Revision of Incision and Drainage from Fri, 09/30/2011 - 11:32

According to the US NHAMCS 2008 Survey (Table 18) there were about 1.4 million I&Ds done in US EDs last year, making it the 6th most common ED procedure.  Something everyone should know how to do then.

 

 Indications

1. An identifiable abscess (Wikipedia).  Some are easy to identify, others less so.  When in doubt assume there is one. (EM Lit of Note)

 Contraindications

1. Extremely large or deep abscess that are likely to require extensive debridement and are best done in the OR. Particularly true of large perineal abscess.

2. Palmar space abscess - usually require surgical consultation.

3. Nasolabial abscess (in the 'Danger Triangle' - Wikipedia)- risk of septic phlebitis of the cavernous sinus.

4. (Relative) Abscesses near, or overlying, neurovascular structures - peritonsillar abscess, deep groin or antecubital fossa abscess etc.  Localization of fluid collection and/or vascular structures with Ultrasound or aspiration prior to procedure may mitigate this risk.

Pearls & Pitfalls

Topical anaesthetic for I&D in Children (Academic Life in EM)

Local anaesthesia for I&D (Michele Lin of Academic Life in EM via ACEP News)

Packing or No Packing - the evidence points to NO!  BestBET (incomplete), theNNT.

Antibiotics or not? - a recent review in Annals of Emergency Medicine shows little evidence for benefit of antibiotics (even with MRSA), but questions remain - extensive surrounding cellulitis etc.  EM Lit of Note reviews a more recent article (still NO).

 Supplies

 

How to do an I&D

Fleshing out the post. More to come.

Added videos and new links.

Videos are now linked instead of inline - this may change

testing inline image function