
 


Why of course, what other choice do you have in that case?
Link Posted: 10/7/2010 3:11:18 PM EDT
Originally Posted By Justin-Kase:

Originally Posted By TheGrayMan:
Originally Posted By MK262:
I apologize if this has already been asked and answered... I do plan on reading the whole thread... but what is the typical course of anti-biotics prescribed following a gunshot wound? Does the course of anti-biotics change depending on where a person is shot (Extremity vs. Abdomen)?

Thanks!


If you're gutshot, antibiotics are not going to help you.  You'll still get peritoneal soilage and peritonitis... and antibiotics don't fix that.

As for the rest, the average rule-of-thumb treatment course is ten days, though that can be greatly extended depending on how the patient responds, and the type of infection.

I understand that gut shot + no surgical intervention = almost certain dirt nap, but how about a "flesh wound" gun shot or deep penetrating wound of some sort with no arterial or organ damage.

Would you consider a prophylactic course of abx if advanced medical care was not available and which one(s) would you choose either from your list or the commonly available fish abx?

Thank you
 


First off, the wound has to be cleaned... foreign material in a wound = badness.

That aside, as long as the wound can drain, and you have antibiotics for any sort of surrounding cellulitis, you might do fine.  I'd treat with antibiotics until there were no signs of infection... that might be a good deal longer than ten days.
Link Posted: 10/7/2010 3:11:33 PM EDT



Originally Posted By EXPY37:



Originally Posted By Justin-Kase:




Originally Posted By TheGrayMan:


Originally Posted By MK262:

I apologize if this has already been asked and answered... I do plan on reading the whole thread... but what is the typical course of anti-biotics prescribed following a gunshot wound? Does the course of anti-biotics change depending on where a person is shot (Extremity vs. Abdomen)?



Thanks!




If you're gutshot, antibiotics are not going to help you.  You'll still get peritoneal soilage and peritonitis... and antibiotics don't fix that.



As for the rest, the average rule-of-thumb treatment course is ten days, though that can be greatly extended depending on how the patient responds, and the type of infection.


I understand that gut shot + no surgical intervention = almost certain dirt nap, but how about a "flesh wound" gun shot or deep penetrating wound of some sort with no arterial or organ damage.



Would you consider a prophylactic course of abx if advanced medical care was not available and which one(s) would you choose either from your list or the commonly available fish abx?



Thank you

 




Why of course, what other choice do you have in that case?


Wait for signs of infections is the other option. I was curious whether the Dr would wait and see if something developed or hit it with a preventative strike.





 
Link Posted: 10/7/2010 3:17:35 PM EDT



Originally Posted By TheGrayMan:



Originally Posted By Justin-Kase:




Originally Posted By TheGrayMan:


Originally Posted By MK262:

I apologize if this has already been asked and answered... I do plan on reading the whole thread... but what is the typical course of anti-biotics prescribed following a gunshot wound? Does the course of anti-biotics change depending on where a person is shot (Extremity vs. Abdomen)?



Thanks!




If you're gutshot, antibiotics are not going to help you.  You'll still get peritoneal soilage and peritonitis... and antibiotics don't fix that.



As for the rest, the average rule-of-thumb treatment course is ten days, though that can be greatly extended depending on how the patient responds, and the type of infection.


I understand that gut shot + no surgical intervention = almost certain dirt nap, but how about a "flesh wound" gun shot or deep penetrating wound of some sort with no arterial or organ damage.



Would you consider a prophylactic course of abx if advanced medical care was not available and which one(s) would you choose either from your list or the commonly available fish abx?



Thank you

 




First off, the wound has to be cleaned... foreign material in a wound = badness.



That aside, as long as the wound can drain, and you have antibiotics for any sort of surrounding cellulitis, you might do fine.  I'd treat with antibiotics until there were no signs of infection... that might be a good deal longer than ten days.


Hopefully it goes without saying that cleaning and keeping the wound as clean as possible is mandatory for those of us that prep.



Would it be best to go with an abx cocktail to cover all the bases or a single item in your opinion?





 
Link Posted: 10/7/2010 3:35:51 PM EDT
Originally Posted By Justin-Kase:

Originally Posted By TheGrayMan:
Originally Posted By Justin-Kase:

Originally Posted By TheGrayMan:
Originally Posted By MK262:
I apologize if this has already been asked and answered... I do plan on reading the whole thread... but what is the typical course of anti-biotics prescribed following a gunshot wound? Does the course of anti-biotics change depending on where a person is shot (Extremity vs. Abdomen)?

Thanks!


If you're gutshot, antibiotics are not going to help you.  You'll still get peritoneal soilage and peritonitis... and antibiotics don't fix that.

As for the rest, the average rule-of-thumb treatment course is ten days, though that can be greatly extended depending on how the patient responds, and the type of infection.

I understand that gut shot + no surgical intervention = almost certain dirt nap, but how about a "flesh wound" gun shot or deep penetrating wound of some sort with no arterial or organ damage.

Would you consider a prophylactic course of abx if advanced medical care was not available and which one(s) would you choose either from your list or the commonly available fish abx?

Thank you
 


First off, the wound has to be cleaned... foreign material in a wound = badness.

That aside, as long as the wound can drain, and you have antibiotics for any sort of surrounding cellulitis, you might do fine.  I'd treat with antibiotics until there were no signs of infection... that might be a good deal longer than ten days.

Hopefully it goes without saying that cleaning and keeping the wound as clean as possible is mandatory for those of us that prep.

Would it be best to go with an abx cocktail to cover all the bases or a single item in your opinion?

 


If you know what you're doing, you can cone it down somewhat, rather than using a shotgun approach (which, even so, is arguably better than nothing).

And this isn't a medical opinion or "medical advice" (etc, etc, blah blah blah)...

But it would depend on the wound, and the area of the body.  If we're talking about skin organisms, you're better off treating for gram-positive organisms (staph, strep).  If the wound involved the perineum, buttocks, or upper thigh areas, I might add some coverage for bowel flora (gram-negatives and anaerobes... ditto for an oral wound... humans have incredibly filthy mouths).  For a puncture wound or deep penetrating wound, you MUST consider anaerobes... because that category contains all sorts of bad things like the Clostridia genus (with pleasant clinical syndromes like gas gangrene, tetanus, etc).
Link Posted: 10/7/2010 4:11:36 PM EDT



Originally Posted By rxdawg:



Originally Posted By AJ_Dual:

Just FYI, Flagyl (Metronidazole ) is really good for knocking down tooth abscesses, which is one of the kinds of post-SHTF things you may come across.



