How to Drain an Abscess, by Lonestar Doc

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Most of us have heard of them and many of us have had to creep surreptitiously to the nearest emergency room to have one drained. In a TEOTWAWKI situation, someone is going to have to do the dirty deed and take care of the darn thing. This is a short description on how to try to fix an abscess and to determine when do you really need to break into the antibiotic storage? I must warn you you up front, do not do this if there is any other option. If there is medical care available, they are the ones who do this. If this is a SHTF situation and you are on your own for who knows how long, this just might be something you need to know. I do not take any responsibility for those cowboys out there who jump in and do this when there is perfectly good medical care available. This is a survival blog and this should only be undertaken in a survival situation. Never should you practice medicine without a license. If the country/world collapses and there is no doctor or other medical resource, this is general medical information if this particular health problem arises. Proceed at your own risk .

Skin abscesses have become epidemic in this country. Go to any football locker room and you will see one or two with evidence of a previous abscess. What is it you ask? It is a collection of pus and bacteria and “inflammatory fluids” all collected in a space in the skin or under the skin. Yes, you can get an abscess deep inside, but unless you have previous medical training, you will not be able to get to those. And realistically, even those with previous medical training will have a hard time, without all the bells and whistles, getting to a deep abscess.  This short essay will help you deal with a skin abscess in a survival situation. Realize, this is simply for a survival scenario. If there is medical care available, you need to take advantage of their knowledge and skill set, but if not, pus under pressure needs to be opened up.

Most abscesses we see on or in the skin are caused by a few skin bacteria that normally live there and are given the opportunity by way of a small skin tear or nick to set up an infection. The first few days, it starts to grow and although it may start out as a pimple, it soon grows to a hard, red, hot lump that is very painful… It may even be surrounded by an area of redness; cellulitis in the medical parlance. The person sporting the lump may actually start to run a temperature and feel lousy.

One of the most common abscess forming bacteria we see nowadays is Staph aureus.  This bacterium comes in two varieties: Methicillin resistant “MRSA” and Methicillin Sensitive: “MSSA”.  The methicillin part refers to the bacteria’s character in response to a specific antibiotic. MRSA is the dreaded acronym everyone hears about from football teams to surgery suites. Although it is a bacterium you may associate with abscess, there are many more bacteria that can cause the furuncle or boil or “risin” (my personal favorite) that you see on your body. Whether the bug is MRSA or not, the treatment is the same and that is to open up the pus pocket, irrigate it out and then decide, do I really need antibiotics for this or not? Most of us will be hoarding our precious antibiotic supply in a SHTF situation and there are really good reasons for not breaking into an antibiotic supply for abscesses. 

Diabetics with immune systems that do not work so well are a special challenge. They often get an abscess that has multiple bacteria (polymicrobial) and in their particular situation, any infection is potentially life threatening. I don’t have an answer for this, in a SHTF situation. Even with modern medicine, diabetics lose feet and legs at an alarming rate from simple injuries like stepping on a needle or rubbing a blister on their heel. They can also get a rapidly moving infection that looks like an abscess and progresses in a few hours to a full blown septic shock that would be untreatable in a disaster situation.

So, you discover an abscess on one of your survival mate’s body, or they bring it to your attention or “Ruh row” (as Scooby so fondly says), you get one. The first decision is: do I need to open this up?  Not all lumps are abscesses. One of the giveaways is pus or purulent fluid draining from the lump.  If there is “pus in der”, you can be almost sure you have an abscess. Be sure to get a history about a possible foreign body like a sliver or shrapnel or thorn, etc. If there is pus, try to delineate the margins of swelling (we call it induration) and push lightly on the lump to see if it feels “boggy”. That is a sign that there is still inflammatory fluid, white cells and bacteria collected in a little lake under there.

