I&D Flashcards
Indications for I&D (3)
1) . localized fluctuant infection
2) . doesn’t resolve spontaneously
3) . signs of infection
signs of infection? (6)
pain, fever, erythema, edema, loss of function, swelling
contraindications of I&D (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
how to tx facial furuncles in triangle of doom?
ABX and warm compress
also refer
why is I&D in triangle of doom so risky?
there’s a risk of septic phlebitis with intracranial extension
how to tx abscesses near genitalia/rectum?
REFER to general surgeon/gynecologist
if there isn’t cellulitis at time of I&D then how do you tx?
DONT NEED ABX
in 50% of cases, perianal/pilonidal abscess I&D results in what?
chronic anal fistula
if simple I&D fails to relieve erythema, pain, pus or edema, then suspect what?
suspect deep infection
how to tx pilonidal abscess?
make incision site parallel to midline, clean out abscess pus (remove cyst if that’s cause), lightly pack touching wound edges
if using medicated packing after pilonidal abscess removal, what is important to remember?
only use for 2-3 days and then switch over to non medicated packing (will kill good tissue if medicated left in too long)
what is an abscess?
focal circumscribed accumulation of purulent material (pus and other inflammatory tissue), usually fluctuant
acute abscess usually presents as? dry abscess tx?
acute- red, hot, painful, swollen
dry- resolves without rupture
what isn’t necessary for a sterile abscess?
doesn’t need cultured
chronic abscesses are usually associated with what?
liquefactive necrosis of tuberculous lesions
what is a furuncle vs carbuncle?
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
how to treat a small abscess (<5cm)?
warm compress and maybe ABX (if pt is febrile or exhibit systemic symptoms)
-maybe I&D if not already draining or if fluctuant
how to treat an enlarging abscess with inflammation, pus collection, and wall off of cavity?
I&D (warm compress and ABX ineffective)
how to tx if you suspect a complicated abscess, have an immunocompromised pt or recurrent abscess?
CULTURE- aspirate or swab pus/cavity
abscesses in these locations require aspiration with an 18 gauge needle on 10 ml syringe rather than I&D
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
anesthesia for abscesses?
regional field block technique
general procedure of tx abscess
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
why is packing good in some cases?
prevents wound from closing, allows adequate drainage, remove and reinsert BID to 4x
drains are indicated for what pt population? word catheter is good for what?
drains- KIDS
word catheter: Bartholin gland cyst or abscess
when to prescribe ABX after I&D? (5)
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