And considering it acts against a wide variety of non bacterial protozoan GI parasites, (which are waterborne, hence it's use in aquariums), it's obvious it should be on a SHTF short-list.



Although as a treatment for anaerobic bacterial infections, it's generally not indicated for superficial skin infections or wound infections.




Clindamycin is another option for anaerobe coverage, and has decent gram positive coverage for folks allergic to penicillin.


It's also known for inducing post-antibiotic infections in the intestine.



 
Link Posted: 10/7/2010 4:14:15 PM EDT
TGM, what do you know about Amikacin?  I'm not sure what its spectrum of activity is.



I can get it, but it's not cheap ($9/500mg vial).
Link Posted: 10/7/2010 4:19:11 PM EDT
[Last Edit: 10/7/2010 4:20:00 PM EDT by TheGrayMan]
Originally Posted By BushBoar:
TGM, what do you know about Amikacin?  I'm not sure what its spectrum of activity is.

I can get it, but it's not cheap ($9/500mg vial).


It's like Gent... good for gram-negative infections.  It must be given parenterally (IV or IM), and you have to adjust the dose for renal insufficiency, same as Gent.

ETA:  Gent = Gentamycin
Link Posted: 10/7/2010 5:53:46 PM EDT



Originally Posted By TheGrayMan:



Originally Posted By BushBoar:

TGM, what do you know about Amikacin?  I'm not sure what its spectrum of activity is.



I can get it, but it's not cheap ($9/500mg vial).




It's like Gent... good for gram-negative infections.  It must be given parenterally (IV or IM), and you have to adjust the dose for renal insufficiency, same as Gent.



ETA:  Gent = Gentamycin


Does it have any gram positive activity?



I'd like an injectable broad spectrum antibiotic for extreme emergencies, but all I have access to (not counting vet meds) is amikacin and primaxin (imipenem and cilastatin), which is $32 a vial; with the normal dosing protocol I'd need 3-4 vials per day.

Link Posted: 10/7/2010 6:01:21 PM EDT
[Last Edit: 10/7/2010 7:38:46 PM EDT by Rich_V]
Amikacin


Link - you need to register to use


ADVERSE DRUG REACTIONS
COMMON

   * Renal failure (usually reversible): risk factors include older patients, preexisting renal and hepatic disease, volume depletion, traditional Q8h dosing, large doses, concomitant nephrotoxic drug (including vancomycin), and length of therapy (most important). Controversial but trough level may be associated with nephrotoxicity.


OCCASIONAL

   * Irreversible vestibular toxicity (4-6%). Most patient compensate with visual and proprioceptive cues. Monitor for nausea, vomiting, nystagmus and vertigo (exacerbated in the dark).
   * Irreversible cochlear toxicity (3-14%). Risk factors include repeated exposure (cumulative dose and duration of therapy), genetic predisposition, renal impairment, specific aminoglycoside (neomycin>streptomycin>gentamicin>tobramycin>amikacin>netilmicin), elderly, age, bacteremia, hypovolemia, degree of temperature elevation and liver dysfunction (JID 1984:149:23-30). 62% of hearing lost were at frequency above 9kHz (high pitch) at a mean of 9 days of therapy (JID 1992; 165:1026-1032).
   * Genetic predisposition may be present in some cases of vestibular and cochlear toxicity. Check family Hx for aminoglycoside ototoxicity.
   * Monitor for ototoxicity in any patients receiving >3 days of aminoglycoside. Vestibular toxicity monitoring: check baseline visual acuity using a Snellen pocket card. After 3 days of aminoglycoside, have patient shake head (side to side) while reading a line. Early sign of ototoxicity if patient loses 2 lines of visual acuity. Check Romberg sign. Cochlear toxicity monitoring: audiology test.


––––––––––––––––––––––––––––––––––––––––––––­––––––––––––––––––––––––––––––––––––––––

Almost no gram-positive activity for this antibiotic

post edited to comply with the copyright policy
Link Posted: 10/7/2010 6:17:59 PM EDT
[Last Edit: 10/7/2010 6:18:25 PM EDT by MK262]
Originally Posted By TheGrayMan:
Originally Posted By Justin-Kase:

Originally Posted By TheGrayMan:
Originally Posted By MK262:
I apologize if this has already been asked and answered... I do plan on reading the whole thread... but what is the typical course of anti-biotics prescribed following a gunshot wound? Does the course of anti-biotics change depending on where a person is shot (Extremity vs. Abdomen)?

Thanks!


If you're gutshot, antibiotics are not going to help you.  You'll still get peritoneal soilage and peritonitis... and antibiotics don't fix that.

As for the rest, the average rule-of-thumb treatment course is ten days, though that can be greatly extended depending on how the patient responds, and the type of infection.

I understand that gut shot + no surgical intervention = almost certain dirt nap, but how about a "flesh wound" gun shot or deep penetrating wound of some sort with no arterial or organ damage.

Would you consider a prophylactic course of abx if advanced medical care was not available and which one(s) would you choose either from your list or the commonly available fish abx?

Thank you
 


First off, the wound has to be cleaned... foreign material in a wound = badness.

That aside, as long as the wound can drain, and you have antibiotics for any sort of surrounding cellulitis, you might do fine.  I'd treat with antibiotics until there were no signs of infection... that might be a good deal longer than ten days.


TheGreyMan,

In survival medicine, would you factor cauterization into your options for treatment of extremity GSWs? Does the wound still need to be cleaned prior to cauterization? Obviously, packing the wound and applying pressure to stop the bleeding would be preferable, but if you didn't have sterile packing material, cauterization would be an option. What are the risks of infection following cauterization (with hot object, not chemical cauterization)? If you took the cipro, flagyl, amoxicillin combo, could most infection be prevented?

What is the best substance for wound cleaning? Iodine? Peroxide?

And if possible, could you talk a little about debridement of GSWs?

