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Flashcards in I&D Deck (26)
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1
Q

Define Folliculitis

A

Superficial infection of the hair follicles in the epidermis

2
Q

Treatment of Folliculitis

A

Usually resolve spontaneously
Warm compresses
Avoid shaving involved areas

3
Q

Common Bug with Hot Tub Folliculitis

A

Pseudomonas aeroginosa

4
Q

Define Skin Abscess

A

Collection of pus within dermis & deeper skin tissues

5
Q

Define Furuncle (Boil)

A

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

6
Q

Define Carbuncle

A

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

7
Q

Contraindications or Concerns with an I&D

A

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

8
Q

Abscess Locations that Should be Drained by a Surgeon

A
Perirectal area
Anterior & lateral neck
Breast near areola
Near vital nerves/blood vessels
Hand abscesses
Central triangle of face
9
Q

Abscess Types Indicating Surgical I&D

A

Recurrent & interconnected abscesses

>5 cm

10
Q

Patient Factors to Indicate Surgical I&D

A

Airway issues

Bleeding disorder or anticoagulation

11
Q

Risk Factors for Skin Abscesses

A

DM
Immunologic abnormalities
Breaches of skin barrier

12
Q

Pre-procedure Preparation

A

Evaluation of abscess
Medical issues
Patient counseling

13
Q

Medical Issues & I&D’s

A

Lidocaine allergy

Heart valve or total joint: need antibiotics

14
Q

Patient Counseling for I&D

A

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
Q

When to Consider Antibiotic Therapy

A
Abscess >5 cm
Extensive cellulitis
Signs of systemic infection
Co-morbidities
Immunosuppression
Prosthetic joints & valves
16
Q

Antibiotic Agents for I&D’s

A

Clindamycin
Doxycycline
SMX/TMP
Vancomycin (MRSA, IV)

17
Q

Supplemental Sedation for Children or Large Abscesses

A

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

18
Q

Equipment for I&D

A
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
Q

I&D Procedure

A

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
Q

Abscess Best Left Open in Which Patients

A

Immunocompromised
Systemic infections
Significant cellulitis

21
Q

When to Pack a Wound

A

Where there is a cavity
Keep wound from closing
Penrose drain

22
Q

Covering an Abscess

A

Sterile ace dressing

Sterile tape

23
Q

Instructions & Follow Up After an I&D

A

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
Q

Resolving Wounds After I&D Procedure

A

Soak in warm, soapy water or shower

Protect with dry, sterile dressing until wound is closed

25
Q

Complications More Likely In

A

Anterior facial triangle
Nose & mouth
Pilonidal cyst
Perirectal area

26
Q

Types of Complications with I&D Procedure

A

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