SORE THROAT Flashcards
MANAGEMENT
CRITICAL PATIENT:
Cardiac Monitor
Oxygen
Vitals
IV Access
Equipment: Airway
AIRWAY
Rapid Bedside Assessment:
Drooling
Voice change (hoarse, muffled, “hot potato”)
Stridor
Inability to speak
Tripod or sniffing positioning
Hypoxia
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 / Nasal Intubation if Limited oral access
Fiberoptic Visualization > Video Laryngoscopy > Direct
Prepare for surgical airway PRIOR to non-surgical airway
Serial Airway Assessment
Urgent ENT Consult for further visualization/urgent nasopharyngeal scope/laryngoscopy in stable patients
CIRCULATION
Bolus 30 ml / kg Crystalloid if needed
Broad spectrum antibiotics coverage for Staph, Strep, Anaerobes:
Abx: 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
Abx: Adults
Pip-Tazo 3.375 g IV q 6 hr
OR
Clindamycin 900 mg IV q 8 hr
Dexamethasone 0.6 mg/kg (10 mg) PO
OR
Methylprednisone 2-3mg / kg (125 mg)
CRITICAL DDX
Angioedema
Bacterial Tracheitis
Diphtheria
Epiglottitis
Lemierre Syndrome
Ludwig Angina
Mononucleiosis
Peritonsillar Abscess
Retropharyngeal Abscess
INVESTIGATIONS
+/- Basic Labs
+/- Blood Cultures
+/- Lactate
+/- Rapid Strep Test
+/- Monospot test
+/- Oral swab Gn / Cl
+/- CRP
+/- Lateral plain XRAY
+/- CT
Intraoral Ultrasound
Bedside nasopharyngoscopy
DOCUMENTATION
CRITICAL DDX:
Angioedema
Bacterial Tracheitis
Diphtheria
Epiglottitis
Lemierre Syndrome
Ludwig Angina
Mononucleiosis
Peritonsillar Abscess
Retropharyngeal Abscess
Uvulitis
HISTORY
Onset: rapid vs. slow. Rapid bad.
Progression: Increasing severity Odynophagia -> unable to swallow solids -> unable to swallow liquids -> unable to tolerate secretions
Trismus: difficulty opening mouth
Dyspnea
Change in voice
Difficulty Swallowing / Drooling
Pain with Neck ROM
Inability / Unwillingness to Lie Flat
Trauma to the neck or recent surgery
Medications: response to previous treatments. Exposure to ACEi.
Exposures: Strep, COVID, Mono, STI, allergic exposure
PMHx: Immunocompromise
PHYSICAL EXAM:
Fever
Work Of Breathing
Tripod Position
Drooling
Muffled Voice
Stridor
Torticollis
Oropharyngeal Erythema
Palate Petechia
Exudates
Uvular Swelling or deviation
Peritonsillar Swelling
Tongue Deviation
Swelling / Tenderness of the floor of the mouth
Thrush
Cervical LAD
Neck Stiffness
RED FLAGS:
Dyspnea
Difficulty Swallowing / Drooling
Muffled / Hoarse Voice
Neck Swelling
Pain with Neck ROM
Inability / Unwillingness to Lie Flat
Head Held Extended Forward
Pain out of Proportion with Exam
CENTOR CRITERIA
XRAY: RETROPHARYNGEAL ABSCESS
prevertebral space (the distance between the anterior border of the vertebral body and the air within the pharynx/trachea
a retropharyngeal space wider than 7 mm at C2 or wider than 14 mm (children) or 22 mm (adults) at C7 is abnormal
XRAY: EPIGLOTITTIS
Thumb print sign
Epiglottis width of >6.3 mm has a sensitivity of 75.8% and specificity of 97.8% for the diagnosis of acute epiglottitis
XRAY: BACTERIAL TRACEITIS
Subglottic narrowing with ragged tracheal epithelium
