Skin abscess - Revision history

Rossdonaldson1 at 13:42, 29 May 2022

2022-05-29T13:42:52Z

← Older revision		Revision as of 13:42, 29 May 2022
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	==Differential Diagnosis==		==Differential Diagnosis==
	*Furuncle
	*Carbuncle
	*Duct ectasia		*Duct ectasia
	*Cyst		*Cyst

Rossdonaldson1: /* Background */

2022-05-29T13:41:01Z

Background

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	*[[MRSA]] is the most common cause of purulent skin and soft-tissue infections.<ref>Maligner D et al. The prevalence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) in skin abscesses presenting to the pediatric emergency department. N C Med J. 2008 Sep-Oct;69(5):351-4.</ref><ref>Pickett A et al. Changing incidence of methicillin-resistant staphylococcus aureus skin abscesses in a pediatric emergency department. Pediatr Emerg Care. 2009 Dec;25(12):831-4.</ref><ref>Bradley W. Frazee et al. High Prevalence of Methicillin-Resistant Staphylococcus aureus in Emergency Department Skin and Soft Tissue Infections http://dx.doi.org/10.1016/j.annemergmed.2004.10.011</ref>		*[[MRSA]] is the most common cause of purulent skin and soft-tissue infections.<ref>Maligner D et al. The prevalence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) in skin abscesses presenting to the pediatric emergency department. N C Med J. 2008 Sep-Oct;69(5):351-4.</ref><ref>Pickett A et al. Changing incidence of methicillin-resistant staphylococcus aureus skin abscesses in a pediatric emergency department. Pediatr Emerg Care. 2009 Dec;25(12):831-4.</ref><ref>Bradley W. Frazee et al. High Prevalence of Methicillin-Resistant Staphylococcus aureus in Emergency Department Skin and Soft Tissue Infections http://dx.doi.org/10.1016/j.annemergmed.2004.10.011</ref>
	*Standard skin abscess are ''not'' typically due to [[spider bites]] and should not be diagnosed as such		*Standard skin abscess are ''not'' typically due to [[spider bites]] and should not be diagnosed as such
	*Terminology
	**Furuncles (i.e. boils) are skin abscesses caused by staphylococcal infection, which involve a hair follicle and surrounding tissue		===Terminology===
	**Carbuncles are clusters of furuncles connected subcutaneously, causing deeper suppuration and scarring.		*Furuncles (i.e. boils) are skin abscesses caused by staphylococcal infection, which involve a hair follicle and surrounding tissue
			*Carbuncles are clusters of furuncles connected subcutaneously, causing deeper suppuration and scarring.

	==Clinical Features==		==Clinical Features==

Rossdonaldson1: /* Background */

2022-05-29T13:40:37Z

Background

← Older revision		Revision as of 13:40, 29 May 2022
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	*Localized collection of pus surrounded by inflamed tissue, usually caused by bacterial infection		*Localized collection of pus surrounded by inflamed tissue, usually caused by bacterial infection
	*[[MRSA]] is the most common cause of purulent skin and soft-tissue infections.<ref>Maligner D et al. The prevalence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) in skin abscesses presenting to the pediatric emergency department. N C Med J. 2008 Sep-Oct;69(5):351-4.</ref><ref>Pickett A et al. Changing incidence of methicillin-resistant staphylococcus aureus skin abscesses in a pediatric emergency department. Pediatr Emerg Care. 2009 Dec;25(12):831-4.</ref><ref>Bradley W. Frazee et al. High Prevalence of Methicillin-Resistant Staphylococcus aureus in Emergency Department Skin and Soft Tissue Infections http://dx.doi.org/10.1016/j.annemergmed.2004.10.011</ref>		*[[MRSA]] is the most common cause of purulent skin and soft-tissue infections.<ref>Maligner D et al. The prevalence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) in skin abscesses presenting to the pediatric emergency department. N C Med J. 2008 Sep-Oct;69(5):351-4.</ref><ref>Pickett A et al. Changing incidence of methicillin-resistant staphylococcus aureus skin abscesses in a pediatric emergency department. Pediatr Emerg Care. 2009 Dec;25(12):831-4.</ref><ref>Bradley W. Frazee et al. High Prevalence of Methicillin-Resistant Staphylococcus aureus in Emergency Department Skin and Soft Tissue Infections http://dx.doi.org/10.1016/j.annemergmed.2004.10.011</ref>
	*Standard abscess are ''not'' typically due to [[spider bites]] and should not be diagnosed as such		*Standard skin abscess are ''not'' typically due to [[spider bites]] and should not be diagnosed as such
			*Terminology
			**Furuncles (i.e. boils) are skin abscesses caused by staphylococcal infection, which involve a hair follicle and surrounding tissue
			**Carbuncles are clusters of furuncles connected subcutaneously, causing deeper suppuration and scarring.

