Building on my theme of combating odors in the Emergency Department (see Toxic Sock Syndrome), foul-smelling pus from large abscesses has got to be one of the most nauseating smells in the ED for me.
How can you minimize such odors?
- Prepare a Yankauer wall suction set up.
- Start by making only a small initial incision in the abscess, such that you can fit the Yankauer tip in the opening.
- Suction out as much of the pus into the closed suction canister as possible.
- Widen the incision and continue suctioning out the pus, as needed.
Basically you are moving the smell from one closed system (the abscess) into another closed system (wall canister).What tricks do you have to minimize odors when performing I+Ds of abscesses?
Ugh, I think from over the years in the ER, my sense of smell has been compromised. The worst for me? Probably pilonodal cysts. Thankfully, we now have residents who need to learn these I & D procedures, so that, I would say, is my best defense! LOL Oh, and some kind of menthol under the nose. Good post.
ReplyDeleteHa, that's hilarious that your defense is to have the resident get in close with the I+Ds.
ReplyDeleteI have found that residents (esp the tall ones) are great to stand behind while xrays are being taken in the resuscitation rooms. They have the lead aprons on. They are my "human irradiation shields". I duck a little for the short residents.
I always carry a tin of Carmex. Rub it on the upper lip and edge of nares. Works great. Have an attending who keeps a thing of Vicks VapoRub in his mailbox for the same purpose.
ReplyDeleteVapoRub and Carmex - great idea. I have also heard of placing coffee grounds near the patient's bedside. Not sure if that's a worthwhile endeavor.
ReplyDeleteYou can also wipe an alcohol swab or chapstick in the inside of a surgical mask before wearing it. You will only smell the alcohol fume or the chapstick smell.
ReplyDeleteStella: Do you mean alcohol swab, or just straight vodka? Just kidding. Great trick. Nice meeting you finally at CORD.
ReplyDelete- "The American Stella"
Michelle, I am not worthy. :>
ReplyDeleteMichelle,
ReplyDeleteIf you had received a truly complete medical training you would have no need for such inventive tricks of the trade...
'Dispel the Smell from Hell' at http://lifeinthefastlane.com/2010/03/dispell-the-smell-from-hell/
Chris ;-)
Wow, that's hard core, Chris.
ReplyDeleteWhile I mostly use the Yankauer trick above, I was taught a method of sticking several layers of blue chux below your working area, and whenever you express pus from the abscess, wrap it up tightly in the next chux down. I still use this for smaller abscesses I can't stick a Yankauer into (eg. hidradenitis, etc).
ReplyDeleteSteven DeFord - Is that you? Yes, those small abscesses don't cause as much of a stink. Chux are the way to go for smaller pus pockets.
ReplyDeleteI prefer to disperse the foul smell around the emergency department as much as possible. An audit at my institution shows that this greatly reduces overall ED lengths-of-stay... We may meet the 4 hour rule objectives yet!
ReplyDeleteC
@Chris: Too funny about actually SPREADING the odor instead of CONTAINING it! Spreading it may seem like a winning strategy at first, but it's you that actually loses.
ReplyDelete