Difference between revisions of "Incision and drainage"

(Treatment)
(Updated format to procedure-centric)
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==Background==
 
==Background==
 +
*Check: Blood Glucose, IV drug use (XR r/o needle), consider HIV counseling/testing
  
==Diagnosis==
+
==Indications==
#[[Ultrasound: Soft tissue|Ultrasound can be helpful]]
 
#Needle aspiration
 
#Check: Blood Glucose, IV drug use (XR r/o needle), consider HIV counseling/testing
 
  
==Differential Diagnosis==
 
{{Template:SSTI DDX}}
 
  
==Treatment==
+
==Contraindications==
#[[Antibiotics]]
 
##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]]
 
##Preprocedure abx for pt with high risk cardiac lesions
 
#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===
 
*Be sure to document if packing was placed in the wound
 
*Anesthesia should be [[lidocaine]] or Marcaine without epinephrine
 
*Most patients need some pain medicine prior to procedure
 
  
 +
==Procedure==
 +
 +
===Anesthesia===
 
{{Maximum doses of anesthetic agents}}
 
{{Maximum doses of anesthetic agents}}
 +
 +
===Post-procedure===
 +
*[[Antibiotics]] only indicated if overlying cellulitis or evidence of systemic infection
 +
**Cover [[staph]] and [[strep]]
 +
*Update [[Tetanus]], if indicated
  
 
==Follow-up==
 
==Follow-up==
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*[[Bartholin Gland Abscess]]
 
*[[Bartholin Gland Abscess]]
  
==Source==
+
==References==
 +
<references/>
 
*Liu C, Bayer A, Cosgrove SE, et al. Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis 2011;52:e18-e55
 
*Liu C, Bayer A, Cosgrove SE, et al. Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis 2011;52:e18-e55
 
*Singer A, Talan D. Management of Skin Abscesses in the Era of Methicillin-Resistant Staphylococcus aureus. N Engl J Med 2014; 370:1039-1047
 
*Singer A, Talan D. Management of Skin Abscesses in the Era of Methicillin-Resistant Staphylococcus aureus. N Engl J Med 2014; 370:1039-1047

Revision as of 10:37, 21 June 2015

Background

  • Check: Blood Glucose, IV drug use (XR r/o needle), consider HIV counseling/testing

Indications

Contraindications

Procedure

Anesthesia

Maximum Doses of Anesthetic Agents

Agent Without Epinephrine With Epinephrine Duration Notes
Lidocaine 5 mg/kg (max 300mg) 7 mg/kg (max 500mg) 30-90 min
  • 1% soln contains 10 mg/ml
  • 2% soln contains 20 mg/ml
Mepivicaine 7 mg/kg 8 mg/kg
Bupivicaine 2.5 mg/kg (max 175mg) 3 mg/kg (max 225mg) 6-8 hr
  • 0.5% soln contains 5 mg/ml
  • May cause cardiac arrest if injected intravascularly
  • Do not buffer with bicarbonate
Ropivacaine 3 mg/kg
Prilocaine 6 mg/kg
Tetracaine 1 mg/kg 1.5 mg/kg 3hrs (10hrs with epi)
Procaine 7 mg/kg 10 mg/kg 30min (90min with epi)

Post-procedure

Follow-up

Wound check in 1-2 days and wound care sheet

See Also

References

  • Liu C, Bayer A, Cosgrove SE, et al. Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis 2011;52:e18-e55
  • Singer A, Talan D. Management of Skin Abscesses in the Era of Methicillin-Resistant Staphylococcus aureus. N Engl J Med 2014; 370:1039-1047