Page 100 - PJ MED OPS Handbook 8th Ed

Cellulitis/Cutaneous Abscess

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 Incision and Drainage (I&D) in the tactical set-
ting IF:
a. The abscess is clearly well demarcated and superficial.
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 fasciitis, a
life-threatening infection of the deeper tissues that should be treated and evacuated
5. Fluctuant (fluidy), tender, well-defined mass indicates abscess formation
Management:
1. Moxifloxacin (Avelox) 400mg PO daily for 10 days
2. OR Doxycycline 100mg tab 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 improvement 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 or into the “pointer” of the abscess, but no further
iv) Incision should be parallel to skin tension lines if possible
v) On initial treatment, leave wound open and pack with iodoform or dry sterile gauze. Sub-
sequent dressings, loosely pack the wound, leave gauze protruding to facilitate drainage,
wick the wound. DO NOT SUTURE THE SITE
b. Bandage site and perform wound checks daily
8. Treat per Pain Management Protocol

DISPOSITION:
1. Re-evaluate daily and watch for progression of erythema while on antibiotics.
2. Cellulitis in critical areas (head, neck, hand, joint involvement, perineal) requires Priority
evacuation.
3. Use of IV antibiotics requires Priority evacuation.

98 n Pararescue Medical Operations Handbook / 8th Edition