Bartholin abscesses are challenging to manage, partly because of Word catheter insertion. Sometimes, the space is not large enough (unable to fit the catheter) or too large (catheter falls out). How else can you “pack” the abscess space?
Why are we still teaching the traditional incision and drainage approach to simple abscess drainage? They require frequent, painful packing changes to ensure persistent drainage of retained pus.
Incision and loop drainage (I&LD) technique
As per usual, Dr. Rob Orman (ercast) beat me to this. He already reviewed the technique on his blog in 2010. This stems from a landmark article in the Journal of Pediatric Surgery, which involves creating a persistently draining fistula at two points by using a small vascular loop, tied into a non-tensile loop.
It makes sense to extrapolate and use this technique for both pediatric and adult patients with uncomplicated abscess, especially if the patients may not follow-up for packing changes as scheduled. The added benefit is that showering is encouraged to help encourage drainage without the risk of dislodging the secured loop.
Does anyone have experience with this that they would like to share? Particularly, what if you don’t have the skinny vascular loops in your Emergency Department?
Per the Tsoraides article1:
Continuing the theme of mandibular dislocation tricks (protecting your thumbs, post-reduction stabilization), Dr. Daniel Gromis from Advocate Christ Medical Center describes a novel reduction technique, based on the Cunningham shoulder reduction technique using muscle relaxation.
How do you capture the image of the eye on slit lamp exam either for the patient or your ophthalmology consult? It’s often easier to show someone a photo rather than trying to describe that atypical dendritic lesion, degree of corneal edema, or pattern of corneal abrasion.
You, however, don’t have the expensive camera attachment (nor a SLR camera for that matter).
Medication error is something that we all fear in Emergency Medicine and do our best to avoid. Here’s a scenario and simple approach for you, provided by Zlatan Coralic, PharmD (Assistant Clinical Professor in the UCSF School of Pharmacy).
You are an emergency physician working in an underserved country. You are presented with an asthmatic kid with severe retractions and tight wheezes. Multiple nebulizers and corticosteroids have failed. You want to try some magnesium sulfate before risking intubation in a place with no reliable access to ventilator equipment. You know the dose should be 1 gm IV over 20 minutes.
A patient presents with a tungsten ring on their injured finger and is unable to remove the ring. Tungsten rings are unique in that ring cutters can’t even make a scratch in them. There are even anecdotes of firefighter equipment not being able to cut off these “unbreakable” rings.