I know that is a lot to cover, so thank you in advance for your response Doc. It's much appreciated.
Link Posted: 10/7/2010 7:39:09 PM EDT
Originally Posted By MK262:
Originally Posted By TheGrayMan:
Originally Posted By Justin-Kase:

Originally Posted By TheGrayMan:
Originally Posted By MK262:
I apologize if this has already been asked and answered... I do plan on reading the whole thread... but what is the typical course of anti-biotics prescribed following a gunshot wound? Does the course of anti-biotics change depending on where a person is shot (Extremity vs. Abdomen)?

Thanks!


If you're gutshot, antibiotics are not going to help you.  You'll still get peritoneal soilage and peritonitis... and antibiotics don't fix that.

As for the rest, the average rule-of-thumb treatment course is ten days, though that can be greatly extended depending on how the patient responds, and the type of infection.

I understand that gut shot + no surgical intervention = almost certain dirt nap, but how about a "flesh wound" gun shot or deep penetrating wound of some sort with no arterial or organ damage.

Would you consider a prophylactic course of abx if advanced medical care was not available and which one(s) would you choose either from your list or the commonly available fish abx?

Thank you
 


First off, the wound has to be cleaned... foreign material in a wound = badness.

That aside, as long as the wound can drain, and you have antibiotics for any sort of surrounding cellulitis, you might do fine.  I'd treat with antibiotics until there were no signs of infection... that might be a good deal longer than ten days.


TheGreyMan,

In survival medicine, would you factor cauterization into your options for treatment of extremity GSWs? Does the wound still need to be cleaned prior to cauterization? Obviously, packing the wound and applying pressure to stop the bleeding would be preferable, but if you didn't have sterile packing material, cauterization would be an option. What are the risks of infection following cauterization (with hot object, not chemical cauterization)? If you took the cipro, flagyl, amoxicillin combo, could most infection be prevented?

What is the best substance for wound cleaning? Iodine? Peroxide?

And if possible, could you talk a little about debridement of GSWs?

I know that is a lot to cover, so thank you in advance for your response Doc. It's much appreciated.


I wouldn't use cautery (except maybe actual surgical electrocautery to control cutaneous vessels).  Actual Civil-War-era cautery (with a hot iron) causes an awful lot of tissue damage.  That burnt/dead tissue can act as a nidus of infection, and would simply have to be debrided down to healthy tissue in order for the wound to heal.  I'd use direct pressure to stop the bleeding, and regular dressing changes while the wound drains.  If I were confronted by a bleeding vessel (assuming it's not a major vessel), I'd simply clamp/ligate it and tie it off... or put in a figure-of-eight or locking stitch to control the bleeding.  There's more than one way to skin a cat.

I do that in the ER in the case of head wounds that continue to bleed.  The skin and sub-Q tissue over the skull is a great place to encounter sizable vessels, so surgical control of them is often done in the interest of hemostasis and hematoma prevention.

As for wound cleansing, you'd be hard-pressed to beat regular tap water.  Or not even tap water... just drinking water.  If it's potable, you can irrigate wounds with it (and you won't have sterile solutions out in the boonies... but you can always boil up some water).  As for disinfectants...  Iodine and Peroxide are awfully tough on healing tissues, and can do more harm than good.  Just irrigate... dilution is the solution to pollution.

Debridement is actually beyond the scope of our discussion here, since it will be different depending on the site, type of wound, and patient.  A few rules of thumb are that dead tissue doesn't hurt, and doesn't bleed.  Necrotic tissue needs to go... and that's best left in the hands of somebody who knows the difference between healthy and dead... as well as somebody who knows a little surgical technique.
Link Posted: 10/7/2010 8:03:46 PM EDT
[Last Edit: 10/7/2010 8:04:36 PM EDT by Rich_V]
Originally Posted By TheGrayMan:

As for wound cleansing, you'd be hard-pressed to beat regular tap water.  Or not even tap water... just drinking water.  If it's potable, you can irrigate wounds with it (and you won't have sterile solutions out in the boonies... but you can always boil up some water).  As for disinfectants...  Iodine and Peroxide are awfully tough on healing tissues, and can do more harm than good.  Just irrigate... dilution is the solution to pollution.



Any reason not to use an antibiotic solution to irrigate a wound?

Also, I have often wondered why topical antibiotics are not more widely used as a prophylactic in puncture wounds or as treatment in infected surface wounds. I'm not thinking antibiotic creams with 1-2% actives but more like a thin past of the pure antibiotic itself. This would allow you to achieve local concentrations of the antibiotic hundreds or thousands of time higher than systemic dosing and therefor exceed the MIC by several logs.
Link Posted: 10/7/2010 8:06:06 PM EDT
Originally Posted By Rich_V:
Originally Posted By TheGrayMan:

As for wound cleansing, you'd be hard-pressed to beat regular tap water.  Or not even tap water... just drinking water.  If it's potable, you can irrigate wounds with it (and you won't have sterile solutions out in the boonies... but you can always boil up some water).  As for disinfectants...  Iodine and Peroxide are awfully tough on healing tissues, and can do more harm than good.  Just irrigate... dilution is the solution to pollution.



Any reason not to use an antibiotic solution to irrigate a wound?

Also, I have often wondered why topical antibiotics are not more widely used as a prophylactic in puncture wounds or as treatment in infected surface wounds. I'm not thinking antibiotic creams with 1-2% actives but more like a thin past of the pure antibiotic itself. This would allow you to achieve local concentrations of the antibiotic hundreds or thousands of time higher than systemic dosing and therefor exceed the MIC by several logs.


Because it's ineffective, and doesn't penetrate.  You cannot cure cellulitis with topicals.
Link Posted: 10/7/2010 8:08:29 PM EDT
Originally Posted By TheGrayMan:
Originally Posted By MK262:
Originally Posted By TheGrayMan:
Originally Posted By Justin-Kase:

Originally Posted By TheGrayMan:
Originally Posted By MK262:
I apologize if this has already been asked and answered... I do plan on reading the whole thread... but what is the typical course of anti-biotics prescribed following a gunshot wound? Does the course of anti-biotics change depending on where a person is shot (Extremity vs. Abdomen)?

Thanks!


