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Auricular hematoma, shown below, is a complication that results from direct trauma to the anterior auricle and is a common facial injury in wrestlers.[1, 2, 3] Shearing forces to the anterior auricle can lead to separation of the anterior auricular perichondrium from the underlying, tightly adherent cartilage.
The torn perichondrial vessels compromise the viability of the avascular underlying cartilage.
The goal of treatment is to completely evacuate subperichondrial blood and to prevent its reaccumulation.
The auricle and external acoustic meatus (or external auditory canal) compose the external ear.
The arterial supply of the auricle is composed of the posterior auricular artery, the anterior auricular branch of the superficial temporal artery, and the occipital artery, which also contributes.
Presentation within 7 days after trauma (After 7 days, the formation of granulation tissue may complicate the procedure. Local anesthesia with lidocaine 1% with or without epinephrine can be infiltrated directly into the area to be incised.
Many authors advocate the use of the lidocaine without the presence of a vasoconstrictive agent such as epinephrine. Cleanse the skin with povidone iodine, ChloraPrep (chlorhexidine gluconate 2% and isopropyl alcohol 70%), or another cleanser. Although still widely used, this method is no longer recommended by many sources because of hematoma reaccumulation. Gently separate the skin and perichondrium from the hematoma and cartilage and completely express or suction out the hematoma, as shown below. Compression dressing can be applied noninvasively (more applicable in the ED) or surgically.
Surgical dressing involves securing cotton bolsters, buttons, or thermoplastic splints[8] with through and through sutures to the medial and lateral aspects of the auricle.
Fill all external auricular crevices with either moist gauze (soaked in saline) or Vaseline gauze, as depicted in the image below. Bandage the fluffed gauze into place with Kling or an elastic bandage, as shown in the image below. Specialized compression dressings, such as a silicone splint or dental rolls sewn onto the anterior and posterior pinna, can also be made, though such dressings are normally prepared and applied by a specialist.
Aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), or anticoagulants should be discontinued or avoided for several days to prevent continuing bleeding.
Recommendations indicate that, upon discharge, patients should receive antibiotics that cover common skin flora for 7-10 days. Pseudomonas species are discovered during follow-up, the patient should be admitted to the hospital for open drainage and intravenous antibiotics. The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Moira Davenport, MD, Christopher McStay, MD, Beno Oppenheimer, MD, and Linda Regan, MD, to the development and writing of this article. Medscape's clinical reference is the most authoritative and accessible point-of-care medical reference for physicians and healthcare professionals, available online and via all major mobile devices. The clinical information represents the expertise and practical knowledge of top physicians and pharmacists from leading academic medical centers in the United States and worldwide. More than 6000 evidence-based and physician-reviewed disease and condition articles are organized to rapidly and comprehensively answer clinical questions and to provide in-depth information in support of diagnosis, treatment, and other clinical decision-making. More than 1000 clinical procedure articles provide clear, step-by-step instructions and include instructional videos and images to allow clinicians to master the newest techniques or to improve their skills in procedures they have performed previously. More than 100 anatomy articles feature clinical images and diagrams of the human body's major systems and organs.



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At Jail Medicine we discuss all aspects of medicines practiced in today's jails, prisons and juvenile facilities.
This entry was posted in Dermatology, Infectious Disease, Medical Practice, Procedures and tagged Abscess, correctional medicine, evidence based medicine, Incision and drainage, inmates, jail medicine, jails, MRSA, prisons on December 9, 2012 by Jeffery Keller MD. They did come into our jail 3 different times and do in-services and I can give you a contact phone number if you like. The best approach if you recognise an epidermal inclusion cyst early is to make a large enough incision and remove the entire cyst bluntly without opening it. Fairly often an abscess will not drain any significant amount of pus (not ripe.) If not very large, this is often best handled by excising the indurated area entirely, even suturing closed after irrigation.
Suturing requires a clinical judgement that there is no offending material that could be retained. The symptoms of an ear infection in adults include earache (either a sharp, sudden pain or a dull, continuous pain), a sharp stabbing pain with immediate warm drainage from the ear canal, a feeling of fullness in the ear, nausea, muffled hearing and ear drainage.
While the most common type of infection is an acute minor inflammation of the inner ear, sometimes, if left untreated, even these little infections can turn into something much more serious such as mastoiditis or meningitis. If a child, or even an adult for that matter, shows certain symptoms such as a stiff neck, fever, nausea and vomiting, severe headaches, and dizziness, immediate action should be taken, as these are all signs of meningitis. No matter the situation, an ear infection is not usually anything to fret about; but, if there is any doubt that something serious may be occurring, seek medical attention right away. This may lead to tearing of the perichondrial blood vessels and subsequent hematoma formation. The external ear functions to collect and amplify sound, which then gets transmitted to the middle ear. However, some literature supports the safety of vasoconstrictive agents in areas such as the nose or pinna. The aspiration is often inadequate and the hematoma requires additional management.[7] Some sources recommend primary needle aspiration followed by the incision method, if reaccumulation occurs. Noninvasive methods include a simple compression dressing or, if available, application of silicone splints or plaster mold to the medial and lateral aspects of the auricle, as shown below. Prior to placement, cut out a V-shaped section of gauze so that the gauze fits snugly behind the ear, as shown below. A technique to treat wrestlers' auricular hematoma without interrupting training or competition.


A novel technique for treating auricular hematomas in mixed martial artists (ultimate fighters).
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There is a large body of literature that says antibiotics should not be routinely prescribed for MRSA abscesses as long as they can be fully drained and as long as the patient is otherwise healthy and there is no accompanying cellulitis.  This patient is healthy and I see no cellulitis surrounding the abscess, so I am not going to use antibiotics. National Library of Medicine, “ear infections are one of the most common reasons parents take their children to the doctor.” These infections can range from small, non-threatening cases to extremely serious and possibly even fatal ones. In children, the symptoms include tugging at the ear, poor sleep, fever, irritability, restlessness, ear discharge, reduced appetite and crying at night when lying down.
The mastoid bone, which sits behind the ear, consists of air spaces that help drain the middle ear.
If a person exhibits these signs, he or she should be brought to an emergency department for further examination. If you have concerns about ear infection symptoms contact your local doctor who will arrange for you to see an ear nose throat specialist. The asymmetric shape of the external auricle introduces delays in the path of sound that assist in sound localization. Customize your Medscape account with the health plans you accept, so that the information you need is saved and ready every time you look up a drug on our site or in the Medscape app. The demo was great but what was most impressive was the marriage of rationale blending so well. If we leave the incision as it is will microbes get into the area and cause re linfection ?
When the mastoid cells become infected or inflamed, often as a result of a middle ear infection (otitis media), mastoiditis can develop. Though viral meningitis is typically not fatal, the bacterial type will often cause permanent hearing loss when not treated promptly. Easily compare tier status for drugs in the same class when considering an alternative drug for your patient.
In acute mastoiditis, infection may spread outside of the mastoid bone and cause serious health complications. If you are nervous about making the incision to big or don’t feel comfortable with the blade, you simply push and twist until you feel a pop just under the skin (or pus starts pouring out). If you still not sure your getting enough drainage you can always make an incision over the top of it.




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