Who’s to Blame for MRSA?
Brady Pregerson, MD & Rebekah Child | Scrubs Magazine
Once again, the dynamic ER duo Dr. Brady Pregerson and Nurse Rebekah Child are back and ready to compare notes on the superbug MRSA. But first, they release some of the tension surrounding this very serious issue with a frank and open discussion on the experience of treating ‘abscess al Kahuna.’
Is MRSA the most repulsive epidemic to find its way into the ER? Or is treating the nasty bump a perversely spectacular highlight of patient care?
Between our ER doc, Brady Pregerson, and our sassy nurse, Rebekah Child, they talk about the causes of MRSA, remind us of the seriousness and scope of the MRSA problem, and give some easy tips for nurses to help fight the spread of this nasty epidemic.
RN: So I was at the gym today (finally a day off!), and I was half watching the Oprah show and half watching this really sweaty guy because I thought he was going to fall off the treadmill and code. (Side note: Please, people, if you haven’t been to the gym since 2003, for the sake of us medical personnel, don’t go full blast on your first time out. You’re just giving all of us angina.). The topic of Oprah’s discussion was MRSA, and the more I thought about the perils of MRSA and the more I watched Mr. I’m-Gonna-Lose-70-Pounds-Today, who was sweating his own saltwater pool, the more I was reminded of my first encounter with an MRSA patient a number of years ago.
She was a young girl who was an avid spinner, and couldn’t attend her favorite gym class of late due to this ever-growing, ever-painful red lump on her right buttock. So she came to the ED, and lo and behold, it was a pretty good-size abscess. When the doc injected the lidocaine, it was just enough to release some much pent-up pressure. There, from this young girl’s haunches, sprung forth a fountain of blood and pus similar to the fountains at The Bellagio, but without the obvious beauty and background vocals of Celine Dion and Andrea Bocelli. An obsession was born.
MD: Ew, I hate this stuff. I guess some people like to watch the stuff drain, but honestly, the stuff is stinky and awful. What’s more, I hate to have to drain an abscess, because even though I know I’m helping the patient, I have to be cruel to be kind. I always give some morphine or dilaudid first unless they have to drive home, but that injection still hurts. You nurses are lucky here. You don’t have to inject the lidocaine (it burns) and you can stand a few feet back from the bubbling pus.
RN: Yes, the lido burns, but put a little neut in it! I still don’t understand why this isn’t done all the time. I have since become what I like to call an abscess aficionado. I can usually tell by the amount of pus and the smell whether it is MRSA or not. I have a hard and fast rule: No doc is allowed to I&D my patients without my presence because it’s like missing the opening act of the Academy Awards—the best part!
MD: When I treat a patient for an abscess, it’s definitely a teachable moment. They never want to have to come back for another I&D. So I tell them how they can avoid this in the future: Keep clean, shower often and never pick or squeeze anything unless you wash your hands immediately beforehand and immediately afterward. People just don’t understand how dirty their hands and fingernails are. Even with no visible dirt, per se, Staph aureus is lurking around every corner.