Evidence Based Abscess Management

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Management of Skin Abscesses in the Era of Methicillin-Resistant Staphylococcus aureus

Adam J. Singer, M.D., and David A. Talan, M.D.

N Engl J Med 2014; 370:1039-1047

The authors of this article summarize the literature thusly:

  1. Incision & drainage is definitive treatment. Non-complicated disease does not require additional antibiotic treatment, although the evidence is not strong.
  2. Packing of abscesses is a matter of tradition, and evidence is neither sufficient to conclusively confirm nor refute this practice.
  3. Primary closure of abscesses after I&D is reasonable, particularly for larger, exposed, and cosmetically important areas.
  4. Antibiotic coverage for primarily cellulitic soft-tissue infections ideally includes streptococcal coverage
  5. Wound cultures are not necessary.

Using wall suction to drain that ascites

Recommended limits for total fluid removal vary depending on the source, but the consensus among guidelines is 5–6 liters without the need for volume expanders to lessen chances of major complications.

Mortality after Fluid Bolus in African Children with Severe Infection

Mortality after Fluid Bolus in African Children with Severe Infection

Kathryn Maitland, M.B., B.S., Ph.D., Sarah Kiguli, M.B., Ch.B., M.Med., Robert O. Opoka, M.B., Ch.B., M.Med., Charles Engoru, M.B., Ch.B., M.Med., Peter Olupot-Olupot, M.B., Ch.B., Samuel O. Akech, M.B., Ch.B., Richard Nyeko, M.B., Ch.B., M.Med., George Mtove, M.D., Hugh Reyburn, M.B., B.S., Trudie Lang, Ph.D., Bernadette Brent, M.B., B.S., Jennifer A. Evans, M.B., B.S., James K. Tibenderana, M.B., Ch.B., Ph.D., Jane Crawley, M.B., B.S., M.D., Elizabeth C. Russell, M.Sc., Michael Levin, F.Med.Sci., Ph.D., Abdel G. Babiker, Ph.D., and Diana M. Gibb, M.B., Ch.B., M.D. for the FEAST Trial Group

N Engl J Med 2011; 364:2483-2495

Fluid boluses significantly increased 48-hour mortality in critically ill children with impaired perfusion in these resource-limited settings in Africa.

Chest Pain…

A man in his 60’s presented after 4 days of chest pain, with some increase of pain on the day of presentation. Exact pain history was difficult to ascertain. There was some SOB. He had walked into the ED (did not use EMS). He was in no distress and vital signs were normal.