Peritonsillar Abscess

imagesClinical suspicion


   imagesSwollen/red peritonsillar region causing uvular shift


   imagesFluctuance of area


imagesInterim treatment for peritonsillar closed space infection until tonsillectomy


CONTRAINDICATIONS



imagesExtension into the deep neck tissue


imagesSepticemia/toxic appearance


imagesAirway obstruction


imagesSevere trismus


imagesCoagulopathy



imagesGeneral Basic Steps


   imagesPatient preparation


   imagesAnalgesia


   imagesVisualization


   imagesNeedle aspiration/incision and drainage (I&D)


LANDMARKS



imagesSuperior lateral border of affected tonsil, or area of most fluctuance


imagesAspirate peritonsillar abscess’ (PTA’s) superior pole first, then middle pole, and finally the inferior pole (FIGURE 76.1)


TECHNIQUE



imagesPatient Preparation


   imagesCooperative patient sitting upright in a chair with occipital support


   imagesConsider intravenous analgesia or sedation


   imagesDigital exam key: Must feel abscess!


   imagesUse ultrasound (endocavitary probe) to assess volume, location, and relationship to the carotid artery (FIGURE 76.2)


imagesNeedle Aspiration


   imagesAnesthetize with benzocaine spray or have patient gargle viscous lidocaine


   imagesHave patient depress own tongue by holding laryngoscope, insert as you would for intubation. Patient will be less likely to trigger own gag reflex while pulling down on blade (FIGURE 76.3)


   imagesAnesthetize locally with 1 to 2 mL of 1% lidocaine via 27-gauge needle


   imagesUse a long spinal needle so visualization is not obscured by syringe


   imagesCut the distal 1 cm off of the needle cover and recap the needle, thereby preventing the needle from penetrating >1 cm (FIGURE 76.4)


   imagesInsert spinal needle at area of greatest fluctuance (usually the superior pole) and aspirate the pus



images


FIGURE 76.1 A: Peritonsillar abscess. The tonsil is displaced forward and inferomedial, the uvula is deviated toward the unaffected tonsil, and the soft palate is edematous and ruborous. B: Recommended sites for three-point needle aspiration of a peritonsillar abscess. (From Saladino RA. Pharyngeal procedures. In: Henretig FM, King C, eds. Textbook of Pediatric Emergency Procedures. Philadelphia, PA: Williams & Wilkins; 1997:692, 696, with permission.)

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Aug 9, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Peritonsillar Abscess
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