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Flashcards in I&D Deck (26):
1

Define Folliculitis

Superficial infection of the hair follicles in the epidermis

2

Treatment of Folliculitis

Usually resolve spontaneously
Warm compresses
Avoid shaving involved areas

3

Common Bug with Hot Tub Folliculitis

Pseudomonas aeroginosa

4

Define Skin Abscess

Collection of pus within dermis & deeper skin tissues

5

Define Furuncle (Boil)

Infection of hair follicle: pus extends through dermis into subQ tissue

6

Define Carbuncle

Coalescence of several infected follicles into a single mass with several draining sites

7

Contraindications or Concerns with an I&D

Abscess location may mandate drainage by surgeon
Abscess types
Patient factors
Will leave a scar & may return

8

Abscess Locations that Should be Drained by a Surgeon

Perirectal area
Anterior & lateral neck
Breast near areola
Near vital nerves/blood vessels
Hand abscesses
Central triangle of face

9

Abscess Types Indicating Surgical I&D

Recurrent & interconnected abscesses
>5 cm

10

Patient Factors to Indicate Surgical I&D

Airway issues
Bleeding disorder or anticoagulation

11

Risk Factors for Skin Abscesses

DM
Immunologic abnormalities
Breaches of skin barrier

12

Pre-procedure Preparation

Evaluation of abscess
Medical issues
Patient counseling

13

Medical Issues & I&D's

Lidocaine allergy
Heart valve or total joint: need antibiotics

14

Patient Counseling for I&D

Explain procedure, risk of recurrence, & scar formation
May need bigger incision than anticipated
Involves some discomfort
Explain after care
Will not be totally comfortable in out-patient setting

15

When to Consider Antibiotic Therapy

Abscess >5 cm
Extensive cellulitis
Signs of systemic infection
Co-morbidities
Immunosuppression
Prosthetic joints & valves

16

Antibiotic Agents for I&D's

Clindamycin
Doxycycline
SMX/TMP
Vancomycin (MRSA, IV)

17

Supplemental Sedation for Children or Large Abscesses

Lorazepam
IV MS or dilaudid
Have Narcan (naloxone) & Romazicon (flumazenil) on hand

18

Equipment for I&D

Sterile gloves, drapes, & 4x4 gauze
Goggles or eye protection
Povidone-iodine solution
Local anesthetic
3-10 mL syringe with 25 or 27 gauge needle
Culture swab
#11 blade & scalpel handle
Curved hemostat, forceps, scissors
30-60 mL syringe with irrigation device with splash protection
Basin with sterile saline
Packing material
Dressing of choice

19

I&D Procedure

Prep & drape wound
Establish anesthesia
Incise skin in line with natural folds
Culture pus within the wound
Spread wound with hemostat & look for pockets
Debride necrotic tissue
Irrigate with isotonic saline until wound is clear
Pack or drain wounds with significant dead space
Apply dressing
Antibiotics??

20

Abscess Best Left Open in Which Patients

Immunocompromised
Systemic infections
Significant cellulitis

21

When to Pack a Wound

Where there is a cavity
Keep wound from closing
Penrose drain

22

Covering an Abscess

Sterile ace dressing
Sterile tape

23

Instructions & Follow Up After an I&D

Leave dressing alone
Elevate extremity
Seek medical attention if: fever/chills, reaccumulation of pus, red streaks, increased swelling
Recheck wound in 24-48 hours

24

Resolving Wounds After I&D Procedure

Soak in warm, soapy water or shower
Protect with dry, sterile dressing until wound is closed

25

Complications More Likely In

Anterior facial triangle
Nose & mouth
Pilonidal cyst
Perirectal area

26

Types of Complications with I&D Procedure

Inadequate drainage may result in local extension
Overly aggressive debridement may damage deep structures
Bacteremia