blunt abdominal trauma medication

7/30/2019 Blunt Abdominal Trauma Medication

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1/8emedicine.medscape.com/article/1980980-medication#showall

Blunt Abdominal Trauma MedicationAuthor: John Udeani, MD, FAAEM; Chief Editor: John Geibel, MD, DSc, MA more...

Updated: Sep 20, 2012

Medication Summary

Judiciously prescribe pain medications to patients who are discharged. To prevent masked or delayed

presentations, ensure that a close follow-up for reevaluation is available to all patients who are provided pain

medications. With the potential for hemorrhage, nonsteroidal anti-inflammatory drugs (NSAIDs) probably should be

avoided. Acetaminophen with or without small quantities of mild narcotic analgesics may be all that should be

prescribed initially. Minimize use of analgesics in patients who are admitted for observation.

Patients who undergo laparotomy may require routine perioperative antibiotics. Patients with repaired hollow organ

injury may require additional antibiotics.

Analgesics

Class Summary

Pain control is essential to quality patient care. It ensures patient comfort, promotes pulmonary toilet, and

prevents exacerbations in tachycardia and hypertension.

View full drug information

Morphine sulfate (Duramorph, Astramorph, MS Contin, Avinza, Kadian)

Morphine is the drug of choice for narcotic analgesia due to its reliable and predictable effects, safety profile, and

ease of reversibility with naloxone. Like fentanyl, morphine sulfate is easily titrated to desired level of pain control.

Morphine sulfate administered intravenously may be dosed in a number of ways. It is commonly titrated until the

desired effect is obtained.


Fentanyl citrate (Fentora, Abastral, Duragesic)

A synthetic opioid analgesic that is primarily a mu receptor agonist, fentanyl is 50-100 times more potent than

morphine. It has a short duration of action (1-2 h) and minimal cardiovascular effects, such as hypotension.

Respiratory depression is uncommon, but this effect lasts longer than its analgesic effect. Fentanyl is frequently

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Ceftazidime (Fortaz, Tazicef)

Ceftazidime is a third-generation cephalosporin with broad-spectrum, gram-negative act ivity, including against

Pseudomonas; it has low efficacy against gram-positive organisms and high efficacy against resistant organisms.

This agent arrests bacterial growth by binding to one or more penicillin-binding proteins, which, in turn, inhibits the

final transpeptidation step of peptidoglycan synthesis in bacterial cell wall synthesis, thus inhibiting cell wall

biosynthesis.

The condition of the patient, severity of infection, and susceptibility of the microorganism should determine the

proper dose and route of administration.


Ceftriaxone (Rocephin)

Ceftriaxone is a third-generation cephalosporin with broad-spectrum gram-negative act ivity, low efficacy against

gram-positive organisms, and high efficacy against resistant organisms. It is considered the drug of choice for

parenteral agents in community-acquired pneumonia. Bactericidal activity results from the inhibition of cell wall

synthesis by binding to one or more penicillin-binding proteins. This agent exerts its antimicrobial effect by

interfering with the synthesis of peptidoglycan, a major structural component of the bacterial cell wall. Bacteria

eventually lyse due to ongoing activity of cell wall autolytic enzymes, while the cell wall assembly is arrested.

Ceftriaxone is highly stable in the presence of beta-lactamases, both penicillinase and cephalosporinase, and of

gram-negative and gram-positive bacteria. Approximately 33-67% of the dose is excreted unchanged in urine, and

the remainder is secreted in bile and, ultimately, in feces as microbiologically inactive compounds. This agent

reversibly binds to human plasma proteins, and binding has been reported to decrease from 95% bound at plasma

concentrations of less than 25 mcg/mL to 85% bound at 300 mcg/mL.


Erythromycin (E.E.S., Ery-Tab, Erythrocin, PCE, EryPed)

Erythromycin covers most potential etiologic agents, including Mycoplasma species. The oral regimen may be

insufficient to adequately treat Legionella species, and this agent is less active against H influenzae. Although thestandard course of treatment is 10 days, treatment until the patient has been afebrile for 3-5 days seems a more

rational approach. Erythromycin therapy may result in GI upset, causing some clinicians to prescribe an

alternative macrolide or change to a thrice-daily dosing.