If you're gutshot, antibiotics are not going to help you.  You'll still get peritoneal soilage and peritonitis... and antibiotics don't fix that.

As for the rest, the average rule-of-thumb treatment course is ten days, though that can be greatly extended depending on how the patient responds, and the type of infection.

I understand that gut shot + no surgical intervention = almost certain dirt nap, but how about a "flesh wound" gun shot or deep penetrating wound of some sort with no arterial or organ damage.

Would you consider a prophylactic course of abx if advanced medical care was not available and which one(s) would you choose either from your list or the commonly available fish abx?

Thank you
 


First off, the wound has to be cleaned... foreign material in a wound = badness.

That aside, as long as the wound can drain, and you have antibiotics for any sort of surrounding cellulitis, you might do fine.  I'd treat with antibiotics until there were no signs of infection... that might be a good deal longer than ten days.


TheGreyMan,

In survival medicine, would you factor cauterization into your options for treatment of extremity GSWs? Does the wound still need to be cleaned prior to cauterization? Obviously, packing the wound and applying pressure to stop the bleeding would be preferable, but if you didn't have sterile packing material, cauterization would be an option. What are the risks of infection following cauterization (with hot object, not chemical cauterization)? If you took the cipro, flagyl, amoxicillin combo, could most infection be prevented?

What is the best substance for wound cleaning? Iodine? Peroxide?

And if possible, could you talk a little about debridement of GSWs?

I know that is a lot to cover, so thank you in advance for your response Doc. It's much appreciated.


I wouldn't use cautery (except maybe actual surgical electrocautery to control cutaneous vessels).  Actual Civil-War-era cautery (with a hot iron) causes an awful lot of tissue damage.  That burnt/dead tissue can act as a nidus of infection, and would simply have to be debrided down to healthy tissue in order for the wound to heal.  I'd use direct pressure to stop the bleeding, and regular dressing changes while the wound drains.  If I were confronted by a bleeding vessel (assuming it's not a major vessel), I'd simply clamp/ligate it and tie it off... or put in a figure-of-eight or locking stitch to control the bleeding.  There's more than one way to skin a cat.

I do that in the ER in the case of head wounds that continue to bleed.  The skin and sub-Q tissue over the skull is a great place to encounter sizable vessels, so surgical control of them is often done in the interest of hemostasis and hematoma prevention.

As for wound cleansing, you'd be hard-pressed to beat regular tap water.  Or not even tap water... just drinking water.  If it's potable, you can irrigate wounds with it (and you won't have sterile solutions out in the boonies... but you can always boil up some water).  As for disinfectants...  Iodine and Peroxide are awfully tough on healing tissues, and can do more harm than good.  Just irrigate... dilution is the solution to pollution.

Debridement is actually beyond the scope of our discussion here, since it will be different depending on the site, type of wound, and patient.  A few rules of thumb are that dead tissue doesn't hurt, and doesn't bleed.  Necrotic tissue needs to go... and that's best left in the hands of somebody who knows the difference between healthy and dead... as well as somebody who knows a little surgical technique.


I know we're getting way off topic here, and I apologize, but:

A figure of eight stitch looks pretty simple to do for cutaneous wounds:

http://www.youtube.com/watch?v=IHj6nLALvMA

I'm sure it is much more challenging when suturing vessels. For someone with no medical training, and with no surgeon nearby like they had on LOST , would it be possible for an amateur to suture a vessel and not kill someone (cut off blood flow, etc.)?
Link Posted: 10/7/2010 8:37:09 PM EDT
Originally Posted By MK262:


I know we're getting way off topic here, and I apologize, but:

A figure of eight stitch looks pretty simple to do for cutaneous wounds:

http://www.youtube.com/watch?v=IHj6nLALvMA

I'm sure it is much more challenging when suturing vessels. For someone with no medical training, and with no surgeon nearby like they had on LOST , would it be possible for an amateur to suture a vessel and not kill someone (cut off blood flow, etc.)?


No.  

Repairing a vessel is beyond my skill... and unless you have a set of loupes and the micro-surgical skill of a vascular surgeon, it's probably beyond your skill too.  Tying one off is relatively easy, and in areas with good collateral flow, you can get away with it.  On the other hand, If you ligate an end-artery, you'll kill the tissue distal to it if there is no collateral flow.
Link Posted: 10/7/2010 8:43:14 PM EDT



Originally Posted By Rich_V:


Amikacin





Link - you need to register to use





ADVERSE DRUG REACTIONS

COMMON



   * Renal failure (usually reversible): risk factors include older patients, preexisting renal and hepatic disease, volume depletion, traditional Q8h dosing, large doses, concomitant nephrotoxic drug (including vancomycin), and length of therapy (most important). Controversial but trough level may be associated with nephrotoxicity.




OCCASIONAL



   * Irreversible vestibular toxicity (4-6%). Most patient compensate with visual and proprioceptive cues. Monitor for nausea, vomiting, nystagmus and vertigo (exacerbated in the dark).

   * Irreversible cochlear toxicity (3-14%). Risk factors include repeated exposure (cumulative dose and duration of therapy), genetic predisposition, renal impairment, specific aminoglycoside (neomycin>streptomycin>gentamicin>tobramycin>amikacin>netilmicin), elderly, age, bacteremia, hypovolemia, degree of temperature elevation and liver dysfunction (JID 1984:149:23-30). 62% of hearing lost were at frequency above 9kHz (high pitch) at a mean of 9 days of therapy (JID 1992; 165:1026-1032).

   * Genetic predisposition may be present in some cases of vestibular and cochlear toxicity. Check family Hx for aminoglycoside ototoxicity.

   * Monitor for ototoxicity in any patients receiving >3 days of aminoglycoside. Vestibular toxicity monitoring: check baseline visual acuity using a Snellen pocket card. After 3 days of aminoglycoside, have patient shake head (side to side) while reading a line. Early sign of ototoxicity if patient loses 2 lines of visual acuity. Check Romberg sign. Cochlear toxicity monitoring: audiology test.





–––––––––––––––––––––––––––––––––––––––––––––­–––––––––––––––––––––––––––––––––––––––



Almost no gram-positive activity for this antibiotic



post edited to comply with the copyright policy


I was aware of the ototoxicity and potential for kidney failure.



