winterallsummer Posted December 17, 2014 Share Posted December 17, 2014 How many of you pack abscess s/p id? How many only > 5 cm? Any that don't pack at all? Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted December 17, 2014 Administrator Share Posted December 17, 2014 I still generally do, unless they're too small to pack. Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted December 17, 2014 Moderator Share Posted December 17, 2014 I tend to pack less than half the time, but the majority of abscesses I seem to be seeing are less than 5 cm- and while I was at my old hospital this pilot study came out from our research division about simple cutaneous abscesses and the likely un-necessary need for packing: http://www.emottawa.ca/assets_secure/journal_club/articles/Nov_1_Routine%20Packing%20of%20Wounds%20is%20painful%20and%20probably%20Unnecessary.pdf When I pack, I put in enough material just to keep the wound open- never pack it to the hilt, as that for sure will cause unnecessary pain without any tangible benefit Link to comment Share on other sites More sharing options...
Moderator ventana Posted December 17, 2014 Moderator Share Posted December 17, 2014 changed my ways when MRSA hit big the old (pre-MRSA) abscess were nasty and typically a huge issue with MRSA I found that the packing really didn't help, and iodoform actually causes a fair amount of skin injury and pain so no more packing on small simple I+D - just open em up, probe, let it be.... big, deep or other issues, well then I still pack em Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted December 17, 2014 Moderator Share Posted December 17, 2014 I like this method and have used it before, however none of my current jobs recognizes this as acceptable practice or stocks the required loops. loop drainage option: http://www.acep.org/content.aspx?id=43632 Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted December 18, 2014 Moderator Share Posted December 18, 2014 I like this method and have used it before, however none of my current jobs recognizes this as acceptable practice or stocks the required loops. loop drainage option: http://www.acep.org/content.aspx?id=43632 Couldn't the same be done with a penrose drain? Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted December 18, 2014 Moderator Share Posted December 18, 2014 Couldn't the same be done with a penrose drain? sure. I discussed it with our medical director and he said it wasn't the "standard of care". I'm wondering if it wasn't more about fewer wound checks for repacking...$$$ Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted December 18, 2014 Moderator Share Posted December 18, 2014 sure. I discussed it with our medical director and he said it wasn't the "standard of care". I'm wondering if it wasn't more about fewer wound checks for repacking...$$$ Ah, the almighty dollar. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted December 18, 2014 Moderator Share Posted December 18, 2014 Ah, the almighty dollar. interestingly enough, the local level 1 trauma center has adapted this method to decrease return visits to the ER for wound checks. I learned about the method when I worked there per diem a few years ago. Link to comment Share on other sites More sharing options...
treejay Posted December 18, 2014 Share Posted December 18, 2014 cool method, never seen it before but it makes sense Link to comment Share on other sites More sharing options...
sunny2spot Posted December 19, 2014 Share Posted December 19, 2014 The loop method for I&D of large abscesses was just presented to our PAs last month. We've used penrose drains, and we still have them f/u in 2 days for a recheck, then have the drain removed in 10 days with surgery if it's a large abscess, or in the ED otherwise. The rechecks I've seen have looked fantastic, much better than if it had been packed. Pt's have felt great too. There are some youtube vids demonstrating it. I recommend it. Otherwise, I don't usually pack, and if I do it's minimal packing just to keep the area open. I prefer just making a larger incision though. Link to comment Share on other sites More sharing options...
Febrifuge Posted December 20, 2014 Share Posted December 20, 2014 I'm assuming that showering and bathing is pretty similar for patients with a loop, or maybe even a little easier, as opposed to wicking/ packing, right? Still need to keep the area clean and dry, and not mess with it too much? I can see the value, but I worry that some of my suburban patients might freak out about having a foreign body in place for that long. I realize it isn't logical, but it's not holistic or "natural" or whatever, and this crowd cares about that. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted December 20, 2014 Moderator Share Posted December 20, 2014 normal showering with loop in place, in fact encouraged for heat application to facilitate drainage. Link to comment Share on other sites More sharing options...
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