Erythromycin is a macrolide that inhibits bacterial growth possibly by blocking dissociation of peptidyl t-RNA from

ribosomes, causing RNA-dependent protein synthesis to arrest.


Amoxicillin and clavulanate (Augmentin, Augmentin XR, Amoclan)

Amoxicill in inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins. The addition of clavulanateinhibits beta-lactamase producing bacteria.

It is a good alternative antibiotic for patients allergic to or intolerant of the macrolide class. It is usually is well

tolerated and provides good coverage to most infectious agents. It is not effective against Mycoplasma and

Legionella species. The half-life of the oral dosage form is 1-1.3 hours. It has good tissue penetration but does not

enter cerebrospinal fluid.

For children older than 3 months, base the dosing protocol on the amoxicillin content. Due to different

amoxicillin/c lavulanic acid ratios in the 250-mg tablet (250/125) versus the 250-mg chewable tablet (250/62.5), do

not use the 250-mg tablet until child weighs more than 40 kg.


Ampicillin and sulbactam (Unasyn)

This is a drug combination of a beta-lactamase inhibitor with ampicillin. It interferes with bacterial cell wall

synthesis during active replication, causing bactericidal activity against susceptible organisms. It is an alternative


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to amoxicillin when the patient is unable to take medication orally.

It covers skin, enteric flora, and anaerobes. It is not ideal for nosocomial pathogens.


Piperacillin and tazobactam sodium (Zosyn)

This is an antipseudomonal penicillin plus a beta-lactamase inhibitor. It inhibits the biosynthesis of cell wall

mucopeptide and is effective during the stage of active multiplication.


Ticarcillin and clavulanate (Timentin)

It inhibits the biosynthesis of cell wall mucopeptide and is effective during the stage of active growth.

It is an antipseudomonal penicillin plus a beta-lactamase inhibitor that provides coverage against most gram-

positives, most gram negatives, and most anaerobes.


Ciprofloxacin (Cipro)

Ciprofloxacin is a fluoroquinolone that inhibits bacterial DNA synthesis and, consequently, growth, by inhibiting

DNA gyrase and topoisomerases, which are required for replication, transcription, and translation of genetic

material. Quinolones have broad activity against gram-positive and gram-negative aerobic organisms. It is has no

activity against anaerobes. Continue treatment for at least 2 days (7-14 d typical) after signs and symptoms have

disappeared.


Levofloxacin (Levaquin)

Levofloxacin is rapidly becoming a popular choice in pneumonia; this agent is a fluoroquinolone used to treatcommunity-acquired pneumonia caused by S aureus, S pneumoniae (including penicillin-resistant strains), H

influenzae, H parainfluenzae, Klebsiella pneumoniae, M catarrhalis, C pneumoniae, Legionella pneumophila, orM

pneumoniae. Fluoroquinolones should be used empirically in patients likely to develop exacerbation due to

resistant organisms to other antibiotics.

Levofloxacin is the L stereoisomer of the D/L parent compound ofloxacin, the D form being inactive. It is good

monotherapy with extended coverage against Pseudomonas species and excellent activity against pneumococci.

Levofloxacin acts by inhibition of DNA gyrase activity. The oral form has a bioavailability that is reportedly 99%.

The 750-mg dose is as well tolerated as the 500-mg dose, and it is more effective. Other fluoroquinolones with

activity against S pneumoniae may be useful and include moxifloxacin, gatifloxacin, and gemifloxacin.


Clindamycin (Cleocin, Cleocin Pediatric)

Clindamycin is a lincosamide semisynthetic antibiotic produced by 7(S)-chloro-substitution of 7(R)-hydroxyl group

of the parent compound lincomycin. It inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA

from ribosomes, causing RNA-dependent protein synthesis to arrest. It widely distributes in the body, without

penetration of the CNS. It is protein bound and is excreted by the liver and kidneys.

