Kiwiology Posted March 28, 2010 Share Posted March 28, 2010 Yes, this patients really looks like he's rolling downhill... however there's no evidence that starting abx 20 minutes earlier does change patient mortality. The focus is on starting abx in the first hours, and surely before ICU admission, however it doesn't appear to be such a time-sensitive treatment so that minutes count. What really need to be start asap is aggressive iv fluid administration, as that is one of the early interventions that really has been shown to be a life saver; this patients is only mildy hypotensive, but gives his story of hypertension in multiple treatment, I'll take a gamble and say tha his usual BP is way higher than 110/30 (besides that's quite a big differential BP!)... I've seen a BP of 170/80, I thought that gap was rather large myself! The service that does not carry abx here states that mortality is higher in post-administration phase (release of endotoxin causing significant shock) vs dying from delayed administration. The service that does carry ceftriaxone says that mortality goes up 7% an hour if administration is delayed, I am not sure where that came from (try to find out). Link to comment Share on other sites More sharing options...
chbare Posted March 28, 2010 Share Posted March 28, 2010 I am not all the certain bombing every patient (if antimicrobial therapy may be indicated) with a third generation cephalosporin is necessarily best practice. Still, ceftriaxone does have a rather broad range of activity. I would want to see some data, especially when used in the setting of Fournier's gangrene. The best therapy is still going to be aggressive surgical intervention. Obviously, antimicrobial coverage will pay a role, I am just not that sure it would change outcomes when utilised in this type of patient as a pre-hospital intervention. Take care, chbare. Link to comment Share on other sites More sharing options...
Recommended Posts