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Kefzol Classification Essay

 - Discussion: 
    - fracture types: open tibia fractures, open fractures of femur 
    - treat all open fractures as an emergency;
    - perform thorough initial eval to dx other life-threatening injuries: (see trauma management);
    - open joint injuries
    - gun shot wounds 
    - controversies: non operative treatment:
          - Nonoperative Management of Pediatric Grade 1 Open Fractures With Less Than a 24-Hour Admission

Sequential Management:

Current Practice in the Initial Management of Open Fractures Among Orthopaedic Trauma Surgeons
- antibiotics:
           - essential that antibiotics be given within one hour of injury;
           - therapeutic doses of ancef, clindamycin, and/or tobramycin for 48 hrs are appropriate;
           - w/ contamination consider anaerobic antibiotics (penicillins, clindamycin, flaggyl);
           - tetanus prophylaxis if appropriate;
           - references:
                  - Once daily high-dose gentamicin to prevent infection in open fractures of the tibial shaft: a preliminary investigation. 
                  - Once daily, high dose versus divided, low dose gentamicin for open fractures.
                  - Prospective, randomized, double-blind study comparing single-agent antibiotic therapy, ciprofloxacin, to combination antibiotic therapy in open fracture wounds. 
                  - Ciprofloxacin Inhibition of Experimental Fracture Healing.
                  - Clostridial myonecrosis.
                  - The use of antibiotics in open fractures.
                  - Duration of preventive antibiotic administration for open extremity fractures.  
                  - Current Practice in the Initial Management of Open Fractures Among Orthopaedic Trauma Surgeons.
                  - A comparison of more and less aggressive bone debridement protocols for the treatment of open supracondylar femur fractures.

 - debridement and irrigation: 
         - bacterial cultures:
                 - initial bacterial cultures are probably not helpful;
                 - references:
                      - Efficacy of primary wound cultures in long bone open extremity fractures: are they of any value?
                      - Epidemiology of bacterial infection during management of open leg fractures.
                      - Efficacy of cultures in the management of open fractures. 
                      - The significance of perioperative cultures in open pediatric lower-extremity fracture.
         - skin preparation 
         - topical antimicrobials 
         - pressure irrigation 
         - debridement:
                 - debridement of open tibial fractures / debridement of muscle:
                 - immediately debride wound using copious irrigation (9 lit) and, for type-II and type-III frx, repeat debridement in 24-72 hours;
                 - w/ wounds contaminated by dirt (vs grease, asphault ect) need aggressive repeated debridement in order to avoid
                          infection and subsequent osteomyeltis);
                 - references:
                          - Comparison of isotonic saline, distilled water and boiled water in irrigation of open fractures.
                          - The use of bacitracin irrigation to prevent infection in postoperative skeletal wounds. An experimental study.
                          - Efficacy of cultures in the management of open fractures.
                          - The Effect of Surgical Delay on Acute Infection Following 554 Open Fractures in Children.
                          - Comparison of soap and antibiotic solutions for irrigation of lower-limb open fracture wounds. A prospective, randomized study.
                          - Outcomes in open tibia fractures: relationship between delay in treatment and infection.
                          - A review of open tibia fractures in children.
                          - The use of detergent irrigation for musculoskeletal wounds.
                          - Treatment of isolated type I open fractures: is emergent operative debridement necessary?
                          - The effect of the timing of antibiotics and surgical treatment on infection rates in open long-bone fractures: a 9-year prospective study from a district general hospital.
                          - Infection in conflict wounded
                          - Time to initial operative treatment following open fracture does not impact development of deep infection: a prospective cohort study of 736 subjects.

 - fracture stabilization: 
         - synthes product menu
         - open tibia fractures 
         - open fractures of femur 
         - references:
                        - The role of early internal fixation in the management of open fractures.  
                        - Immediate internal fixation of open fractures of the diaphysis of the forearm.
                        - The influence of skeletal implants on incidence of infection. Experiments in a canine model.
                        - Nonoperative management of pediatric type I open fractures. 
                        - Maintenance of hardware after early postoperative infection following fracture internal fixation
- timing of wound closure:
            - wound closure of open tibial fractures
                  - in many cases, a delayed primary closure is performed for open wounds, but surgical incisions made during the case can be
                           closed primarily;
                  - issues involve complete removal of foreign debris as well as need to reassess devitalized muscle;
                  - second look debridement can be performed at 48 hours w/ wound closure; 
          - local antibiotics:

                  - antibiotic bead pouch and/or wound vac are useful methods of covering the wound;
                  - references:
                          - Wound management for severe open fractures: use of antibiotic bead pouches and vacuum-assisted closure.
                          - Local antibiotic therapy for severe open fractures. A review of 1085 consecutive cases.
          - soft tissue coverage:
                  - general wound management 
                  - contaminated wound care 
                  - drains and closure of wounds
                  - wound dressings and wound vac 

- bone grafting:
         - management of tibial defects and bone grafting for open tibia fracture
         - it is controversial as to whether bone grafting should be performed in open fractures;
                 - Chapman, et al (1997) 31% of open frx were treated w/ bone graft substitutes and 28% of open fractures were treated
                           w/ autogenous bone grafts;
                  - in this same study, infection at the fracture site occured in 5% of patients in which bone graft substitutes were used versus
                          13% of fractures in which autogenous grafts were used; 
         - references:
                 - Staged Bone Grafting Following Placement of an Antibiotic Spacers for the Management of Segmental Long Bone Defects
                 - Current Practice in the Management of Open Fractures Among Orthopaedic Trauma Surgeons. Part B: Management of Segmental Long Bone Defects. A Survey of Orthopaedic Trauma Association Members.                - Current Practice in the Management of Segmental Bone Defects Among Orthopaedic Trauma Surgeons.

