Do you pack all subcutaneous abscesses?

[PlutoBoy]

Do you pack all of them? If not, what helps you decide if you will pack or not?

I've not packed the last two I have done and they have healed well one week after the fact.

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[shoal007]

Do you pack all of them? If not, what helps you decide if you will pack or not?

I've not packed the last two I have done and they have healed well one week after the fact.

Emrap did a talk on this about 1 year ago.
Recs
Culture no
Pack maybe
Wash out no
Antibiotics maybe (nnt 7)

That said I don't pack. I do give antibiotics if any cellulitis.


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[PlutoBoy]

Emrap did a talk on this about 1 year ago.
Recs
Culture no
Pack maybe
Wash out no
Antibiotics maybe (nnt 7)

That said I don't pack. I do give antibiotics if any cellulitis.


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I don't pack if cavity is too small or too superficial. Any other clinical cues to guide your decision?

 

[xaelia]

Haven't packed since I left residency.

Even when the patient comes back and says "They told me I needed to come back in two days and have it re-packed."

Antibiotics more likely now.

 

[PlutoBoy]

Hmmm... so we are not packing. I've read the literature but it is always nice to know that I am not deviating from the standard of care.

 

[LabMonster]

Not packing. The EM literature is quite good for smaller abscesses not requiring packing and the added harm (pain, not benefit) done on packing and re-packing. There may be a benefit in larger abscesses, but those should be handled by our surgical colleagues - in league with admission and antibiotics.

There is no reason NOT to initiate source control when surgical management will be necessary though. Drains are also more useful than packing in my own practice - i.e. a Penrose through a linear abscess to be removed in a couple of days.