Page 205 - ATP-P 11th Ed

CELLULITIS / CUTANEOUS ABSCESS PROTOCOL

SPECIAL CONSIDERATIONS
1. Superficial bacterial skin infection
2. Generally begins about 24 hours following a break in the skin, but more serious
types of cellulitis may be seen as early as 6–8 hours following animal or human
bites.
3. If abscess formation occurs, only attempt I&D in the tactical setting IF:
a. The abscess is clearly well demarcated, superficial, or can be discerned by SECTION 2
ultrasound.
b. Local anesthesia is available

Signs and Symptoms
1. Painful, erythematous, swollen, tender area
2. Fever may or may not be present.
3. Typically, erythema spreads without treatment.
4. Rapidly spreading and very painful infections suggest the possibility of necrotizing fas-
ciitis, a life-threatening infection of the deeper tissues that should be treated per Sepsis/
Septic Shock Protocol.
5. Fluctuant, tender, well-defined mass indicates abscess formation.
Management
1. Moxifloxacin (Avelox ) 400mg PO daily for 10 days OR amoxicillin/clavulanic
®
acid (Augmentin ) 875mg PO bid
®
2. PLUS EITHER trimethoprim-sulfamethoxazole (Septra ) DS 1 tab PO bid OR
®
rifampin (Rifadin ) 600mg PO bid for 10 days.
®
3. Clean and dress wound and surrounding area.
4. Use a pen to mark the demarcation border of the infection and re-evaluate in 24 hours.
5. Limit activity until infection resolves.
6. Add ertapenem (Invanz ) 1g IV/IM daily if worsening at 24 hours or no improve-
®
ment at 48 hours of treatment.
7. IF ABSCESS IS PRESENT:
a. Incise and drain (I&D) if the environment permits:
®
i. Establish sterile incision site with Betadine .
ii. Local anesthesia using lidocaine
iii. Incise the length of the abscess cavity, but no further.
iv. Incision should be parallel to skin tension lines if possible.

194 SECTION 2 TACTICAL MEDICAL EMERGENCY PROTOCOLS (TMEPs) ATP-P Handbook 11th Edition 195