Neck Trauma Medication

Updated: Jul 12, 2017
  • Author: David B Levy, DO, FAAEM; Chief Editor: Trevor John Mills, MD, MPH  more...
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Medication

Medication Summary

Infection subsequent to penetrating wounds of the neck is a major cause of death and disability. Administering prophylactic antibiotics, while not decisively validated by scientific studies, should be a consideration. Recommended medications vary from penicillin to those with broad-spectrum coverage. Factors to consider include the physical nature of the injury (eg, simple laceration vs blunt trauma with tearing-type injuries). If prophylactic antibiotics are to be effective, attempt to obtain adequate tissue levels immediately, preferably within 4 hours of injury.

Other therapeutic agents to consider are the corticosteroids. Massive doses of steroids are believed to have possible benefit in improving neurological function in selected subsets of patients. In the second phase of a benchmark study, patients who had sustained blunt spinal injury within a 12-hour time frame were given a 30 mg/kg intravenous (IV) bolus of corticosteroids followed by 5.4 mg/kg/h for 23 hours. Overall, patients who appropriately received steroids within 8 hours revealed slight improvement in motor and sensory function at 6 months. Other experimental agents include naloxone, dimethylsulfoxide, and growth factors. Spinal cooling also has been proposed.

Drugs that facilitate endotracheal intubation, especially those used for rapid sequence intubation, should be readily available.

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Antibiotics

Class Summary

Therapy must cover all likely pathogens in the context of the clinical setting.

Cefotetan (Cefotan)

Second-generation cephalosporin indicated for infections caused by susceptible gram-positive cocci and gram-negative rods.

Dosage and route of administration depends on condition of patient, severity of infection, and susceptibility of causative organism.

Gentamicin (Garamycin)

Aminoglycoside antibiotic for gram-negative coverage. Used in combination with both an agent against gram-positive organisms and one that covers anaerobes. Not the DOC. Consider if penicillins or other less toxic drugs are contraindicated, when clinically indicated, and in mixed infections caused by susceptible staphylococci and gram-negative organisms.

Ampicillin (Omnipen)

Bactericidal activity against susceptible organisms. Alternative to amoxicillin when patient unable to take medication orally.

Clindamycin (Cleocin)

Lincosamide for treatment of serious skin and soft tissue staphylococcal infections. Also effective against aerobic and anaerobic streptococci (except enterococci). Inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-tRNA from ribosomes causing RNA-dependent protein synthesis to arrest.

Ceftriaxone (Rocephin)

Third-generation cephalosporin with broad-spectrum, gram-negative activity; lower efficacy against gram-positive organisms; higher efficacy against resistant organisms. Arrests bacterial growth by binding to one or more penicillin-binding proteins.

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