0071643192.pdf

HEAD, EYE, EAR, NOSE, AND THROAT

EMERGENCIES

SYMPTOMS/EXAM

■ Brawny induration of the floor of the mouth (classic)

■ Bilateral swelling

■ Pain, edema, trismus, and drooling

■ Dysphonia and dysphagia

■ Tongue displaces posteriorly and superiorly, which may cause airway com-

promise.

■ Fever, toxic appearance

DIAGNOSIS

■ Clinical

■ Consider later neck X-ray or CT with IV contrast, if uncertain.

TREATMENT

■ ABCs, as always!

■ ICU admission

■ IV antibiotics (PCN or cephalosporin plus clindamycin)

■ ENT consult: Incision and drainage for patients with abscess and impend-

ing complication or failure to respond to antibiotics

COMPLICATIONS

■ Airway obstruction

■ Extension of infection may occur, resulting in mediastinitis, intracranial

infection, or IJ thrombophlebitis.

Pharyngitis

ETIOLOGY

Most commonly viral, group A strep (Streptococcus pyogenes) is the most

common bacterial cause.

SYMPTOMS/EXAM

■ Strep score (also known as Centor criteria) is a clinical rule to predict the

probability of group A strep as cause of pharyngitis.

■ Tonsillar exudates

■ Anterior cervical adenopathy

■ Fever

■ Absence of cough

TREATMENT

■ Various approaches have been described to decide on the use of antibi-

otics, including treating all patients with Centor scores of 3 or 4, or the

combination of the Centor score and results of rapid strep testing.

■ If thought to be bacterial, treat with PCN, cefuroxime, or erythromycin in

PCN allergic patients.

■ If viral only supportive care, which may include salt warm water gargles

and NSAIDs

■ A single dose of dexamethasone, 10 mg IM or PO, has been shown to reduce

symptoms in patients receiving simultaneous treatment for strep throat.