Incision and drainage

Diagnosis

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

Treatment

1. Antibiotics
   1. give if there is a large cellulitic component or fever
   2. Need to cover staph and strep.
2. Update Tetanus

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

• 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!!!

Follow-up

Wound check in 1-2 days and wound care sheet