It is available in a parenteral form (ie, c lindamycin phosphate) and oral form (ie, clindamycin hydrochloride). Oral

clindamycin is absorbed rapidly and almost completely and is not appreciably altered by the presence of food in

the stomach. Appropriate serum levels are reached and sustained for at least 6 hours following an oral dose. Nosignificant levels are attained in cerebrospinal fluid. It is also effective against aerobic and anaerobic streptococci

(except enterococci).

Contributor Information and Disclosures


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Author

John Udeani, MD, FAAEM Assistant Professor, Department of Emergency Medicine, Charles Drew University

of Medicine and Science, University of California, Los Angeles, David Geffen School of Medicine

John Udeani, MD, FAAEM is a member of the following medical societies:American Academy of Emergency

Medicine andAmerican College of Emergency Physicians

Disclosure: Nothing to disclose.

Coauthor(s)Joseph A Salomone III, MD Associate Professor and Attending Staff, Truman Medical Centers, University of

Missouri-Kansas City School of Medicine; EMS Medical Director, Kansas City, Missouri

Joseph A Salomone III, MD is a member of the following medical societies:American Academy of Emergency

Medicine, National Association of EMS Physicians, and Society for Academic Emergency Medicine


Samuel M Keim, MD Associate Professor, Department of Emergency Medicine, University of Arizona College

of Medicine

Samuel M Keim, MD is a member of the following medical societies: American Academy of EmergencyMedicine,American College of Emergency Physicians,American Medical Association,American Public Health

Association, and Society for Academic Emergency Medicine


Eric L Legome, MD Chief, Department of Emergency Medicine, Kings County Hospital Center; Associate

Professor, Department of Emergency Medicine, New York Medical College

Eric L Legome, MD is a member of the following medical societies: Alpha Omega Alpha,American Academy of

Emergency Medicine,American College of Emergency Physicians, Council of Emergency Medicine Residency

Directors, and Society for Academic Emergency Medicine


Jeffrey P Salomone, MD, FACS, NREMT-P Associate Professor of Surgery, Emory University School of

Medicine; Deputy Chief of Surgery, Grady Memorial Hospital

Jeffrey P Salomone, MD, FACS, NREMT-P is a member of the following medical societies: American College of

Surgeons,American Medical Association, Medical Association of Georgia, National Association of EMS

Physicians, and Society of Critical Care Medicine


Specialty Editor BoardErnest Dunn, MD Program Director, Surgery Residency, Department of Surgery, Methodist Health System,

Dallas

Ernest Dunn, MD is a member of the following medical societies:American College of Surgeons,American

Medical Association,Association for Academic Surgery, Society of Critical Care Medicine, and Texas Medical

Association


Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center

College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Robert L Sheridan, MD Assistant Chief of Staff, Chief of Burn Surgery, Shriners Burns Hospital; Associate

Professor of Surgery, Department of Surgery, Division of Trauma and Burns, Massachusetts General Hospital

and Harvard Medical School


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Robert L Sheridan, MD is a member of the following medical societies: American Academy of Pediatrics,

American Association for the Surgery of Trauma,American Burn Association, andAmerican College of

Surgeons


Rick Kulkarni, MD Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance,

Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha,American Academy of

Emergency Medicine,American College of Emergency Physicians,American Medical Association,American

Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

Chief Editor

John Geibel, MD, DSc, MA Vice Chair and Professor, Department of Surgery, Section of Gastrointestinal

Medicine, and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director,

Surgical Research, Department of Surgery, Yale-New Haven Hospital

John Geibel, MD, DSc, MA is a member of the following medical societies: American GastroenterologicalAssociation,American Physiological Society,American Society of Nephrology,Association for Academic

Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the

Alimentary Tract

Disclosure: AMGEN Royalty Consulting; Ardelyx Ownership interest Board membership

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Sidney R

Steinberg, MD, FACS,to the development and writing of a source article.

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