tag:blogger.com,1999:blog-24021163.post216929616002427700..comments2024-02-18T01:56:38.508-06:00Comments on M.D.O.D.: The Pus Palace911DOChttp://www.blogger.com/profile/06466669111561150174noreply@blogger.comBlogger25125tag:blogger.com,1999:blog-24021163.post-63348495714030034142008-03-05T16:05:00.000-06:002008-03-05T16:05:00.000-06:00Don't routinely culture I&Ds. ONly ever prescribe ...Don't routinely culture I&Ds. ONly ever prescribe ABs if cllulitis or lymphangitis present. I follow them up myself, never had one go bad on me yet.Fat Lazy Male Nursehttps://www.blogger.com/profile/17547512736412178809noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-69974261046795816012008-02-06T12:10:00.000-06:002008-02-06T12:10:00.000-06:00Thanks for all comments on this topic. Blood cult...Thanks for all comments on this topic. Blood cultures on sick folks will likely continue to be a thorn in everyone's side for years to come. It doesn't matter how many studies show their uselessness, the consultants just "vapor-lock" without them. I hate to admit it, but I just gave in and order them.<BR/><BR/>Thanks for all of the "pussy" corrections. I am aware of the purulent word....I know that sarcasm doesn't come across well in text, but you can assume I'm joking or being sarcastic most all of the time!<BR/><BR/>85erdoc85https://www.blogger.com/profile/06373340227068589953noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-1271963084112954072008-02-06T05:12:00.000-06:002008-02-06T05:12:00.000-06:00ER Nurse in CA here- I don't see too many wound c...ER Nurse in CA here- I don't see too many wound cultures sent, but Nurse K is right, everyone and their brothers get blood cultures. As far as abx- some doctors give 'em religiously, some rarely. Bactrim and Rifampin seem to be the most common. And it's purulent drainage!! pus-y..*snort* Speaking of funny charting.... I was once charting on a pt that came in drunk and non-responsive, but was beginning to wake up and I wrote "Pt arousable to manual stimulation" (Meaning if I gave her a sternal rub, she woke up and swore at me) Heh Heh Heh.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-24021163.post-85033457150783079482008-02-01T13:15:00.000-06:002008-02-01T13:15:00.000-06:00God love ya beanie...we're taking applications if ...God love ya beanie...we're taking applications if you want to stop doing the noble stuff!erdoc85https://www.blogger.com/profile/06373340227068589953noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-44300991617764760412008-02-01T10:21:00.000-06:002008-02-01T10:21:00.000-06:00I think I wouldn't culture in healthy adult but I ...I think I wouldn't culture in healthy adult but I never have the chance because all mine are children, pregnant, diabetic, HIV+ or all the above! Also can't rely on them to do twice daily clean dressing changes, much less apply bactroban 4 x daily.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-24021163.post-63839877982768551862008-02-01T10:13:00.000-06:002008-02-01T10:13:00.000-06:00More of the same:-Rarely culture-I&D only for simp...More of the same:<BR/><BR/>-Rarely culture<BR/>-I&D only for simple abscesses, if there's some complication bactrim + doxy ($8 at Walmart)<BR/>-Rarely use bactrobanAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-24021163.post-47719216880328798762008-02-01T07:42:00.000-06:002008-02-01T07:42:00.000-06:00I'm with everyone else. I rarely culture (unless ...I'm with everyone else. I rarely culture (unless I'm going to admit them or they've got underlying complicating problems). I usually treat with Bactrim and Doxy and we have them follow up with us (or PCP if they can get in) in 2 days for packing removal and wound check. I use Bactroban occasionally in recurrent cases.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-24021163.post-5045909195553565412008-02-01T02:41:00.000-06:002008-02-01T02:41:00.000-06:00In FP residency we were told to use "purulent" to ...In FP residency we were told to use "purulent" to describe a lesion which contained pus, thereby avoiding the pitfall of attempting to use "pus" as an adjective. Because adding "y" to some things may end up being more descriptive than you planned.