- references: 
Nonoperative Management of Pediatric Type I Open Fractures
Treatment of Compound Fractures.
The early management of open joint injuries. A prospective study of one hundred and forty patients.
The use of quantitative bacterial counts in open fractures.
Risk of Infection After Open Fracture of the Arm or Leg.
Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses.  
Duration of preventive antibiotic administration for open extremity fractures 
Winner of the Frank Horan essay prize: the effect of war on the evolution of the treatment of open fractures
Lead arthropathy: arthritis caused by retained intra-articular bullets.

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Thursday, January 26, 2017 9:29 am

Kefzol (injection)

Generic Name:cefazolin (injection) (sef A zoe lin)
Brand Name:Ancef, Kefzol

What is cefazolin?

Cefazolin is a cephalosporin (SEF a low spor in) antibiotic. It works by fighting bacteria in your body.

Cefazolin is used to treat many kinds of bacterial infections, including severe or life-threatening forms. Cefazolin is also used to help prevent infection in people having certain types of surgery.

Cefazolin may also be used for purposes not listed in this medication guide.

Important Information

You should not use cefazolin if you have ever had a severe allergic reaction to any type of cephalosporin antibiotic (Omnicef, Keflex, and others).

Before taking this medicine

You should not use this medicine if you have ever had a severe allergic reaction to cefazolin or any other cephalosporin antibiotic, such as:

  • cefaclor (Ceclor), cefadroxil (Duricef);

  • cefdinir (Omnicef), cefditoren (Spectracef);

  • cefixime (Suprax);

  • cefotaxime (Claforan), cefotetan (Cefotan);

  • cefpodoxime (Vantin), cefprozil (Cefzil);

  • ceftaroline (Teflaro), ceftazidime (Ceptaz, Fortaz), ceftibuten (Cedax), ceftriaxone (Rocephin);

  • cefuroxime (Ceftin); or

  • cephalexin (Keflex), cephradine (Velosef).

To make sure cefazolin is safe for you, tell your doctor if you have:

  • kidney disease;

  • liver disease;

  • a stomach or intestinal disorder such as colitis; or

  • if you are allergic to any type of penicillin.

Cefazolin is not expected to harm an unborn baby. Tell your doctor if you are pregnant.

Cefazolin can pass into breast milk, but effects on the nursing baby are not known. Tell your doctor if you are breast-feeding.

How is cefazolin given?

Cefazolin is injected into a vein through an IV.

A healthcare provider will give you this injection when cefazolin is used to prevent infection from surgery.

You may be shown how to use an IV at home to treat an infection. Do not give yourself this medicine if you do not understand how to use the injection and properly dispose of needles, IV tubing, and other items used.

Follow all directions on your prescription label. Do not use this medicine in larger or smaller amounts or for longer than recommended.

Cefazolin may need to be mixed with a liquid (diluent) before using it. If you are using the injections at home, be sure you understand how to properly mix and store the medicine.

Use this medicine for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may also increase your risk of further infection that is resistant to antibiotics. Cefazolin will not treat a viral infection such as the flu or a common cold.

This medicine can cause unusual results with certain lab tests for glucose (sugar) in the urine. Tell any doctor who treats you that you are using cefazolin.

Store unmixed cefazolin at room temperature, away from moisture, heat, and light.

After mixing cefazolin with a diluent, store the mixture in the refrigerator. Do not freeze.

Take the mixture out of the refrigerator and allow it to reach room temperature before injecting your dose. Mixed medicine must be used within a certain number of days once it reaches room temperature. Carefully follow all mixing and storage instructions for this medicine.

Do not use the medicine if it has changed colors or has particles in it. Call your pharmacist for new medication.

Use a disposable needle and syringe only once. Follow any state or local laws about throwing away used needles and syringes. Use a puncture-proof "sharps" disposal container (ask your pharmacist where to get one and how to throw it away). Keep this container out of the reach of children and pets.

What happens if I miss a dose?

Call your doctor for instructions if you miss a dose of cefazolin.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while using cefazolin?

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, call your doctor. Do not use anti-diarrhea medicine unless your doctor tells you to.

Cefazolin side effects

Get emergency medical help if you have signs of an allergic reaction (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning in your eyes, skin pain, red or purple skin rash that spreads and causes blistering and peeling).

Call your doctor at once if you have:

  • severe stomach pain, diarrhea that is watery or bloody;

  • white patches or sores inside your mouth or on your lips;

  • fever, swollen glands, rash or itching, joint pain, or general ill feeling;

  • seizure (convulsions); or

  • liver problems--upper stomach pain, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

Common side effects may include:

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also:Side effects (in more detail)

What other drugs will affect cefazolin?

Other drugs may interact with cefazolin, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell your doctor about all your current medicines and any medicine you start or stop using.

Next → Side Effects

Where can I get more information?

  • Your pharmacist can provide more information about cefazolin.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 3.06.

Date modified: March 06, 2018
Last reviewed: December 08, 2017

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