The treatment of furuncles and carbuncles may include: Question 2 options: Cleansing with soap and water and using wet, hot compresses. Antibiotic agents. Surgical incision and drainage if lesion is mature. All of the above
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Use your ICD-10-CM and CPT to determine the accurate diagnosis and procedure codes. Note: E/M codes do not apply. HISTORY The patient is a 32-year-old male who presented with a red-colored, 2 cm conical-shaped nodule on the back of his neck. He claims it grew in size within the past 24 hours. He had a boil in the same spot 6 months ago and it required removal. Fluctuant was felt with palpation. Severe pain was noted with slight pressure. He denies a history of diabetes mellitus or use of immunosuppressive drugs. Due to the excessive pain and reoccurrence of this furuncle, incision and drainage was recommended. PROCEDURE The patient signed the consent form and was taken to the procedure room. Using sterile technique, the posterior neck was prepped, draped and anesthetized with 1% lidocaine. The lesion was lanced resulting in rapid resolution and reduction of pain. Pressure was held on the site with minimal bleeding noted. Betadine ointment was applied, and it was then covered with gauze and secured with tape. A sample of the fluid was sent to the laboratory. The patient will return in 3-5 days for a wound check.
Shu N.
Tony found it humorous that his "gooey zits" got quick attention at an ED known for its long wait times. Dr. Bergmann, an infectious disease physician, examined Tony, noting heat, extreme erythema, folliculitis, 15 boils ~1-2 cm in diameter, some draining copious amounts of pus, and numerous seeping ulcerations. Dr. Bergmann applied a topical anesthetic before lancing several boils for culture. He ordered four sets of blood cultures drawn, started broad spectrum IV antibiotics, and immediately scheduled Tony for surgical debridement of his infection. 8. Why did the doctor lance boil to collect a specimen for culture when many others were already draining pus? 9. Why did Dr. Bergmann start Tony on antibiotics even though he didn't know the microbe involved or its drug sensitivity? 10. Why were blood cultures ordered? 11. Why was Tony a candidate for immediate surgery? Tom and Julia sat for about an hour in the waiting room before Dr. Bergmann arrived with an update on Tony's condition. Preliminary Gram stain results from the lab confirmed Gram-positive clusters of cocci in Tony's boils. Due to the extensive tissue damage, Dr. Bergmann confided to the family that he suspected community acquired-MRSA. Although Tony was "resting uncomfortably," the surgical debridement of a 3.5 cm * 10 cm area was a success. Tony would receive a three-week course of IV vancomycin before being permitted to return to work. 12. What common skin microbes demonstrate this Gram morphology and staining? 13. What does MRSA stand for? 14. What is the difference between community acquired-MRSA and hospital acquired-MRSA? 15. How does the resistance demonstrated by this organism differ from the resistance it typically shows to penicillin? 16. Why is vancomycin a good treatment choice when penicillin and methicillin are ineffective? 17. What complications are associated with IV vancomycin treatment? 18. Tony's infection progressed rapidly and resulted in substantial soft tissue damage. Why is MRSA able to cause this problem?
Adi S.
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