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Sat Apr 15 18:18:55 BST 2006

In a message dated 4/15/2006 12:12:16 P.M. Central Standard Time,  
bensonblues at comcast.net writes:

It is  you not getting it. The discussion was about a patient with an 
acetabular  fracture, remember? We operate on that here in Detroit. Oh, yes, and they 
get  prophylactic antiobiotics. What a babbling fool. You need to take your  
lithium, buddy.
DB

I am very aware that patients with orthopedic and vascular procedures have  
always gotten prophylactic antibiotics.  Often if here is presumed logic  for 
ONE, THREE are given.   If 8 hours of antibiotics are accepted,  they are 
continued for 3 days.  If three days are acceptable, they are  sometimes continued 
for 7 days.   

Although this is common practice, much like the OLD practice of massive  
fluid resuscitation and cyclic hyperresuscitation, with all its complications,  
these urban legends continue.   The burden of proof falls on those who  continue 
to use something based on culture or blind faith.   We can do  better than 
that now.     

Issues such as MAST PANTS,   Renal Dose Dopamine, Interosseous  infusions,   
Rectal washout, Presacral drains,  Single shot IVP  for penetrating abdominal 
trauma, etc, etc, etc, are other examples of long held  doctrine, but 
subsequently shown to be urban legends only.   

I vote more with Rick than with blind urban legend.    As a  matter of fact, 
I would be more rigidly opposed to prophylactic antibiotics in  the case 
described, than was Dr. Frykberg.    

k

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