Throat Flashcards
GENERAL management of the ‘dodgy’ sore throat:
ENT/Anos. Consider prophylactic airway EARLY, and ideally in OT.
—> Awake fibreoptic
—> Tube size down
…But set up for emergency tube/cric in ED.
Don’t instrument. Position of comfort.
Nebulised adrenaline 5ml 1:1000
Dexamethasone 0.6mgkg IV (10mg)
Antibiotics
–> Augmentin for quinsy, retroP. BenPen+Metro for Ludwig. Ceftriaxone for epiglottitis.
CT head/neck with contrast
May need tube to tolerate
Red Flags in sore throat:
Tripodding
Torticollis
Trismus
Drooling
Stridor
Dysphonia
Dyspnoea
What are the DANGEROUS causes of sore throat:
Quinsy (peritonsillar abscess)
Retropharyngeal abscess
Ludwig angina
Bacterial tracheitis
Epiglottitis
Diptheria
Foreign body
Lemierre
What are the dangerous COMPLICATIONS of sore throat:
Deep space:
- Peritonsillar/ retropharyngeal
- Ludwig
Erosive spread
- Carotids
- Cervical spine
Mediastinitis
Cavernous sinus thrombosis
Lemierre (septic thrombophleb IV)
Airway compromise
Sepsis
Compare and contrast important causes of sore throat:
How to test for Strep A tonsillopharyngitis:
Rapid antigen test from throat swab
Result within minutes.
Or, swab and PCR.
What is the role of antibiotics in simple tonsillopharyngitis?
Majority of tonsillitis/ pharyngitis will get better in 3-4 days regardless, even if it is Strep A.
Phenoxy is given to prevent suppurative and non-suppurative GAS sequelae. But this is only necessary in at-risk patients.
- Age 2 - 25 in community with high incidence rheumatic fever (ATSI)
- Known rheumatic heart disease
- Scarlet fever
Phenoxy may also reduce duration of illness…… by half a day, for 1 in 9 patients. (Outweighed by GI upset, rash already)
________________
SUPP SEQUELAE
- Toxic shock
- Scarlet fever
- Local: nec fasc, OM, septic arthritis, bacteraemia etc.
NONSUPP SEQUELAE
- Rheumatic fever
- Strep A glomerulonephritis
What antibiotics are given (when indicated) for tonsillitis:
Mild: PHENOXYMETHYLPENICILLIN 15mg/kg (500mg) BD for 10 days
Worse: BENPEN
Xray findings in epiglottitis:
“Thumb sign”
“Steeple sign”
–> Tapering of upper trachea (subglottic)
- Croup
- Tracheitis
Ludwig’s Angina:
Purulent cellulitis of SUBLINGUAL and SUBMANDIBULAR spaces
–> Airway risk
–> Mediastinitis
–> Sepsis
70% odontogenic, but any oral/oropharynx source
OE
- Swollen neck
- Trismus
- Elevated/protruding tongue
- ‘Hot potato voice’
- UAO/ resp distress
Mx
- Sit up
- Awake fibreoptic/ tracheostomy
- Dexamethasone IV
- BenPen + Metro
- Needle aspiration or I&D of space (frank pus)
8% mortality even with proper Tx!
What is Lemierre Syndrome?
Complication of oropharyngeal infections (fusobacterium)
Septic thrombophlebitis of IJVs
Propagate up into cav sinus/ brain, down into subclavian.
When does post-tonsillectomy bleed occur?
Primary: day 1
Secondary: 5-10 days post-op
(clot begins to lift)*
Management of post-tonsillectomy bleed:
Set up for a difficult airway, but try not to intubate- will be difficult +++
- Sit up, lean forward
- Optimise view by suctioning clot out, then cophenylcaine spray
-
Direct lateral pressure
–> TXA/ adrenaline/lignocaine soaked gauze packs in McGills forceps
–> Ketamine to tolerate (0.5-1) - ANTIEMETICS (vomit will interrupt haemostasis)
Intubation approach in post-tonsillectomy bleed:
- Anaesthetics back up!
- 2x large bore suction
- Direct laryngoscopy (optimise with bougie/BURP)
- AWAKE ideal. Low dose induction in haemorrhaging patient:
–> Ketamine or fentanyl - NGT immediately after (decompress blood)
- Concurrent haemostatic resus