If it came to the point that I was injecting it, I'd probably have other concerns.



That being said, if the coverage is that narrow, I'm not interested.



Maybe I should just get some penicillin G from a farm supply place.



 
Link Posted: 10/7/2010 8:49:29 PM EDT
What would be the best way to store Pen-G for long term?  If I refrigerate it, will it precipitate?
Link Posted: 10/7/2010 9:12:40 PM EDT
Originally Posted By BushBoar:

Originally Posted By Rich_V:
Amikacin


Link - you need to register to use


ADVERSE DRUG REACTIONS
COMMON

   * Renal failure (usually reversible): risk factors include older patients, preexisting renal and hepatic disease, volume depletion, traditional Q8h dosing, large doses, concomitant nephrotoxic drug (including vancomycin), and length of therapy (most important). Controversial but trough level may be associated with nephrotoxicity.


OCCASIONAL

   * Irreversible vestibular toxicity (4-6%). Most patient compensate with visual and proprioceptive cues. Monitor for nausea, vomiting, nystagmus and vertigo (exacerbated in the dark).
   * Irreversible cochlear toxicity (3-14%). Risk factors include repeated exposure (cumulative dose and duration of therapy), genetic predisposition, renal impairment, specific aminoglycoside (neomycin>streptomycin>gentamicin>tobramycin>amikacin>netilmicin), elderly, age, bacteremia, hypovolemia, degree of temperature elevation and liver dysfunction (JID 1984:149:23-30). 62% of hearing lost were at frequency above 9kHz (high pitch) at a mean of 9 days of therapy (JID 1992; 165:1026-1032).
   * Genetic predisposition may be present in some cases of vestibular and cochlear toxicity. Check family Hx for aminoglycoside ototoxicity.
   * Monitor for ototoxicity in any patients receiving >3 days of aminoglycoside. Vestibular toxicity monitoring: check baseline visual acuity using a Snellen pocket card. After 3 days of aminoglycoside, have patient shake head (side to side) while reading a line. Early sign of ototoxicity if patient loses 2 lines of visual acuity. Check Romberg sign. Cochlear toxicity monitoring: audiology test.


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Almost no gram-positive activity for this antibiotic

post edited to comply with the copyright policy

I was aware of the ototoxicity and potential for kidney failure.

If it came to the point that I was injecting it, I'd probably have other concerns.

That being said, if the coverage is that narrow, I'm not interested.

Maybe I should just get some penicillin G from a farm supply place.
 


There's no such thing as single-agent-coverage for all situations... so "getting both" would be more in-line with actual practice... or some Ampicillin in place of the Pen-G.  "Amp + Gent" is a common antibiotic combo to empirically cover gram (+) and gram (-) bacteria in kids (+/- Vanc for MRSA)... or they'll use "Amp and Claf" (Claforan).  I don't know why Pen-G + Amikacin wouldn't work just as well.

Realize, however, that you're getting into multiple nephrotoxic agents, and following renal function is a MUST.  Without doing that, you're just spitballing whether your kidneys will still work after it's all over.
Link Posted: 10/7/2010 9:36:54 PM EDT



Originally Posted By TheGrayMan:



Originally Posted By BushBoar:




Originally Posted By Rich_V:

Amikacin





Link - you need to register to use





ADVERSE DRUG REACTIONS

COMMON



   * Renal failure (usually reversible): risk factors include older patients, preexisting renal and hepatic disease, volume depletion, traditional Q8h dosing, large doses, concomitant nephrotoxic drug (including vancomycin), and length of therapy (most important). Controversial but trough level may be associated with nephrotoxicity.




OCCASIONAL



   * Irreversible vestibular toxicity (4-6%). Most patient compensate with visual and proprioceptive cues. Monitor for nausea, vomiting, nystagmus and vertigo (exacerbated in the dark).

   * Irreversible cochlear toxicity (3-14%). Risk factors include repeated exposure (cumulative dose and duration of therapy), genetic predisposition, renal impairment, specific aminoglycoside (neomycin>streptomycin>gentamicin>tobramycin>amikacin>netilmicin), elderly, age, bacteremia, hypovolemia, degree of temperature elevation and liver dysfunction (JID 1984:149:23-30). 62% of hearing lost were at frequency above 9kHz (high pitch) at a mean of 9 days of therapy (JID 1992; 165:1026-1032).

   * Genetic predisposition may be present in some cases of vestibular and cochlear toxicity. Check family Hx for aminoglycoside ototoxicity.

   * Monitor for ototoxicity in any patients receiving >3 days of aminoglycoside. Vestibular toxicity monitoring: check baseline visual acuity using a Snellen pocket card. After 3 days of aminoglycoside, have patient shake head (side to side) while reading a line. Early sign of ototoxicity if patient loses 2 lines of visual acuity. Check Romberg sign. Cochlear toxicity monitoring: audiology test.





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Almost no gram-positive activity for this antibiotic



post edited to comply with the copyright policy


I was aware of the ototoxicity and potential for kidney failure.



If it came to the point that I was injecting it, I'd probably have other concerns.



That being said, if the coverage is that narrow, I'm not interested.



Maybe I should just get some penicillin G from a farm supply place.

 




There's no such thing as single-agent-coverage for all situations... so "getting both" would be more in-line with actual practice... or some Ampicillin in place of the Pen-G.  "Amp + Gent" is a common antibiotic combo to empirically cover gram (+) and gram (-) bacteria in kids (+/- Vanc for MRSA)... or they'll use "Amp and Claf" (Claforan).  I don't know why Pen-G + Amikacin wouldn't work just as well.



Realize, however, that you're getting into multiple nephrotoxic agents, and following renal function is a MUST.  Without doing that, you're just spitballing whether your kidneys will still work after it's all over.


Oh, I'm aware of that, but as you know some antibiotics offer a much bigger spread, such as fluoroquinolones.  I can't get them in an injectable, though.  Actually, it'd be theoretically possible to prepare injectables from tablets but that's not something I'd ever consider doing.  I'm not a medical professional or chemist, and 2 semester of gen chem and 1 of orgo doesn't make me that confident.



If the time comes where I'm injecting an antibiotic into myself or anyone else, the situation is so dire that the potential for kidney problems would be an acceptable risk.
 
