PERITONSILLAR ABSCESS Flashcards
CRITICAL DDx
Angioedema
Bacterial Tracheitis
Diphtheria
Epiglottitis
Lemierre Syndrome
Ludwig Angina
Mononucleiosis
Peritonsillar Abscess
Retropharyngeal Abscess
Uvulitis
MANAGEMENT
PRIMARY SURVEY
AIRWAY
ASSESS for airway compromise:
Drooling
Muffled Voice
Stridor
Hypoxia
Tripod or sniffing positioning
Inability to speak
Swelling of the posterior oropharynx
Inability or unwillingness to lie flat
Position upright, head tilt / chin lift
SECURE Airway in patients with impending airway obstruction
Awake Intubation if Limited oral access
Fiberoptic Visualization > Video Laryngoscopy > Direct
Prepare for surgical airway PRIOR to non-surgical airway
INVESTIGATIONS
Clinical Diagnosis
CT Head and Neck with IV Contrast:
if diagnostic uncertainty, assess for complications or extent of Abscess
Ultrasound: intraoral or extraoral
STEROIDS
Dexamethasone 10 mg IV
OR
Methylprednisone 125 mg IV
ANTIBIOTICS: ADULT
Pip-Tazo 3.375 g IV q 6 hr
OR
Clindamycin 900 mg IV q 8 hr
OR
Amipicilin-Sulbactam 3 g IV q 6 hr
ANTIBIOTICS: PEDS
Ampicillin-sulbactam 50 mg/kg intravenous every 6 hours (maximum dose 3,000 mg)
Clindamycin 15 mg/kg intravenous every 8 hours (maximum dose 900 mg)
Piperacillin-tazobactam (dose by age):
Age 2 months to 9 months: 80 mg/kg/dose (based on piperacillin component) intravenous every 8 hours (maximum dose 3,000 mg piperacillin)
Age >9 months, children, and adolescents weighing <40 kg: 100 mg/kg/dose (based on piperacillin component) intravenous every 6 hours (maximum dose 4,000 mg piperacillin)
Children and adolescents weighing >40 kg: 4,500 mg piperacillin intravenous every 6 hours
ENT CONSULT
For further visualization/urgent nasopharyngeal scope/laryngoscopy in stable patients
NEEDLE ASPIRATION
22 Gauge Spinal Needle
Cut 1 cm off protective sheath
10 cm syringe
Anesthetic Spray
Laryngoscope (patient held)
Suction (patient held)
Aim for Superior Pole -> Middle Pole -> Inferior Pole
1 cm down an 1 cm in
INCISION AND DRAINAGE
U/S to confirm depth
Rectract blade to desired depth
Horizontal incision at mid to upper pole
OUTPATIENT ANTIBIOTICS
Amoxicillin-clavulanate 875 mg PO q 12 hours
OR
Clindamycin 300 mg PO q 6-8 hours
10 to 14 days
DOCUMENTATION
HISTORY: ASK ABOUT
sore throat
fever
malaise
odynophagia
voice change
Unilateral Neck Swelling
a/w
Pooling of saliva
Trismus (up to 2/3 of patients)
PHYSICAL: ASSESS FOR
Drooling
Muffled Voice
Stridor
Hypoxia
Sniffing Position
Trismus
Unilateral tonsillary Swelling
Contralateral uvular deviation
