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26 Cards in this Set
- Front
- Back
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Indication for I&D
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localized collection of infection that is tender and not resolving spontaneously
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Cardinal signs of infection
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pain
fever redness swelling loss of function |
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Contraindications for I&D
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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 |
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Why not to I&D facial in triangle
And tx |
risk of septic phlebitis with intracranial extension
atbx and warm compress |
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Complications of I&D
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Cellulitis or re-collection of pus
Bacteremia Septicemia |
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Perianal Abscess I&D can cause
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chronic anal fistula in 50% of pt
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sterile abscess
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bacteria cannot be cultured from it
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dry abscess
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resolves without rupture
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chronic or cold abscess
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lacks cardinal signs
is associated with liquefactive necrosis or tuberculous lesions |
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Etiology of abscess
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S. aureus (most common)
Streptococcus spp. G- and anaerobes Via puncture wounds or foreign bodies |
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Why is it difficult to treat abscesses with atbx
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They are encapsulated by connective tissue
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how do abscesses interfere with normal fxn
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expansion and pressure on structures
expulsion of contents int o surrounding areas or vascular system |
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Locations in close proximity to major vessel
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Peritonsillar or retropharyngeal
anterior triangle of the neck subclavicular fossa deep in the axilla antecubital space groin popliteal space |
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What should be done to avoid inadvertant incision into an artery
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aspirate with 18G needle attatched to 10mL syringe before drainage
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Pt prep I&D
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Risks/Benefits
describe care to pack wound let them ask ?? pt supine |
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Skin prep I&D
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povidone iodine
single layer let dry |
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Anesthesia I&D
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regional field block 1cm away from erythematous border
superficial infiltrate linearly across abscess and then perpendicular to that line |
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I&D PRocedure
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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 |
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Purpose of iodoform gauze
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prevents incision from sealing over
provides adequate drainage |
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How often do you change the gauze
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every 12-24h
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Additional tx (atbx) may be necessary for what pts?
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surrounded by lymphangitis or large area of cellulitis
Immunosuppressed Use dicloxacillan (250-500mg every 6h) |
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Aspiration confirms what
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that the material in the cavity is purulent and not serosanguineous or pure blood
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What if you see a non-lactating woman with a breast abscess that is not subareolar
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this is rare, so do a biopsy, culture, and give atbx
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Pain Relief I&D
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If packing tight - acetominophrn or NSAID
otherwise I&D provides pain relief |
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F/U Instructions I&D
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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 |
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Pt should notify PA immediately if
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re-collection of pus in the abscess
fever and chills increased redness or pain red streaks increased swelling |
