Basic Office Procedures.docx.pdf

Basic Office Procedures Lab and SDL Procedure Indications CI/Complications Equipment Technique I&D of Abscess -definitive tx for soft tissue abscess; abx alone are often not adequate, done when collection of pus is present that is not resolving spontaneously -premature incision before localization o...

Basic Office Procedures Lab and SDL Procedure Indications CI/Complications Equipment Technique I&D of Abscess -definitive tx for soft tissue abscess; abx alone are often not adequate, done when collection of pus is present that is not resolving spontaneously -premature incision before localization of pus is not indicated -No. 11 scalpel blade -hemostat -25G needle -local anesthetic -alcohol/chlorhex -Gauze and dressing -Culture is needed -simple I&D → prep with alcohol/chlorhex, anesthetic field block around periphery, cut along langerhan lines when possible, express material, explore cavity with cotton applicator/hemostats, pack with gauze (but not tightly) -don’t do it on face or genital areas, or if really large -recurrent infection, necrosis of skin, MRSA, bleeding Shave Bx -Used to bx lesion (obtain tissue sample) to guide definitive treatment -May be just to excise for curative or cosmetic purposes -CI: melanoma suspected → do punch bx instead -Radiofrequency loop may cause excessive scarring -Excisions require moist healing -local anesthetic -single-edged razor or No. 15 scalpel -alcohol/chlorhex -Hemostatic agents (Monsel’s or aluminum chloride) -Abx ointment and bandage -Prep area, anesthesia underneath lesion to elevate it, shave lesion with scalpel blade parallel to skin (or razor blade), apply pressure and topical solution to achieve hemostasis, apply abx ointment and bandage → send out specimen for culture Punch Bx -complete removal of small lesions