Peritonsillar Abscess

Retropharyngeal Abscess

EMKF

  1. What is the differential for a sore throat?
  2. What would make you consider retropharyngeal abscess?
  3. What are the upper airway signs that signify an impaired airway (and the need to intubate)?
  4. How do you diagnose retropharyngeal abscess? 
  5. What is the management of a retropharyngeal abscess? 

 

Peritonsillar abscess aspiration technique

EMKF

Build a kit similar to the butterfly phlebotomy setup (above drawing).

  • Attach IV extension tubing to the spinal needle.
  • Attach the other end of the IV tubing to the syringe.
  • Ask the assistant to apply negative pressure on the syringe once you have penetrated the oral mucosal surface.
  • Now you can focus on just directing the needle to the appropriate area.

Owning the Quinsy (Peritonsillar abscess)

EMKF

Tonsillitis+labelled

‘Good’ symptoms for quinsy include:

  • ‘Thick’ or ‘hot potato’ voice (not hoarse, croaky voice)
  • Stertor
  • Trismus
  • Inability to swallow more than saliva or a sip or water
  • Pain much worse on one side than the other (+/- otalgia)

To differentiate it from tonsillitis, a quinsy will have many of the following signs:

  • There is usually a degree of trismus
  • On the affected side, the anterior arch will be pushed medially
  • On the affected side, the palate will bulge towards you ie the normally concave palate becomes convex
  • The uvula may or may not be pushed away from the affected side
  • On the affected side, the mucosa of the arch and palate may look angrily erythematous

A swollen tonsil is NOT a quinsy; a swollen tonsil is a swollen tonsil

 

 

How to drain a peritonsillar abscess in the ED…it’s not rocket science and your patient will love you for the pain relief