Dr. Gordon doesn’t like failed I&Ds

I really don’t like doing an I&D and then finding nothing or no pus anyway. I find it helpful to know just where the pus is, where it goes, if there’s something else besides pus, or if it needs serious surgical intervention. Once I looked at neck swelling that didn’t look too horrible but the POCUS was scary: a huge collection of pus with the carotids and jugular floating inside just waiting for an unsuspecting ED.

One picture shows a rectal abcess. I wasn’t sure from the palpation if it was ready for I&D. The picture shows it was. Also it tells me I have to go at least 2 cm down to get to it. So I made a superficial incision and then gentle dissection with my baby finger.

Another picture was of  a person on antibiotics and a swollen somewhat red area anterior to the ear. POCUS shows a tender lymph node. Nothing to I&D.

The last shows the typical appearance of part abcess and part something else: infected sebaceous cyst or cellulitis degenerating into an abcess. This one looks like it’s Ok to I&D-it turned out to be an infected sebaceous cyst.

Soft tissues have a wide range of appearances: odema (maybe cellulitis), pus, lymph nodes, cysts, abscesses, sebaceous cysts. I find it’s often nice to see what it looks like before sticking a needle in or doing an I&D.