Incision and drainage: Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
# | #[[Ultrasound: Soft tissue|Ultrasound can be helpful]] | ||
#Needle aspiration | |||
#Check: Blood Glucose, IV drug use (XR r/o needle), consider HIV counseling/testing | #Check: Blood Glucose, IV drug use (XR r/o needle), consider HIV counseling/testing | ||
Revision as of 16:20, 30 January 2015
Background
Diagnosis
- Ultrasound can be helpful
- Needle aspiration
- Check: Blood Glucose, IV drug use (XR r/o needle), consider HIV counseling/testing
Differential Diagnosis
Skin and Soft Tissue Infection
- Cellulitis
- Erysipelas
- Lymphangitis
- Folliculitis
- Hidradenitis suppurativa
- Skin abscess
- Necrotizing soft tissue infections
- Mycobacterium marinum
Look-A-Likes
- Sporotrichosis
- Osteomyelitis
- Deep venous thrombosis
- Pyomyositis
- Purple glove syndrome
- Tuberculosis (tuberculous inflammation of the skin)
Treatment
- Antibiotics
- 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
- 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
- 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