ANTIBIOTICS, SEPSIS, AND OTHER DRUGS - PCC

Background

Complete Basic TCCC Management Plan for Antibiotics then:

Antibiotics should be given immediately after injury or as soon as possible after the management of MARCH and Pain Management and appropriately documented (medication administered, dose, route and time).

Confirm that initial TCCC dose of moxifloxacin (Avelox®) or Ertapenem (Invanz®) have already been given for any penetrating trauma. If available, administer tetanus toxoid IM as soon as possible.

Antibiotics should be given daily for seven to 10 days, depending on the type of antibiotic given (see below tables for antibiotics). When able/available, transition IV/IO antibiotics to PO as soon as possible to conserve supplies and equipment.

Sepsis Management

- Blunt or penetrating injuries may cause sepsis in untreated or undertreated patients
- Early recognition of impending sepsis and immediate treatment are imperative to improve changes of survival
- Maintain a high degree of suspicion for signs of early and/or progressing sepsis while performing continuous triage
- Sepsis is defined as suspected or proven infection plus evidence of end organ dysfunction.
- The National Early Warning Score (NEWS)17 is an aggregate scoring system indicating early physiologic derangements:

- For the purposes of this guideline, a NEWS score of >2 is used to increase the sensitivity for detection of and evaluation for sepsis.
- Early teleconsultations should be used for any signs of sepsis
- Additional parenteral antibiotics may be required to treat sepsis as well as vasopressors.
- All use of pressers should be administered by role-based approved protocols or teleconsultation approval.

NOTE: Surgical telemedicine consultation is highly recommended to guide management of intra-abdominal infections (i.e. appendicitis, cholecystitis, diverticulitis, abdominal abscess).

Sepsis Treatment

**This is the least recommended approach as it commits a high volume of epinephrine to a large bag. If the patient’s vital signs (BP/MAP/HR) stabilize, the bag must be discontinued and the medic risks wasting some of their resources – “you can mix a drug in an IV bag, but you can’t take it out.”

Ancillary Medications

During PCC, additional medications may be required during the extended treatment of casualties, in addition to pain and antibiotic medications. These medications may have synergistic effects to further reduce pain or fever. Some medications may be utilized to treat side-effects of medications, to include nausea or other GI related issues.

Deep vein thrombosis (DVT) prophylaxis is also recommended for patients that are expected to be in a PCC setting for greater than 48 hours that have achieved hemostasis from wounds or are not at risk for further hemorrhage.

*Link to Infection Prevention in Combat-related Injuries, 27 Jan 2021 CPG 18

*Link to Sepsis Management in Prolonged Field Care, 28 Oct 2020 CPG 19