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What to Do After You Cut: Recommendations for Abscess Management in the Emergency Setting

Anyone out there seen an abscess recently? We are guessing yes! We know ’em. We love ’em. But most important, everything about their management is cut-anddried (or cut and squeezed).right? Well, until a new publication throws doubt on the usual management. Much has changed since the old standard practice of anesthetize, cut, blunt dissect, irrigate, and pack.

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Featured

 Loop Drainage Is Noninferior to Traditional Incision and Drainage of Cutaneous Abscesses in the Emergency Department

In summary, we conclude that the loop drainage treatment is not inferior to the incision and drainage treatment of an abscess in this study population. The average number of return visits within the study period for subjects in the loop drainage group and complications in the loop drainage group were also lower.

 Pain control for I&D of skin abscesses

I&D of skin abscesses has been rated as the second most painful procedure by patients next to only NG tube insertion. Use large volumes: Be generous with your local anesthetic. Our experts recommend the use of a 25G needle bent at the hub and deliver 10mL of 2% lidocaine with epinephrine in a circumferential pattern.

Previously Featured

Abscess incision and drainage

If there is a localized area of induration but no fluctuance on exam or fluid collection on ultrasound, home care with application of heat via warm compresses or soaks along with antibiotics may be attempted. However, it may be the very early development of an abscess which will be ready to drain within 24-36 hours, so these patients should be well educated on the signs of abscesses and reasons to return to the ER for re-evaluation.

Abscess Management: The Reformation of an Antibiotic Nihilist

Take Home Points: There is room for a safe increase in antibiotic use, There does not need to be reckless over-use of antibiotics, Use ultrasound with any abscess you are unsure of, Use a loop vessel rather than packing.

Antibiotics and Cutaneous Abscesses – Is there a Role?

Until such studies are available, Surgery recommends routine abscess wound cultures and anti-MRSA antimicrobial coverage with Bactrim first-line therapy, Clindamycin second-line therapy.

Antibiotics for simple skin abscesses: the new evidence in perspective

My patients might be interested to hear that, were it me or my family member with a small skin abscess, I would choose no antibiotics after I&D. I might also share my unproven suspicion that frequent soaking and washing in hot soapy water, in the first days following I&D, is likely more important than systemic antibiotics.

Avoid wound cultures in emergency department patients with uncomplicated skin and soft tissue abscesses after successful incision and drainage...

Skin and soft tissue infections are a frequent reason for visiting an emergency department. Some infections, called abscesses, become walled off and form pus under the skin. Opening and draining an abscess is the appropriate treatment. Culture of the drainage is not needed as the result will not routinely change treatment.

Cutaneous Abscess – Management

In general, the treatment of abscesses is incision and drainage; antibiotics are unnecessary in absence of surrounding cellulitis.

EM@3AM: Abscess

Most commonly caused by Staphylococcus aureus (either methicillin-resistant (MRSA) or susceptible (MSSA)).

Skin and Soft Tissue Infections: A PoCUS Guided Approach

Due to the similarities between different SSTI cutaneous findings and their different treatments, it is important to establish if there is an abscess present. It was common, before the introduction of ultrasound, to perform a blind needle aspiration of the infected area in order to determine the presence/absence of an abscess

Skin Deep: A Closer Look at Treatment of Skin and Soft Tissue Infections

Both of these studies identify clear targets for antibiotic (and diagnostic) stewardship with respect to SSTIs. Utilization of SXT in cases of impetigo could lead to more monotherapy and reduction of unnecessary “double coverage” antibiotic use; reinforcement of the need for only beta-lactams for non-purulent cellulitis is an important area for improvement; and avoidance of unnecessary blood cultures reduces the need for inappropriate antibiotic therapy for contaminants.

The Treatment of Cutaneous Abscesses: Comparison of Emergency Medicine Providers’ Practice Patterns

Cutaneous abscesses are commonly treated in the emergency department (ED). Although incision and drainage (I&D) remains the standard treatment, there is little high-quality evidence to support additional interventions such as pain control, type of incision, and use of irrigation, wound cultures, and packing.

Trimethoprim-Sulfamethoxazole for Uncomplicated Skin Abscesses?

One strategy would be a “wait and see” approach, reserving antibiotics for the subset of patients who are not clinically improving after incision and drainage. In other words provide a prescription for trimethoprim-sulfamethoxazole, with the specific instructions that if symptoms of infection have not improved at 48 hours then start taking the antibiotic.

Update on the management of skin abscesses in the emergency department

Loop drainage is an improved skin abscess drainage procedure. For significantly large or continuously draining abscesses, bipolar small incisions are made at the abscess borders and a drain may be left in place as needed and for up to several days, to facilitate complete resolution.

Weird and Wild: Scalp Abscesses and Kerions

Regardless of the underlying process or irritation, scalp abscesses must be drained and deloculated. Incision and drainage remains "an essential part of the treatment of bacterial abscesses...