The Duality of Abscesses
I had the honor and pleasure of draining two disparate examples of skin abscesses during a recent shift, back to back. There seems to be a spectrum of boils, but for convenience sake, I'll divide them into two categories representing the polar opposites:
1) The thin-walled raised bubble, nearly painless to drain with an abundance of free-flowing pus ready to gush forth with a gentle stab of the blade. Step back!
Draining one of these babies is about as much fun as I can have in the ER, unless the drug reps bring chinese food.
and
2) The inflamed, indurated abscess; flatter and somewhat woody, this is really just a cellulitis with some scant pus interspersed. Universally painful to anesthetize, difficult to de-loculate, and disappointing in the amount of bounty obtainable. This class of abscess is often amenible to a trial of antibiotics, allowing a couple of days to ripen or defervesce if the patient is reliable and willing. Even if some pus is obtained with a needle aspiration beforehand, I've almost always wished I hadn't cut into this type after all is said and done. But I've occasionally been surprised.
The difference in feel between the two is sort of like the difference between slicing into a tomato and an orange.
(these aren't my pictures, btw, I stole them off the internet)
1) The thin-walled raised bubble, nearly painless to drain with an abundance of free-flowing pus ready to gush forth with a gentle stab of the blade. Step back!Draining one of these babies is about as much fun as I can have in the ER, unless the drug reps bring chinese food.
and
2) The inflamed, indurated abscess; flatter and somewhat woody, this is really just a cellulitis with some scant pus interspersed. Universally painful to anesthetize, difficult to de-loculate, and disappointing in the amount of bounty obtainable. This class of abscess is often amenible to a trial of antibiotics, allowing a couple of days to ripen or defervesce if the patient is reliable and willing. Even if some pus is obtained with a needle aspiration beforehand, I've almost always wished I hadn't cut into this type after all is said and done. But I've occasionally been surprised.The difference in feel between the two is sort of like the difference between slicing into a tomato and an orange.
(these aren't my pictures, btw, I stole them off the internet)
Labels: pus
posted by scalpel at 2:50 AM
2 Comments:
I bet that would be satisfying. But I have to ask... how can they possibly let them get so big before seeking treatment?! The first one, I would do it myself, I'd think.
I know this entry is quite old, but I must comment. I had an abscess almost 7 years ago. As for location, I can simply say that the surgeon used a scar on my neck from an earlier cervical lymph node biopsy.
It was severe enough that I had to manually pull my mouth open and push it closed. The surgeon told me (after I asked) that it contained about 8 ounces of yick. I waited so long because I thought it was an enlarged node, and by the time it was obviously something else, I was pretty ill and confused.
Anyway, the ER docs thought it was pretty cool. I got paraded about before I was sent off for surgery.
What is it with you guys and abscesses?
(BTW infectious disease doc called the pathogen streptococcus milleri)
Post a Comment
<< Home