Clean the area with providone-iodine or chlorhexidine.
Consult surgeon or other advanced provider
Determine optimal I&D technique
Consider culture for specific populations
Loosely pack abscess cavity to wound margins with sterile gauze, iodoform gauze, or silver-containing hydrofiber leaving 1 cm wick
Contraindications to epinephrine?
Risk for foreign body?
X-ray to identify radiopaque materials
Abscess >5 cm, Pilonidal abscess, Immunocompromised, diabetic?
Warm water soaks 3 times a day until healed
Will this abscess require incision and drainage?
Will abx be beneficial?
Contraindications to probiotics?
Probiotics
Endocarditis prophylaxis?
Will patient need tetanus prophylaxis?
Wound checks every 2 days with packing removal when purulent drainage stops
Warm compresses 4 times a day, follow up with PMD
Patient to require sedation?
Patient to benefit from regional nerve block?
Perform regional nerve block
1% lidocaine with epinephrine field block
1% lidocaine field block
Will patient benefit from antibiotics?
Contraindications to probiotics?
Probiotics
Probe the wound to release loculations and irrigate with copious amounts of tap water
Incision I&D
Clindamycin or TMP-SMX + Cephalexin
Loop I&D
Clindamycin or TMP-SMX + Cephalexin
Contraindications to lidocaine with epinephrine