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Abscess Drainage

Mike Menchine, MD, Mike Weinstock, MD, Sanjay Arora, MD, and Gillian Schmitz, MD
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Say you’ve got a huge pus filled abscess that needs draining.  Do you drain it, irrigate and pack it?  Do you just pack, no irrigation?  Or just irrigate and don’t pack it?  Weinstock hears from Sanjay and Mike who discuss a relevant paper, then Weinstock sits with the paper's author, to summarize, final points.

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Kaylin O. -

should IV drug users automatically be sent to the ER for an ECHO if they have an abscess? more specifically an abscess in the AC region

Mizuho M., DO -

IVDA are a special patient population that warrant careful clinical decision making. However that doesn't mean they need to be automatically send to the ER every time they present to us with an abscess. They are by default going to be a population prone to many abscesses. These can be I&D'd as we normally do. However, if you have systemic signs (fever, SIRS) together with any obvious physical findings of endocarditis (i.e.: petechiae, splinter hemorrhages, Janeway lesions, Osler's nodes, Roth spots etc.) these should raise a red flag & the pt certainly demands workup. Of course many of these dermatologic/nail bed findings are not commonly present, so if you have fever in ANY IVDA patient and you clincally suspect endocarditis, yes these patients warrant further workup. These are hard diagnoses to make. It does behoove us to pause, and be more conservative with these patients in general, but to reflexively send every IVDA to the ER I think is not warranted. Hope this helps.

Stan N. -

Stan Neal, MD 4/28/16
2 questions
1 is home cleaning or probing of the abscess cavity after drainage or removing loose packing necessary or helpful?
2 How about the special abscesses like on the eyelid or hydradenitis supperativa?

Mike W., MD -

Washing with soap and (tap) water or a sitz bath is a good idea, but I would not recommend the patient probe the wound at home. A finger gently in the wound is fine. The soap and water idea would apply to all wounds including the eyelid and hidradenitis - of course, unless you were upside down a sitz bath would not apply!

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