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-24021163.post-87698496113904496842008-02-01T00:51:00.000-06:002008-02-01T00:51:00.000-06:00I once saw a pregnant EMT barf all over the ER flo...I once saw a pregnant EMT barf all over the ER floor...she caught a wiff of an abcess. I was giving the doc heck, "man, why didn't you let me drain it, blah blah blah" he said he'd drained it that morning, before I was at work...this was around dinner time...I would have hated (and loved...its a love hate relationship, :P) to be there when he drained it!EEhttps://www.blogger.com/profile/13697074755915208566noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-59405945496220427012008-01-31T22:24:00.000-06:002008-01-31T22:24:00.000-06:00911: I think anaerobic butt puss would smell bett...911: I think anaerobic butt puss would smell better than what you describe!<BR/><BR/>I love to drain these and watch the staff gag for hours afterwards!<BR/><BR/>85erdoc85https://www.blogger.com/profile/06373340227068589953noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-79532002176229783612008-01-31T21:33:00.000-06:002008-01-31T21:33:00.000-06:00Ew!Ew!EEhttps://www.blogger.com/profile/13697074755915208566noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-8703753435500273522008-01-31T21:26:00.000-06:002008-01-31T21:26:00.000-06:00anaerobic, 'pus-y' smell...take the chuck taylors ...anaerobic, 'pus-y' smell...<BR/><BR/>take the chuck taylors you wore for a week straight at summer camp without changing your socks, pee in them, put a dog turd in them and one spoonfull of peanutbutter, tie the shoe under rosie o'donnell's armpit while death marching her on a treadmill for ten hours, let shoe bake in sun for two weeks = there you have it, the smell that comes out of an anaerobic abscess.911DOChttps://www.blogger.com/profile/06466669111561150174noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-25946047489237031032008-01-31T21:14:00.000-06:002008-01-31T21:14:00.000-06:00Thanks for the input. Sounds like most don't see ...Thanks for the input. Sounds like most don't see a need for a culture in these patients and there's a lot of variability in other practices.<BR/><BR/>A few years ago, one of my partners got called before the Med Exec committee because he didn't culture one of these. The patient got worse and ended up in the hospital and of course, the admitting doc was held in complete vapor-lock because there wasn't a culture sent.<BR/><BR/>To the anon question, I may need some help from Etotheipi to describe the anaerobic pussy (pus-sy) smell..........<BR/><BR/>You know when you walk out in the back yard and take a whiff....and you're sure something is dead somewhere? You search around and find a dead squirrel or mouse? That's as close as I can come to describing it.<BR/><BR/>85erdoc85https://www.blogger.com/profile/16116576009136502023noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-32460556716832975992008-01-31T20:14:00.001-06:002008-01-31T20:14:00.001-06:00I meant would NOT pay for a culture.CATI meant would NOT pay for a culture.<BR/><BR/>CATshrodingers cathttps://www.blogger.com/profile/04020541322469047041noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-82756806256340795272008-01-31T20:14:00.000-06:002008-01-31T20:14:00.000-06:00It's always MRSA until proven otherwise. Most of ...It's always MRSA until proven otherwise. Most of our patients bitten by the dreaded spider Hygenicus Inadequas would pay for a culture, much less there bill.shrodingers cathttps://www.blogger.com/profile/04020541322469047041noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-48602872052626768642008-01-31T20:03:00.000-06:002008-01-31T20:03:00.000-06:00I think I've swabbed like 3 wounds in 2 years...ev...I think I've swabbed like 3 wounds in 2 years...everyone and they's mammies get blood cultures though. Cough? SEPSIS! Fever of 99.2? SEPSIS! Body aches? SEPSIS!!Nurse Khttps://www.blogger.com/profile/06408755992926959084noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-70926015412312878472008-01-31T18:30:00.000-06:002008-01-31T18:30:00.000-06:00I almost never culture abscesses. I only put them...I almost never culture abscesses. I only put them on antibiotics if I suspect MRSA (report of spider bite, multiple abscesses, H/O MRSA abscesses, etc). Almost never use Bactroban, but mostly because I forget to think about it.<BR/><BR/>Good question though--I'm not sure we're doing any good. We don't even know if Bactrim/Clinda works in vivo, not even considering the question of if you need to ever treat I&D'ed abscesses. Did we ever really have to MSSA?<BR/><BR/>Good blog, by the way. I just started my own and linked yours. Hope you don't mind. :)Jeffhttps://www.blogger.com/profile/04101275809415528676noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-66491894830527645212008-01-31T18:07:00.000-06:002008-01-31T18:07:00.000-06:00"If it smells anaerobic."I'm almost afraid to ask ..."If it smells anaerobic."