I and D is used in what two situations why?
-Open Comedones (black heads) or closed comedones (white heads)
- because they are commonly the start of abcess because we pick at them and cause infection
Black heads are commonly removed for ______ purposes. And white heads are removed to prevent white heads from ________?
- rupturing and becoming larger
Removal of black or white heads does not ____ resolution of acne lesion?
What is the true treatment of abscess?
- I and D (lance it).... but now ppl are also giving antibiotics which is causing an increase in MRSA
What is the two words that go with abcess?
1. Fluctuant - full and bouncy (center part)
2. Indurated - full and hard (the skin surrounding the center)
With abscesses you will want to ? (2 things)
wear eye protection and stay out of the way because they things will squirt
What can be found in the center of an abscess? what will the pH be?
- WBC, inflammatory cells, dead tissue/cells
- acidic pH in the abcess
Why is pH important?
- because ansthetics works at body pH, which is basic (7.35-7.45)
- this meansing that will will not inject the ansethetic into the abscess... we will inject around it
what is the difference btwn a vesicle an abscess?
vesicle on the top of the skin and is fluid filled as where an abcess is burrowed under the skin
there is a ___% chance that an abscess will reoccur?
I and D is indicated for?
treatment of localzed infection that is tender and not resolving
Symptoms that indicate I and D are necessary?
loss of function
Containdications of I and D?
- facial frunkles should not be incised or drained if in the triangle made by the bridge of the nose to the coners of the mouth. tx with abs and warm compresses. Refer to specialist if indicated
- abcesses near rectum or gentialia must be evaluated carfully. Consider referral to surgeon
- pt. with DM, debiliting disease, or compromised immunity should be closley observed post procedure - refer to GYN give antibiotics regardless
- cellulitis of collection of pus
- bacteremia and septicemia if inadequately treated
- perianal abcess incison and drainage fequently results in a chronic anal fistula up to 50% time
- infections of the palmar aspect of the hand can extend from superfical to deep tissue via palmar fascia
- Deep infection should be suspected when simple I and D fails to reduce swelling, redness, pus or pain
Where is pilondial ?
right in the butt crack, high lower back
What is an abcess?
a focal circumscribed accmulation of purulent materials
Acute/ hot abscess?
fluctuant on palpation
one that resolves without rupture
one from which bac. can not be cultured
Chronic/ Cold abscess?
Abscess-lacks redness, heat, pain or swelling. Usually associated with liquefactive necrosis of tuberculous lesions... typically on chest
search for possible underlying cause
faulty/overwhelmed immune system
Types of abscesses?
sweat gland/ hair follicle
Swear gland/ hair follicle?
fruncle or boil
if fruncle extends into SC tissue
abscess involving the nail
typically found on extremities, buttocks, breasts or hair follicles
where does MRSA live? what do we treat ppl with who have MRSA?
- nasal pharynx
- Muprosin (bactroban)to minimize colonization of MRSA in nasal passage ... so also be on antibiotic as well
what size scalpel do we use to drain abcesses? why?
11 gage scalpel
- 11 blades come to a sharp point... start as the center and cut outward, be sue to burry the hilt do where you cant see the blade anymore
what size blade do we use for surgical excisions/incisions?
10 and 15
differences in 10 blade verse 15 size balde?
10 - larger more beveled shaped.... will use everywhere but the face
15 - very thin blade, will use more on face
What are the two reasons why we pack an abscess?
1. Debridement because when pull out packing everything will have stuck to it
2. To keep it open so that it can drain
cut open and drain
- cut open
- explored and packed it
- 3 to 4 times more costly than a simple abcess
treatment of abscesses?
Small abscess may respond to warm compresses or antibiotic therapy
If no better, consider I & D
Obtain culture if possible
Notify patient of benefits and risks
Discuss post procedure care as well
Provide opportunity for question/answer period
Primary management of abscesses should be incision and drainage with routine culture
Antibiotic therapy not indicated for typical abscesses in patient with normal defenses
Abscesses requiring antibiotics are those with surrounding cellulitis or lymphangitis
antibiotic must cover what organism?
staphylococcus until cultures back
May require acetaminophen or NSAID.
Narcotics rarely needed (if taking the scalpel to them)
Procedure alone generally provides sufficient pain relief
follow up care instructions?
Warm wet soaks to area four to six times a day for 5-7 days.... or warm bath tubes...clean first and after (isolated bath tube) the tube
Nonadherent dressing should be applied over wound (Adaptic, Telfa)
Motion may interfere with healing
Elevate injured extremity-improves venous and lymphatic drainage, helps control swelling, pain and edema
follow up and care instructions cotninued?
Wound must be kept clean and dry
Remove dressing in 2 days
Replace with dry, sterile dressing.
Change dressing daily
Needs follow-up for packing changes-some patients
Watch for signs of recurrence or cellulitis
Notify provider immediately if any redness, drainage, pus, fever, chills or swelling