	==Clinical Features==		==Clinical Features==

Rossdonaldson1: Rossdonaldson1 moved page Abscess to Skin abscess

2022-05-29T13:39:45Z

Rossdonaldson1 moved page Abscess to Skin abscess

← Older revision	Revision as of 13:39, 29 May 2022
(No difference)

Rossdonaldson1: /* Differential Diagnosis */

2022-05-29T13:36:17Z

Differential Diagnosis

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	*Carbuncle		*Carbuncle
	*Duct ectasia		*Duct ectasia
	*[[Hidradenitis suppurativa]]
	*Cyst		*Cyst
	*Vascular malformation		*Vascular malformation

Rossdonaldson1: /* Management */

2022-05-29T13:33:24Z

Management

← Older revision		Revision as of 13:33, 29 May 2022
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	***Can cover with gauze to absorb the residual drainage.		***Can cover with gauze to absorb the residual drainage.
	***Can shower and/or bathe.		***Can shower and/or bathe.
	**The loop drain can be removed when ~~(copied from Pediatric EM Morsels)~~<ref>[https://pedemmorsels.com/incision-loop-drainage-abscess/ Incision and Loop Drainage of Abscess BY SEAN M. FOX Pediatric EM Morsels]</ref>		**The loop drain can be removed when:<ref>[https://pedemmorsels.com/incision-loop-drainage-abscess/ Incision and Loop Drainage of Abscess BY SEAN M. FOX Pediatric EM Morsels]</ref>
	***Drainage has stopped.		***Drainage has stopped.
	***Cellulitis has improved.		***Cellulitis has improved.

Rossdonaldson1: /* Management */

2022-05-29T13:33:02Z

Management

← Older revision		Revision as of 13:33, 29 May 2022
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	*Packing		*Packing
	**Abscess >5 cm in diameter		**Abscess >5 cm in diameter
	**Pilonidal abscess		**[[Pilonidal abscess]]
	**Abscess in an immunocompromised or diabetic patient		**Abscess in an immunocompromised or diabetic patient
	*Alternative to packing is loop drainage technique with vessel ties<ref>[https://pedemmorsels.com/incision-loop-drainage-abscess/ Incision and Loop Drainage of Abscess BY SEAN M. FOX Pediatric EM Morsels]</ref>, Penrose Drain, or you can cut the proximal cuff of a sterile glove<ref>[https://sinaiem.org/sterile-glove-used-as-a-drain-for-a-skin-abscess/ Sterile Glove Used As a Drain for a Skin Abscess? SinaiEM]</ref>		*Alternative to packing is loop drainage technique with vessel ties<ref>[https://pedemmorsels.com/incision-loop-drainage-abscess/ Incision and Loop Drainage of Abscess BY SEAN M. FOX Pediatric EM Morsels]</ref>, Penrose Drain, or you can cut the proximal cuff of a sterile glove<ref>[https://sinaiem.org/sterile-glove-used-as-a-drain-for-a-skin-abscess/ Sterile Glove Used As a Drain for a Skin Abscess? SinaiEM]</ref>
	**Failure rate of 4.1% for loop vessel technique vs 9.8% for conventional packing. <ref>[http://www.ncbi.nlm.nih.gov/pubmed/28917436 Am J Emerg Med, 2018. Comparison of the loop technique with incision and drainage for soft tissue abscesses: A systematic review and meta-analysis.] </ref>		**Failure rate of 4.1% for loop vessel technique vs 9.8% for conventional packing. <ref>[http://www.ncbi.nlm.nih.gov/pubmed/28917436 Am J Emerg Med, 2018. Comparison of the loop technique with incision and drainage for soft tissue abscesses: A systematic review and meta-analysis.] </ref>
	**Other advantage is don’t have to keep coming back to the ER for painful repacking.		**Other advantage is don’t have to keep coming back to the ER for painful repacking.
	**Home Care ~~(copied from Pediatric EM Morsels)~~<ref>[https://pedemmorsels.com/incision-loop-drainage-abscess/ Incision and Loop Drainage of Abscess BY SEAN M. FOX Pediatric EM Morsels]</ref>		**Home Care<ref>[https://pedemmorsels.com/incision-loop-drainage-abscess/ Incision and Loop Drainage of Abscess BY SEAN M. FOX Pediatric EM Morsels]</ref>
	***Keep area clean.		***Keep area clean.
	***Can cover with gauze to absorb the residual drainage.		***Can cover with gauze to absorb the residual drainage.