Link Posted: 10/8/2010 12:47:27 AM EDT
[Last Edit: 10/8/2010 1:22:21 AM EDT by Spiffster]
The only reason you would be injecting (or even consider injecting) a fluoroquinolone in an austere situation would be if the person physically cannot take oral medications. If that is the case then you might as well save them for someone where they will actually do some good. Unlike many medications, the oral/IV bioavailability of stuff like ciprofloxacin and levofloxacin is pretty much equivalent sothe mere fact of injecting it really doesn't buy you much.
Link Posted: 10/8/2010 12:57:42 AM EDT
Though ABX preferences vary from region to region, here in the Pacific NW I would say amakacin is not frequently used.  In my 6.5 years of working in a hospital I have seen it used maybe twice.  Also remember if there is an abscess ABX only penetrate minimally in most cases so as stated previously they must be drained. YMMV
Link Posted: 10/8/2010 1:07:14 AM EDT
[Last Edit: 10/8/2010 1:12:20 AM EDT by Spiffster]
Originally Posted By TheGrayMan:
ETA:  I just realized that I've committed a grievous oversight.  I didn't throw in anything about parasites (roundworms, tapeworms, hookworms, etc).  They're not generally an acute life-threat like some of the other infections we're discussing, but in a SHTF scenario, your nutrition is going to be tenuous enough without a large parasite load sucking up your hard-won vitamins and calories.  In that vein, I'd suggest including some Vermox or Albenza.


Totally agree (actually had Albenza on my list ). In SHTF, basically you have to start thinking of yourself being in a third world country –– dealing with stuff we don't see very often right now. That is why parasites, protozoans (Flagyl takes care of most of these), and zoonoses arise as serious potential problems. My other addition to your list was some Diflucan –– mainly to treat all these yeast infections we will be giving people after dispensing all of these antibiotics .
Link Posted: 10/8/2010 1:07:28 AM EDT
Guys, the only thing I still treat with Penicillin is syphilis.

I would look for different gram positive coverage.
Link Posted: 10/8/2010 1:09:59 AM EDT
[Last Edit: 10/8/2010 1:20:10 AM EDT by Spiffster]
Penicillin's applications are limited but it can be used as a cheap "enhancer". For example, the combination of metronidazole and penicillin is a cheap and effective combo for dental infections. It all comes down to knowing thy enemy.


ETA: as far as shooting people up with Amikacin, unless you can monitor pharmacokinetics (i.e serum drug levels) and renal function, you are either going to end up under dosing people (and therefore not doing any good) or doing more harm than good when you whack their already stressed kidneys.
Link Posted: 10/8/2010 9:29:04 AM EDT
Originally Posted By Mr_Psmith:
Guys, the only thing I still treat with Penicillin is syphilis.

I would look for different gram positive coverage.


Not me.  Dental infections, strep throat... you can even get some of the intermediate-resistant pneumococcus if you bump up the dose.

Whatever your choice for economical gram-positive coverage, it's probably going to be some sort of Beta-Lactam.

Link Posted: 10/8/2010 3:17:08 PM EDT
tag
Link Posted: 10/8/2010 6:24:28 PM EDT
[Last Edit: 10/8/2010 6:27:52 PM EDT by BushBoar]





Originally Posted By TheGrayMan:





Originally Posted By Mr_Psmith:


Guys, the only thing I still treat with Penicillin is syphilis.





I would look for different gram positive coverage.








Not me.  Dental infections, strep throat... you can even get some of the intermediate-resistant pneumococcus if you bump up the dose.





Whatever your choice for economical gram-positive coverage, it's probably going to be some sort of Beta-Lactam.








My next oral ABX purchase is going to be Augmentin, since it incorporates a beta-lactamase inhibitor.  Unfortunately it's not cheap ($1/tab from ADC for 500/125, $2/tab for 875/125).





 
Link Posted: 10/8/2010 6:25:46 PM EDT



Originally Posted By Spiffster:


The only reason you would be injecting (or even consider injecting) a fluoroquinolone in an austere situation would be if the person physically cannot take oral medications. If that is the case then you might as well save them for someone where they will actually do some good. Unlike many medications, the oral/IV bioavailability of stuff like ciprofloxacin and levofloxacin is pretty much equivalent sothe mere fact of injecting it really doesn't buy you much.


Well, that was what I was thinking about.  But your next sentence is an excellent point.



 
Link Posted: 10/8/2010 6:26:51 PM EDT



Originally Posted By Spiffster:


Penicillin's applications are limited but it can be used as a cheap "enhancer". For example, the combination of metronidazole and penicillin is a cheap and effective combo for dental infections. It all comes down to knowing thy enemy.





ETA: as far as shooting people up with Amikacin, unless you can monitor pharmacokinetics (i.e serum drug levels) and renal function, you are either going to end up under dosing people (and therefore not doing any good) or doing more harm than good when you whack their already stressed kidneys.


Good info, thanks.



 
Link Posted: 10/9/2010 5:47:59 PM EDT
can we sticky this?
Link Posted: 10/9/2010 10:11:03 PM EDT
tag
Link Posted: 10/18/2010 9:07:21 AM EDT
[Last Edit: 10/18/2010 9:11:10 AM EDT by monkeyman]
Bumping this interesting thread to  say that last Thursday I went in for minor umbilical hernia repair (stemming from my diverticulitis surgery last year) and ended up in the hospital for 4 days. The incision from last year opened a little bit in June and I ignored it. It gradually got bigger and bigger as being overweight/obese stresses the abdominal wall.  I started having symptoms of a bowel obstruction in September and thought it was a reoccurance of diverticulitis.  I modified my diet, lost 20 pounds and made an appointment to have the hernia repaired.

When I went in for the out patient repair, I woke up three hours later  with a 9" incision full of staples up my belly and about a foot of bowel missing. Apparently the bowel got strangled by the hernia and then formed lesions which caused an obstruction.  The point is that had this been a situation where I couldn't have gotten to the hospital I would have eventually been in pretty bad shape. They had me on an IV antibiotic and am now finishing up orally with augmentin/amoxicillin.

