A diagnosis of cellulitis with abscess was made based on history, exam, and ultrasound findings. The patient was treated with incision and drainage of the observed fluid collection, prescribed a 7-day course of doxycycline 100mg twice daily, and provided resources by a social worker and community health worker. The patient declined consultation with addiction medicine and was discharged with alcohol wipes, sterile water, hydrogen peroxide, sterile gauze, sterile needles, sterile syringes, directions to a supervised consumption facility.
Soft tissue infections represent a spectrum of disease. Some infections can be managed with observation and/or antibiotics in cases of simple cellulitis, but others may require management with incision and drainage or placement of a drain. Rapidly making decisions about soft tissue infection management is a frequent challenge for emergency medicine (EM) physicians made easier and more efficient with use of bedside ultrasound.
Specifically, ultrasound allows clinicians to answer important questions at the bedside with minimal delay when presented with a soft tissue infection.
Is there a fluid pocket that should be drained?
Is this a necrotizing infection by gas forming bacteria?
Is there a retained foreign body?
Does this infection extend to deep space?
Do I need cross sectional imaging and/or surgical consultation?
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