Difference between revisions of "Incision and drainage"

(Added recommendations from Infectious disease Society of America and new NEJM article)
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==Treatment==
 
==Treatment==
 
#[[Antibiotics]]
 
#[[Antibiotics]]
##Give if there is a large cellulitic component or [[fever]]
+
##Give if there is a large cellulitic component or [[fever]], multiple sites, young or advanced age, abscess in area difficult to drain, associated septic phlebitis, and failure with I&D alone
 
##Need to cover [[staph]] and [[strep]]
 
##Need to cover [[staph]] and [[strep]]
 +
##Preprocedure abx for pt with high risk cardiac lesions
 
#Update [[Tetanus]]
 
#Update [[Tetanus]]
 +
#MRSA decolonization for pts with recurrent skin infections
 +
##Nasal mupirocin+chlorhexidine body wash+/-oral anti-MRSA abx for 5-10 days
  
 
===Incision & Drainage===
 
===Incision & Drainage===

Revision as of 16:22, 10 June 2014

Background

Diagnosis

  1. May use US or needle aspiration
  2. Check: Blood Glucose, IV drug use (XR r/o needle), consider HIV counseling/testing

Differential Diagnosis

Skin and Soft Tissue Infection

Look-A-Likes

Treatment

  1. Antibiotics
    1. Give if there is a large cellulitic component or fever, multiple sites, young or advanced age, abscess in area difficult to drain, associated septic phlebitis, and failure with I&D alone
    2. Need to cover staph and strep
    3. Preprocedure abx for pt with high risk cardiac lesions
  2. Update Tetanus
  3. MRSA decolonization for pts with recurrent skin infections
    1. Nasal mupirocin+chlorhexidine body wash+/-oral anti-MRSA abx for 5-10 days

Incision & Drainage

  1. Be sure to document if packing was placed in the wound
  2. Anesthesia should be lidocaine or Marcaine without epinephrine
  3. Most patients need some pain medicine prior to procedure
  • Beware of toxic dose of lidocaine!
  • Lido lasts 30-90 min, bupivicaine (.25%) max= 2mg/kg lasts 6-8 hr. Do NOT inject bupivicaine intravascularly b/c= refractory cardiac arrest!!!

Follow-up

Wound check in 1-2 days and wound care sheet

See Also

Source