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26 Cards in this Set

  • Front
  • Back
Indication for I&D
localized collection of infection that is tender and not resolving spontaneously
Cardinal signs of infection
loss of function
Contraindications for I&D
Facial furuncles in the triangle formed by the nose and corners of the mouth
Abscesses near rectum or genitalia
Pt with DM, immunosuppression, or debilitating dz should be monitored after I&D
Why not to I&D facial in triangle
And tx
risk of septic phlebitis with intracranial extension

atbx and warm compress
Complications of I&D
Cellulitis or re-collection of pus
Perianal Abscess I&D can cause
chronic anal fistula in 50% of pt
sterile abscess
bacteria cannot be cultured from it
dry abscess
resolves without rupture
chronic or cold abscess
lacks cardinal signs
is associated with liquefactive necrosis or tuberculous lesions
Etiology of abscess
S. aureus (most common)
Streptococcus spp.
G- and anaerobes
Via puncture wounds or foreign bodies
Why is it difficult to treat abscesses with atbx
They are encapsulated by connective tissue
how do abscesses interfere with normal fxn
expansion and pressure on structures
expulsion of contents int o surrounding areas or vascular system
Locations in close proximity to major vessel
Peritonsillar or retropharyngeal
anterior triangle of the neck
subclavicular fossa
deep in the axilla
antecubital space
popliteal space
What should be done to avoid inadvertant incision into an artery
aspirate with 18G needle attatched to 10mL syringe before drainage
Pt prep I&D
describe care to pack wound
let them ask ??
pt supine
Skin prep I&D
povidone iodine
single layer
let dry
Anesthesia I&D
regional field block 1cm away from erythematous border
superficial infiltrate linearly across abscess and then perpendicular to that line
I&D PRocedure
Incise along Langer's lines
across full dimension of abscess
Get culture
Explore with cotton tipped applicator
Irrigate with normal saline
Insert gauze with 1 cm sticking out, pack
Appply sterile dressing
Purpose of iodoform gauze
prevents incision from sealing over
provides adequate drainage
How often do you change the gauze
every 12-24h
Additional tx (atbx) may be necessary for what pts?
surrounded by lymphangitis or large area of cellulitis

Use dicloxacillan (250-500mg every 6h)
Aspiration confirms what
that the material in the cavity is purulent and not serosanguineous or pure blood
What if you see a non-lactating woman with a breast abscess that is not subareolar
this is rare, so do a biopsy, culture, and give atbx
Pain Relief I&D
If packing tight - acetominophrn or NSAID
otherwise I&D provides pain relief
F/U Instructions I&D
After removal of packing, apply warm wet soak 4-6x/d for 5-7d
Non-adherant dressing c gauze over wound
Some parts may need immobilized or elevated
Keep clean and dry
Watch for recurrance
Pt should notify PA immediately if
re-collection of pus in the abscess
fever and chills
increased redness or pain
red streaks
increased swelling