<BR/><BR/>I'm almost afraid to ask if you would mind elaborating. If I have an open lesion, should I be sniffing it? What is it supposed to smell like? More to the point, what is it *not* supposed to smell like?<BR/><BR/>As you can tell, I do not have a clinical background... thank god. Some things are better left to the experts. :)Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-24021163.post-15178943803233140702008-01-31T17:32:00.000-06:002008-01-31T17:32:00.000-06:00I defer to the use of pus-filled fluid........I'm ...I defer to the use of pus-filled fluid........I'm a weinie!My Own Womanhttps://www.blogger.com/profile/08520236125332553784noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-4301804584910922392008-01-31T13:33:00.000-06:002008-01-31T13:33:00.000-06:00I almost never culture abcesses. Mostly emperical...I almost never culture abcesses. Mostly emperical therapy after lancing and put in a drain. Always antibiotics. Then again, I'm a vet... :)Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-24021163.post-45100955027646027322008-01-31T13:01:00.000-06:002008-01-31T13:01:00.000-06:00If I can get something out of it, I culture it. T...If I can get something out of it, I culture it. These days with all the freakin' MRSA, I empirically start bactrim and change it if I need to. Unfortunately, I haven't had to change it much lately. If I'm doing this in the outpatient setting, I have them follow up in a week's time (sooner if it's looking nastier). If I'm doing this in the ER, I have them follow up with their PCP.<BR/><BR/>There's been a lot of debate betwixt the ID docs and non-ID docs in my department as to what to do for an abscess and almost everyone is doing the drain and Bactrim song and dance.<BR/><BR/>I only use Bactroban in the nose if this is a patient's second time or more with a CA-MRSA infection. One of our ID docs has a handout on how to eradicate it, which includes nasal Bactroban. I haven't given it to enough of my patients to see if it works yet.Beth Nelsenhttps://www.blogger.com/profile/04489498223489567024noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-51541674517929369232008-01-30T21:18:00.000-06:002008-01-30T21:18:00.000-06:00Gah. I love blood and guts as much as the next no...Gah. I love blood and guts as much as the next non-doctory type, but that video was almost too much for me to handle, (and I translated for docs in a third world clinic, so I'm not overly squeamish. We saw some nasty stuff there.).Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-24021163.post-86506380378817377802008-01-30T19:26:00.000-06:002008-01-30T19:26:00.000-06:00The ER that I work in seems to culture all wounds....The ER that I work in seems to culture all wounds. Generally the doctor will place them on an antibiotic. The culture results get sent directly to the patient's PCP who we tell them to follow up with in a few days. <BR/><BR/>Rarely do we see the patient back in the ER unless he doesn't want to make an appointment with his PCP or he doesn't have one. We try to discourage repeat visits to the ER for follow up.<BR/><BR/>Oh, by the way. I think you sent Anonymous Ass over to my place. He's so witty.........NOTMy Own Womanhttps://www.blogger.com/profile/08520236125332553784noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-25081760639445543082008-01-30T19:16:00.000-06:002008-01-30T19:16:00.000-06:00I rarely culture any abscesses, maybe 1 in 20, and...I rarely culture any abscesses, maybe 1 in 20, and that's usually in a patient I intend to admit with a complicated infection.<BR/><BR/>I do put almost 100% of them on antibiotics, but only in the CYA sense. I don't think it's necessary most of the time, but like you, I do it anyway because everybody else does. I also pack most of my abscesses.<BR/><BR/>I like to follow them up myself in two days if I happen to be working...I'll tell them to come back when my shift starts. Otherwise someone else in our group will see them. We never send them back to the PCP for followup, but I do occasionally refer selected cases to a surgeon.scalpelhttps://www.blogger.com/profile/12163296819469420123noreply@blogger.comtag:blogger.com,1999:blog-24021163.post-40504670373417626942008-01-30T17:21:00.000-06:002008-01-30T17:21:00.000-06:00when i was working with some ER docs, we would do ...when i was working with some ER docs, we would do plenty of I&D's but would rarely send cultures...one doc would prescribe abx for almost all the patients, whereas another saved them for those that 'looked' like they needed it. we tell them they can follow up with us or their PCP, it's up to themAMiBhttps://www.blogger.com/profile/15630556503449531761noreply@blogger.com