The next decision is can I drain this? The biggest deterrent to drainage is what is under the abscess. I say this to caution you that if you go cutting into someone’s abscess, you better have an idea of what is under the thing and how deep can you go  without cutting any big blood vessels, nerves or structures your friend may need to pick up and get outta Dodge…

Have a medical book with you that show you what the underlying anatomy is. Frank Netter Anatomy is a great set of books to have where there is no doctor, but they are expensive and heavy. Look for a little anatomy book on Amazon or some other bookstore to keep with your medical supplies.  Just a note, Gray’s Anatomy is the book that seems to jump to mind for lay persons…I do not find that particular book very helpful. [JWR's Adds: Here I should mention that the widely-available "Classic Collector's Edition" reprint of the 1901 edition of Gray's Anatomy is practically useless. It has sparse illustrations and the terminology is out-dated. I second the recommendation for Frank Netter Anatomy.] Browse a few books at the library or a medical library before the SHTF to find a book you can understand and find stuff in.

There are a few places where I don’t even cut, (e.g.: near an eye, around the anus or on the fingers), but if there is no other option and no hope of another option (emergency room or doctor) because the world fell apart, I would try at least to drain it with a large bore needle (like a 16 or 18 gauge needle) even if I would not frankly cut into it.

So, you have identified an abscess, you know it is not overlying any high price real estate like a carotid artery (look that up in your anatomy book-good practice for finding stuff in it) and it is red, hot, swollen , boggy and painful. Remember I said, not all lumps are abscesses, so be careful…Once you have identified it, put on some of your medical gloves and take about 4 ml of lidocaine from your stock supply and ask the patient if they are allergic to lidocaine or any other anesthetic. If they tell you “no”, then  clean the overlying skin off with your medical antiseptic ( chlorhexidine swab, iodine swab or alcohol), use a 27-gauge needle to  inject right under the skin, a line of lidocaine that welts up like a little road across the middle of the boggy part of  the abscess. You need to stay pretty superficial and the line goes right across the top of the abscess. Should look like a little “trail” across the top. Once you inject enough to make a little wheal, then remove the needle and direct downward into the abscess being careful not to go too deep into the underlying structures. Inject the rest of the lidocaine into the area performing a “field block”. You can inject at 12 o'clock, 3 o’clock, 6 o’clock and 9 o’clock using about ½ ml. Wait for about 10 minutes. Then take a scalpel and cut through just the skin right along the little wheal you made with the first injection. Once you are through the skin, hopefully the pus comes pouring out as it is under some pressure in there filling up the little lake under the skin. You can take a Q-tip and gently move around the pocket to break up little pockets in the abscess and then take a big syringe and fill with clean tap or purified water and wash out the wound like you would wash out the inside of a sink with the sprayer.  If the thing is bleeding, make sure you put direct pressure on it and hold that until the bleeding stops. Put several of your dressing bandages on top to soak up the rest of the stuff that will be draining out over the 24 hours or so.

Most newer information says you do not need to leave anything in the wound to keep the skin open. Once drained you need to decide, do I give antibiotics? The answer is no. Drainage is the treatment for abscesses. Antibiotics do not do anymore than drainage does so save them for someone who needs them because they will be really hard to come by in TEOTWAWKI.

Again, don’t cut any patient on the hand, right around the anus or near an eye. Barter with a doctor or medic to help you with that if there is one in the area. They have a better idea of what the stakes are if it is in a high rent district like that…..

If you were able to drain this effectively, the wound should start to look less red and swollen by the next day. The hardness (induration) should also start to get better. Once the pressure is taken off the surrounding skin by drainage, the person should also get some relief immediately once it is drained. Tell the patient to keep it covered while the residual pus drains out and to try to wash it twice a day in a stream of water that is clean or purified. You don’t need sterile water, but you don’t want to introduce a bunch of other dirty bacteria into the wound you just drained and irrigated.

Disclaimers: Remember, this is not to be used in the country we live in, on the present day. You cannot practice medicine without a license in this country or you could go to jail. If the SHTF, and there is no one around to get medical care from, you may have just learned a skill that can keep someone from getting really sick or dying.  This article does not constitute professional advice.  It is intended for general informational use only.   No doctor-patient relationship is implied nor otherwise established between the author and blog readers.

I am praying that you will never need to use this.

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This page contains a single entry by Jim Rawles published on December 8, 2011 10:54 PM.

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