Incision and drainage

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Abscess / I & D:

 

Anesthesia should be lidocaine or Marcaine without epinephrine.

Most patients need some pain medicine prior to procedure.

 

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

 

Follow-up : Wound check in 1-2 days and wound care sheet.

 

Antibiotics – given if there is a large cellulitic component or fever. Need to cover staph and strep.

 

Update Tetanus

 

Be sure to document if packing was placed in the wound.

 

*Toxic dose of Lidocaine is 5mg/kg with NO epi & 7 mg/kg w/ Epi! (toxic= ring in ears & se). Lido from code cart has no HCl that floor epi has, use HCO3 (1cc to 10cc Lido) to decr pain of floor lido d/t HCl! inject through wound edges NOT intact skin!

 

*Lido lasts 30-90 min, bupivicaine (.25%)  max= 2mg/kg lasts 6-8 hr. Do NOT inject bupivicaine intravascularly b/c= refractory cardiac arrest!!!