BTW... Being hooked up to an IV,  suction tube down your throat draining bile from your stomach and a catheter with nothing to eat or drink for 3 days is not a fun experience.  Having your belly cut open and you bowels removed is not fun either. I did lose another 10 pounds and am now recovering at home. Gotta lose another 50 pounds.

PS. Take care of your bowels, eat a good high fiber diet or you will pay the price later in life.
Link Posted: 10/18/2010 12:59:12 PM EDT
"PS. Take care of your bowels, eat a good high fiber diet or you will pay the price later in life."

Right on MM.

As I sit here, at each computer table, there's a GatorAide 24 oz bottle my SO keeps replenished [usually ] with raw oatmeal.

I dump in a mouthful and pour in some RO water [keep that handy as well in a 32 oz G-A bottle] and chew it up. Doing it right now actually. Usually eat about 3 or 4 mouthfuls.

Sometimes if the oats is nearby at supper I will add a mouthful as well.

Once you get used to eating it this way it's actually pretty good albeit bland. Helps with chlosterol too it's said. Just common sense [that's in such short supply nowadays]
Link Posted: 11/11/2010 9:10:03 PM EDT
Originally Posted By BushBoar:

Originally Posted By TheGrayMan:
Originally Posted By Mr_Psmith:
Guys, the only thing I still treat with Penicillin is syphilis.

I would look for different gram positive coverage.


Not me.  Dental infections, strep throat... you can even get some of the intermediate-resistant pneumococcus if you bump up the dose.

Whatever your choice for economical gram-positive coverage, it's probably going to be some sort of Beta-Lactam.


My next oral ABX purchase is going to be Augmentin, since it incorporates a beta-lactamase inhibitor.  Unfortunately it's not cheap ($1/tab from ADC for 500/125, $2/tab for 875/125).
 


So how much can you buy?   I am guessing this is one of the online doctors to write the script?
Link Posted: 11/11/2010 9:50:02 PM EDT
Originally Posted By TheGrayMan:
Originally Posted By Mr_Psmith:
Guys, the only thing I still treat with Penicillin is syphilis.

I would look for different gram positive coverage.


Not me.  Dental infections, strep throat... you can even get some of the intermediate-resistant pneumococcus if you bump up the dose.

Whatever your choice for economical gram-positive coverage, it's probably going to be some sort of Beta-Lactam.



To be clear, I meant Penicillin itself, not in the generic sense, under which I could categorize everything from Augmentin to Zosyn.  I suspect you know that, though, and honestly I don't treat many dental infections or strep throat =)

I definitely agree with your final statement: "Whatever your choice for economical gram-positive coverage, it's probably going to be some sort of Beta-Lactam."
Link Posted: 11/11/2010 10:29:27 PM EDT



Originally Posted By GlocksareGood:



Originally Posted By BushBoar:




Originally Posted By TheGrayMan:


Originally Posted By Mr_Psmith:

Guys, the only thing I still treat with Penicillin is syphilis.



I would look for different gram positive coverage.





Not me.  Dental infections, strep throat... you can even get some of the intermediate-resistant pneumococcus if you bump up the dose.



Whatever your choice for economical gram-positive coverage, it's probably going to be some sort of Beta-Lactam.





My next oral ABX purchase is going to be Augmentin, since it incorporates a beta-lactamase inhibitor.  Unfortunately it's not cheap ($1/tab from ADC for 500/125, $2/tab for 875/125).

 




So how much can you buy?   I am guessing this is one of the online doctors to write the script?


No, it's an international pharmacy that doesn't require a prescription.



You can buy as much as you can afford.



 
Link Posted: 11/11/2010 11:45:58 PM EDT
Some great info in this thread, thanks.

I'm wondering about topical antibiotics- is good old Neosporin enough? Is there a size or depth or type of wound (like burns) that would cause you to not mess around with it?
Link Posted: 11/12/2010 8:50:26 AM EDT
Originally Posted By cool_story_bro:
Some great info in this thread, thanks.

I'm wondering about topical antibiotics- is good old Neosporin enough? Is there a size or depth or type of wound (like burns) that would cause you to not mess around with it?


Neosporin doesn't penetrate much; none of the topicals do.  This means they don't give you systemic absorption.  They're completely inadequate for cellulitis, and deeper tissue infections.  They do seem to help some common cuts heal, but you don't have to go nuts with them.

They're good for impetigo, and to help heal some minor wound infections, but actual sterile/clean wounds (or wounds that aren't contaminated, and have been properly cleaned/sutured in the appropriate time frame) don't benefit much from antibiotic goop, if at all.  

Also, given my choice, I'd take Bacitracin or Bactroban over Neosporin.  The Neomycin ingredient in Neosporin can be sensitizing/irritating, and people are more likely to end up allergic to it (this is a minor point... use what you have).

Link Posted: 11/12/2010 10:00:47 AM EDT
[Last Edit: 11/12/2010 10:00:58 AM EDT by BushBoar]





Originally Posted By TheGrayMan:





Originally Posted By cool_story_bro:


Some great info in this thread, thanks.





I'm wondering about topical antibiotics- is good old Neosporin enough? Is there a size or depth or type of wound (like burns) that would cause you to not mess around with it?






Neosporin doesn't penetrate much; none of the topicals do.  This means they don't give you systemic absorption.  They're completely inadequate for cellulitis, and deeper tissue infections.  They do seem to help some common cuts heal, but you don't have to go nuts with them.





They're good for impetigo, and to help heal some minor wound infections, but actual sterile/clean wounds (or wounds that aren't contaminated, and have been properly cleaned/sutured in the appropriate time frame) don't benefit much from antibiotic goop, if at all.  





Also, given my choice, I'd take Bacitracin or Bactroban over Neosporin.  The Neomycin ingredient in Neosporin can be sensitizing/irritating, and people are more likely to end up allergic to it (this is a minor point... use what you have).








Is a combination of a systematic antibiotic and a topical antibiotic ever indicated, or is it a "one or the other" thing?





 
Link Posted: 11/12/2010 10:06:38 AM EDT
Originally Posted By BushBoar:

Originally Posted By TheGrayMan:
Originally Posted By cool_story_bro:
Some great info in this thread, thanks.

I'm wondering about topical antibiotics- is good old Neosporin enough? Is there a size or depth or type of wound (like burns) that would cause you to not mess around with it?


