I&D

Question 1

Indications for I&D (3)

Answer 1

1) . localized fluctuant infection
2) . doesn’t resolve spontaneously
3) . signs of infection

Question 2

signs of infection? (6)

Answer 2

pain, fever, erythema, edema, loss of function, swelling

Question 3

contraindications of I&D (3)

Answer 3

1) . facial furuncles in triangle (of doom/death)
2) . abscesses near rectum/genitalia
3) . pts with DM, debilitating dz, immune compromise NEED to be observed after procedure

Question 4

how to tx facial furuncles in triangle of doom?

Answer 4

ABX and warm compress

also refer

Question 5

why is I&D in triangle of doom so risky?

Answer 5

there’s a risk of septic phlebitis with intracranial extension

Question 6

how to tx abscesses near genitalia/rectum?

Answer 6

REFER to general surgeon/gynecologist

Question 7

if there isn’t cellulitis at time of I&D then how do you tx?

Answer 7

DONT NEED ABX

Question 8

in 50% of cases, perianal/pilonidal abscess I&D results in what?

Answer 8

chronic anal fistula

Question 9

if simple I&D fails to relieve erythema, pain, pus or edema, then suspect what?

Answer 9

suspect deep infection

Question 10

how to tx pilonidal abscess?

Answer 10

make incision site parallel to midline, clean out abscess pus (remove cyst if that’s cause), lightly pack touching wound edges

Question 11

if using medicated packing after pilonidal abscess removal, what is important to remember?

Answer 11

only use for 2-3 days and then switch over to non medicated packing (will kill good tissue if medicated left in too long)

Question 12

what is an abscess?

Answer 12

focal circumscribed accumulation of purulent material (pus and other inflammatory tissue), usually fluctuant

Question 13

acute abscess usually presents as? dry abscess tx?

Answer 13

acute- red, hot, painful, swollen

dry- resolves without rupture

Question 14

what isn’t necessary for a sterile abscess?

Answer 14

doesn’t need cultured

Question 15

chronic abscesses are usually associated with what?

Answer 15

liquefactive necrosis of tuberculous lesions

Question 16

what is a furuncle vs carbuncle?

Answer 16

Furuncle is a skin abscess often caused by staph that involves a hair follicle and surrounding tissue; carbuncle are clusters of furuncles that are connected through the SubQ

Question 17

how to treat a small abscess (<5cm)?

Answer 17

warm compress and maybe ABX (if pt is febrile or exhibit systemic symptoms)
-maybe I&D if not already draining or if fluctuant

Question 18

how to treat an enlarging abscess with inflammation, pus collection, and wall off of cavity?

Answer 18

I&D (warm compress and ABX ineffective)

Question 19

how to tx if you suspect a complicated abscess, have an immunocompromised pt or recurrent abscess?

Answer 19

CULTURE- aspirate or swab pus/cavity

Question 20

abscesses in these locations require aspiration with an 18 gauge needle on 10 ml syringe rather than I&D

Answer 20

1) . Peritonsillar and retropharyngeal region
2) . Anterior triangle of neck
3) . Supraclavicular fossa
4) . Deep in axilla
5) . Antecubital space
6) . Groin
7) . Popliteal space
* *bc of close location to arteries

Question 21

anesthesia for abscesses?

Answer 21

regional field block technique

Question 22

general procedure of tx abscess

Answer 22

1) . manually express purulent material
2) . explore cavity (break up septum or loculations)
3) . irrigate with normal saline
4) . completely drain cavity
5) packing if needed

Question 23

why is packing good in some cases?

Answer 23

prevents wound from closing, allows adequate drainage, remove and reinsert BID to 4x

Question 24

drains are indicated for what pt population? word catheter is good for what?

Answer 24

drains- KIDS

word catheter: Bartholin gland cyst or abscess

Question 25

when to prescribe ABX after I&D? (5)

Answer 25

1) . surrounded by lymphangitis or cellulitis
2) . purulent material cultured from DM or immunocompromised pt (until results obtained)
3) . use of aspiration to confirm dx (no I&D)
4) . non-subareolar breast abscess in nonlactating women
5) . febrile or signs of systemic illness