First 5 minutes for the critical patient
›Critical workflow
›Cardiorespiratory monitoring
›Two large bore IV lines when unstable
›Oxygen if SpO2 less than 92 percent
›Point of care glucose
›Lactate if sepsis concern
›Early antibiotics for sepsis physiology
›Incision and drainage decision
›Fluctuant abscess
›Failure of conservative care
›Large abscess size
›Significant pain
›Procedure essentials
›Adequate anesthesia
›Incision over maximal fluctuance
›Break loculations
›Irrigation
›Avoid routine packing for small uncomplicated abscess
›Procedural cautions
›Face and periorbital location
›Hand deep spaces
›Perineal location
›Proximity to major vessels
›When antibiotics not required
›Small uncomplicated abscess after adequate drainage
›No systemic features
›When antibiotics favored
›Extensive cellulitis surrounding abscess
›Systemic features
›Immunocompromised host
›Extremes of age
›Difficult to drain location
›Recurrent abscess
›Inadequate drainage concern
›Empiric MRSA coverage options
›TMP SMX DS 1 tablet PO twice daily
›Duration 5 to 7 days
›Avoid in late pregnancy local protocol dependent
›Doxycycline 100 mg PO twice daily
›Duration 5 to 7 days
›Avoid in pregnancy
›Clindamycin 300 to 450 mg PO four times daily
›Duration 5 to 7 days
›C difficile risk
›Streptococcal coverage considerations
›Cephalexin 500 mg PO four times daily
›Add MRSA agent when purulence risk high
›Severe infection IV options
›Vancomycin IV local protocol dependent
›Weight based dosing local protocol dependent
›Renal adjustment required
›Cefazolin IV for nonpurulent cellulitis local protocol dependent
›Piperacillin tazobactam IV when polymicrobial risk local protocol dependent
›Special pathogen risk
›Animal bite coverage
›Amoxicillin clavulanate 875 mg PO twice daily
›Hand bite higher risk
›Marine water exposure coverage local protocol dependent
›Vibrio risk
›Aeromonas risk
›Interval reassessment
›Repeat vitals within 30 to 60 minutes if systemic features
›Pain and swelling trajectory
›Drainage adequacy after procedure