Two Letters Re: How to Drain an Abscess

Monday, Dec 12, 2011

Hi Mr. Rawles, 
I am happy to see the additional information to address abscess drainage in a SHTF situation. Thanks to Dr. Prepper for the  drawing salve idea. I did a pub-med search and found the icthammol does have antibiotic properties although I could not find the mechanism for white cell migration to the surface. I know ranchers use this stuff and modern medicine doesn't always have all the answers. Thanks.

Ladydoc is exactly right about using a big enough incision to get wide drainage without going into healthy tissue-very good addition. I also liked the fact she clarified that even if you did not have lidocaine you still need to drain the abscess. Thanks.

As far as packing an abscess, there is plenty of evidence in the new literature that there is no need to pack, it is painful and may actually delay healing. Read: O’Malley et al. Routine packing of simple cutaneous abscesses is painful and probably unnecessary. (Acad Emerg Med 2009;16:470-73.)

There is also new literature to suggest that lidocaine with epinephrine is also safe for those abscesses on fingers or noses, but since I think the prudent thing to do is to find a prepper doctor in the instance you have a finger or facial abscess, I was addressing the the other instances. Read: Plast Reconstr Surg. 2001 Feb;107(2):393-7. Do not use epinephrine in digital blocks: myth or truth?

I know tradition dies hard in medicine, but being a doc in an teaching hospital, I have to keep up with the newest literature or the residents would soon discount my teaching.  I guess this serves to show there is no "one right way" to do things in medicine. - Lonestar Doc

 

Dear Mr. Rawles,
As an avid young follower of your blog, I would like to comment on the article titled, 'How to drain an abscess'. I am presently a neurosurgery resident in, and my exposure to operating room procedures involving drainage of abscesses makes my advice applicable in this case. I have drained abscesses with various general surgeons and trauma surgeons during my earlier training. In concordance with the well-written and practical article, an abscess may be drained without
the use of local anesthetics.

In fact, the pH of the tissues surrounding an abscess is too low to permit the natural use of local anesthetics in the '-caine' family. For example, for lidocaine to permeate into the axon of the nerve fiber, to block the membrane channel on the axon surface and to halt transmission of the pain fiber (which is the goal of lidocaine), the pH must be high enough (physiologic levels in healthy tissue is adequate) so that lidocaine is in the unprotonated form.

Essentially, infected tissue is acidic, and the form of lidocaine cannot enter the cell membrane and will not help the individual. Draining abscesses in all that I have witnessed where local anesthetic is very painful. The best outcomes I have witnessed for the patient is to limit pain by performing the procedures as quickly as possible. A cruciate incision is all that is necessary, large enough to allow irrigation with saline and self-drainage. Unroofing the abscess is done by most of the surgeons I have assisted to prevent reclosure of the dome of the abscess and recurrence.

Thank You again for your great web site, as well as your books. I have moved from a rural area of upstate New York to Philadelphia for residency, and I can only more agree with you that we live in a vulnerable society. My friends and I have a love for Austrian Economics and with that, we have only been more and more concerned with the state of our currency, the more we learn about our economic practices. Thanks again, Sincerely, - G.M.


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