Journal Club Podcast for April 20

Abscesses: Lancing the myths! This podcast and the journal club answer the following questions:
Irrigate and abscess: yes or no?
Pack an abscess: yes or no?
Antibiotics for an abscess: yes or no?
Ultrasound an abscess: yes or no?
Inject lido or lido/tetra patch: which is better?
With the usual tangential flight of ideas that accompanies these ‘casts – such as what was buffered lidocaine and why don’t we bother using it anymore?

Here are the articles – at the end is the study by Jerry Hoffman (okay so it was an abstract) that showed that buffered lidocaine was not worth much to the patient.

Chinnock, Brian et al. Irrigation of Cutaneous Abscesses Does Not Improve Treatment Success Annals of Emergency Medicine , Volume 67 , Issue 3 , 379 – 383

O’Malley et al Routine Packing of Simple Cutaneous Abscesses Is Painful and Probably Unnecessary Academic Emergency Medicine 2009; 16:470–473

Talan DA et al. Trimethoprim-Sulfamethoxazole versus Placebo for Uncomplicated Skin Abscess N Engl J Med. 2016 Mar 3;374(9):823-832.
Alsaawi et al. Ultrasonography for the diagnosis of patients with clinically suspected skin and soft tissue infections: a systematic review of the literature. Eur J Emerg Med 2015

Bourne et al Injectable lidocaine provides similar analgesia compared to transdermal lidocaine/tetracaine patch for the incision & drainage of skin abscesses: A randomized, controlled trial J Emerg Med. 2014 Sep;47(3):367-71

Tornay et al Heated versus buffered lidocaine and the pain on local injection: A comparative study Annals of Emergency Medicine 1994 , Vol. 23, Issue 3, p629
Small study that showed most patients would not pay $2 for buffered lidocaine.  “Heating a solution of lidocaine with epinephrine reduces the pain of local injection, but buffering with bicarbonate is more effective in this regard. The value of this difference to the patient may be minimal”

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