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clinical skills

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 ________?

- cosmetic
- 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

Potential Complications?

- 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

dry abscess?

one that resolves without rupture

sterile abscess?

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

Clinical evaluation?

search for possible underlying cause
puncture wound
unusually organism
foriegn body
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

Perifollicular ?

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

simple abscess?

cut open and drain

complex abscess?

- 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

patient preparation?

Notify patient of benefits and risks
Discuss post procedure care as well
Provide opportunity for question/answer period
Comfortable/supine position

special consideraiton

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

pain relief

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

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