Neosporin doesn't penetrate much; none of the topicals do.  This means they don't give you systemic absorption.  They're completely inadequate for cellulitis, and deeper tissue infections.  They do seem to help some common cuts heal, but you don't have to go nuts with them.

They're good for impetigo, and to help heal some minor wound infections, but actual sterile/clean wounds (or wounds that aren't contaminated, and have been properly cleaned/sutured in the appropriate time frame) don't benefit much from antibiotic goop, if at all.  

Also, given my choice, I'd take Bacitracin or Bactroban over Neosporin.  The Neomycin ingredient in Neosporin can be sensitizing/irritating, and people are more likely to end up allergic to it (this is a minor point... use what you have).


Is a combination of a systematic antibiotic and a topical antibiotic ever indicated, or is it a "one or the other" thing?
 


If you need systemic treatment, you're past the point where topicals would be very useful.
Link Posted: 11/12/2010 11:03:46 AM EDT



Originally Posted By TheGrayMan:



Originally Posted By BushBoar:




Originally Posted By TheGrayMan:


Originally Posted By cool_story_bro:

Some great info in this thread, thanks.



I'm wondering about topical antibiotics- is good old Neosporin enough? Is there a size or depth or type of wound (like burns) that would cause you to not mess around with it?




Neosporin doesn't penetrate much; none of the topicals do.  This means they don't give you systemic absorption.  They're completely inadequate for cellulitis, and deeper tissue infections.  They do seem to help some common cuts heal, but you don't have to go nuts with them.



They're good for impetigo, and to help heal some minor wound infections, but actual sterile/clean wounds (or wounds that aren't contaminated, and have been properly cleaned/sutured in the appropriate time frame) don't benefit much from antibiotic goop, if at all.  



Also, given my choice, I'd take Bacitracin or Bactroban over Neosporin.  The Neomycin ingredient in Neosporin can be sensitizing/irritating, and people are more likely to end up allergic to it (this is a minor point... use what you have).





Is a combination of a systematic antibiotic and a topical antibiotic ever indicated, or is it a "one or the other" thing?

 




If you need systemic treatment, you're past the point where topicals would be very useful.


I was thinking more as a prophylactic measure following an injury.



 
Link Posted: 11/12/2010 11:13:09 AM EDT



Originally Posted By TheGrayMan:



Originally Posted By cool_story_bro:

Some great info in this thread, thanks.



I'm wondering about topical antibiotics- is good old Neosporin enough? Is there a size or depth or type of wound (like burns) that would cause you to not mess around with it?




Neosporin doesn't penetrate much; none of the topicals do.  This means they don't give you systemic absorption.  They're completely inadequate for cellulitis, and deeper tissue infections.  They do seem to help some common cuts heal, but you don't have to go nuts with them.



They're good for impetigo, and to help heal some minor wound infections, but actual sterile/clean wounds (or wounds that aren't contaminated, and have been properly cleaned/sutured in the appropriate time frame) don't benefit much from antibiotic goop, if at all.  



Also, given my choice, I'd take Bacitracin or Bactroban over Neosporin.  The Neomycin ingredient in Neosporin can be sensitizing/irritating, and people are more likely to end up allergic to it (this is a minor point... use what you have).





What do you think about keeping an ophthalmic antibiotic ointment in the SHTF FAK?

Any advice?



 
Link Posted: 11/12/2010 11:19:23 AM EDT
[Last Edit: 11/12/2010 12:07:49 PM EDT by TheGrayMan]
Originally Posted By BushBoar:

Originally Posted By TheGrayMan:
Originally Posted By BushBoar:

Originally Posted By TheGrayMan:
Originally Posted By cool_story_bro:
Some great info in this thread, thanks.

I'm wondering about topical antibiotics- is good old Neosporin enough? Is there a size or depth or type of wound (like burns) that would cause you to not mess around with it?


Neosporin doesn't penetrate much; none of the topicals do.  This means they don't give you systemic absorption.  They're completely inadequate for cellulitis, and deeper tissue infections.  They do seem to help some common cuts heal, but you don't have to go nuts with them.

They're good for impetigo, and to help heal some minor wound infections, but actual sterile/clean wounds (or wounds that aren't contaminated, and have been properly cleaned/sutured in the appropriate time frame) don't benefit much from antibiotic goop, if at all.  

Also, given my choice, I'd take Bacitracin or Bactroban over Neosporin.  The Neomycin ingredient in Neosporin can be sensitizing/irritating, and people are more likely to end up allergic to it (this is a minor point... use what you have).


Is a combination of a systematic antibiotic and a topical antibiotic ever indicated, or is it a "one or the other" thing?
 


If you need systemic treatment, you're past the point where topicals would be very useful.

I was thinking more as a prophylactic measure following an injury.
 


Makes no difference in a clean wound... might help in a mildly-infected one... will NOT help in a cellulitic/abscessed wound.

ETA: sorry Justin... we cross-posted there.  To answer your question, yes... ophthalmic antibiotics would be an excellent addition, particularly if you're in a dry/dusty area.  When I was deployed to the sandbox, we treated a lot of eye injuries; mostly corneal abrasions and corneal ulcers.  It's simply a consequence of the dust and constant wind... and you can't wear those "rat patrol" goggles all the time.  In that vein, most of your eye infections are going to be gram-positive infections... like Staph and such (this changes if you're a contact-lens wearer... many of those are gram-negatives, like Pseudomonas).  

One also has to take into account what you're treating... simple conjunctivitis, versus a corneal abrasion, versus a full-on corneal ulcer.

Sulfa: sulfa is good, and covers Staph, but stings when you put it in... so I don't prescribe much of it.  If a patient won't use it (because it's painful), there's no sense in prescribing it.  

Erythromycin:  macrolide that comes in an ointment.  I end up using more of this than the Sulfa, just because patients tolerate it better... but it's not recommended for corneal ulcers.  It does, however, cover Chlamydia in the eye (yeah...)

Cipro/floxin/moxi/Levaquin drops:  These are used for the contact-lens wearer, and for corneal ulcers.  They're also EXPENSIVE... but for actual corneal ulcers, you'd better use the big guns.  You only get one set of eyes.
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