Rossdonaldson1: /* Evaluation */

2022-05-29T13:31:54Z

Evaluation

← Older revision		Revision as of 13:31, 29 May 2022
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	**For febrile or systemically ill patients, obtain blood cultures, lactate, renal function, and CK		**For febrile or systemically ill patients, obtain blood cultures, lactate, renal function, and CK
	*'''Imaging'''		*'''Imaging'''
	**[[Ultrasound: Soft tissue\|Soft tissue ultrasound]] can differentiate between [[~~abscess~~]] ~~and cellulitis~~		**[[Ultrasound: Soft tissue\|Soft tissue ultrasound]] can differentiate between abscess and [[cellulitis]]
	***Assess for fluid collection and swirl within the collection		***Assess for fluid collection and swirl within the collection
	***Recent small studies have shown limited utility to bedside ultrasound in this capacity as it rarely leads to change in management (i.e. when a provider feels there is an abscess present, ultrasound shows an abscess and when there is diagnostic uncertainty the ultrasound usually is unequivocal as well)<ref>Effect of initial bedside ultrasonography on emergency department skin and soft tissue infection management Mower WR, Crisp JG, Krishnadasan A, et al. Ann Emerg Med. 2019;74(3):372-380.</ref>		***Recent small studies have shown limited utility to bedside ultrasound in this capacity as it rarely leads to change in management (i.e. when a provider feels there is an abscess present, ultrasound shows an abscess and when there is diagnostic uncertainty the ultrasound usually is unequivocal as well)<ref>Effect of initial bedside ultrasonography on emergency department skin and soft tissue infection management Mower WR, Crisp JG, Krishnadasan A, et al. Ann Emerg Med. 2019;74(3):372-380.</ref>

Rossdonaldson1 at 13:31, 29 May 2022

2022-05-29T13:31:26Z

← Older revision		Revision as of 13:31, 29 May 2022
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	[[File:Five day old Abscess.jpg\|thumb\|Fluctulance on exam]]		[[File:Five day old Abscess.jpg\|thumb\|Fluctulance on exam]]
	*Tender nodular region with surrounding induration		*Tender nodular region with surrounding induration
	*Fluctuance		*Fluctuance with or without surrounding erythema
	*Surrounding erythema

	==Differential Diagnosis==		==Differential Diagnosis==
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	==Evaluation==		==Evaluation==
	[[File:Isoechoic abscess.png\|thumb\|Abscess on ultrasound]]		[[File:Isoechoic abscess.png\|thumb\|Abscess on ultrasound]]
	*'''Physical Exam'''		===Workup===
	**fluctulance +/- erythema
	*'''Labs'''		*'''Labs'''
	**Not usually indicated		**Not usually indicated
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	***Assess for fluid collection and swirl within the collection		***Assess for fluid collection and swirl within the collection
	***Recent small studies have shown limited utility to bedside ultrasound in this capacity as it rarely leads to change in management (i.e. when a provider feels there is an abscess present, ultrasound shows an abscess and when there is diagnostic uncertainty the ultrasound usually is unequivocal as well)<ref>Effect of initial bedside ultrasonography on emergency department skin and soft tissue infection management Mower WR, Crisp JG, Krishnadasan A, et al. Ann Emerg Med. 2019;74(3):372-380.</ref>		***Recent small studies have shown limited utility to bedside ultrasound in this capacity as it rarely leads to change in management (i.e. when a provider feels there is an abscess present, ultrasound shows an abscess and when there is diagnostic uncertainty the ultrasound usually is unequivocal as well)<ref>Effect of initial bedside ultrasonography on emergency department skin and soft tissue infection management Mower WR, Crisp JG, Krishnadasan A, et al. Ann Emerg Med. 2019;74(3):372-380.</ref>

			===Diagnosis===
			*Typically a clinical diagnosis, with or without use of bedside [[Ultrasound: Soft tissue\|soft tissue ultrasound]] and/or [[I&D]] for confirmation

	==Management==		==Management==

Rossdonaldson1: /* Background */

2022-05-29T13:29:03Z

Background

← Older revision		Revision as of 13:29, 29 May 2022
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	*Localized collection of pus surrounded by inflamed tissue, usually caused by bacterial infection		*Localized collection of pus surrounded by inflamed tissue, usually caused by bacterial infection
	*[[MRSA]] is the most common cause of purulent skin and soft-tissue infections.<ref>Maligner D et al. The prevalence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) in skin abscesses presenting to the pediatric emergency department. N C Med J. 2008 Sep-Oct;69(5):351-4.</ref><ref>Pickett A et al. Changing incidence of methicillin-resistant staphylococcus aureus skin abscesses in a pediatric emergency department. Pediatr Emerg Care. 2009 Dec;25(12):831-4.</ref><ref>Bradley W. Frazee et al. High Prevalence of Methicillin-Resistant Staphylococcus aureus in Emergency Department Skin and Soft Tissue Infections http://dx.doi.org/10.1016/j.annemergmed.2004.10.011</ref>		*[[MRSA]] is the most common cause of purulent skin and soft-tissue infections.<ref>Maligner D et al. The prevalence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) in skin abscesses presenting to the pediatric emergency department. N C Med J. 2008 Sep-Oct;69(5):351-4.</ref><ref>Pickett A et al. Changing incidence of methicillin-resistant staphylococcus aureus skin abscesses in a pediatric emergency department. Pediatr Emerg Care. 2009 Dec;25(12):831-4.</ref><ref>Bradley W. Frazee et al. High Prevalence of Methicillin-Resistant Staphylococcus aureus in Emergency Department Skin and Soft Tissue Infections http://dx.doi.org/10.1016/j.annemergmed.2004.10.011</ref>
	*Standard abscess are not typically due to [[spider bites]] and should not be diagnosed as such		*Standard abscess are ''not'' typically due to [[spider bites]] and should not be diagnosed as such

	==Clinical Features==		==Clinical Features==