Peritonsilar Abscess Drainage - Revision history

JenniferH: /* Technique */

2022-05-31T21:24:06Z

Technique

← Older revision		Revision as of 21:24, 31 May 2022
Line 4:		Line 4:

	===Technique===		===Technique===
	[[file:Peritonsillar_abscess_setup.jpg\|framed\|Supplies\|~~right~~]]		[[file:Peritonsillar_abscess_setup.jpg\|framed\|Supplies]]
			[[file:Peritonsillar_abscess_setup_cropped.jpg\|frame\|Close up of prepared needle]]
	*Due to the proximity of major vessels of the neck and the lack of vascular surgery at this facility, scalpel I&D of peritonsillar abscesses is ''not recommended'' at YKHC.		*Due to the proximity of major vessels of the neck and the lack of vascular surgery at this facility, scalpel I&D of peritonsillar abscesses is ''not recommended'' at YKHC.
	*Needle drainage is performed as follows (see supplies setup in image):		*Needle drainage is performed as follows (see supplies setup in image):
Line 15:		Line 16:
	*# Send any purulent fluid drained for culture to guide antibiotic management.		*# Send any purulent fluid drained for culture to guide antibiotic management.
	*There is typically scant bleeding following the procedure that resolves without intervention. Any persistent bleeding or concern for vascular trauma should be discussed immediately with ENT and vascular surgery.		*There is typically scant bleeding following the procedure that resolves without intervention. Any persistent bleeding or concern for vascular trauma should be discussed immediately with ENT and vascular surgery.

	~~[[file:Peritonsillar_abscess_setup_cropped.jpg\|frame\|Close up of prepared needle]]~~

	===Resources/References===		===Resources/References===

JenniferH: /* Technique */

2022-05-31T20:12:43Z

Technique

← Older revision		Revision as of 20:12, 31 May 2022
Line 4:		Line 4:

	===Technique===		===Technique===
	[[file:Peritonsillar_abscess_setup.jpg\|right]]		[[file:Peritonsillar_abscess_setup.jpg\|framed\|Supplies\|right]]
	*Due to the proximity of major vessels of the neck and the lack of vascular surgery at this facility, scalpel I&D of peritonsillar abscesses is ''not recommended'' at YKHC.		*Due to the proximity of major vessels of the neck and the lack of vascular surgery at this facility, scalpel I&D of peritonsillar abscesses is ''not recommended'' at YKHC.
	*Needle drainage is performed as follows (see supplies setup in image):		*Needle drainage is performed as follows (see supplies setup in image):
Line 15:		Line 15:
	*# Send any purulent fluid drained for culture to guide antibiotic management.		*# Send any purulent fluid drained for culture to guide antibiotic management.
	*There is typically scant bleeding following the procedure that resolves without intervention. Any persistent bleeding or concern for vascular trauma should be discussed immediately with ENT and vascular surgery.		*There is typically scant bleeding following the procedure that resolves without intervention. Any persistent bleeding or concern for vascular trauma should be discussed immediately with ENT and vascular surgery.

			[[file:Peritonsillar_abscess_setup_cropped.jpg\|frame\|Close up of prepared needle]]

	===Resources/References===		===Resources/References===

JenniferH: /* Technique */

2022-05-31T20:06:17Z

Technique

← Older revision		Revision as of 20:06, 31 May 2022
Line 4:		Line 4:

	===Technique===		===Technique===
			[[file:Peritonsillar_abscess_setup.jpg\|right]]
	*Due to the proximity of major vessels of the neck and the lack of vascular surgery at this facility, scalpel I&D of peritonsillar abscesses is ''not recommended'' at YKHC.		*Due to the proximity of major vessels of the neck and the lack of vascular surgery at this facility, scalpel I&D of peritonsillar abscesses is ''not recommended'' at YKHC.
	*Needle drainage is performed as follows (see supplies setup in image):		*Needle drainage is performed as follows (see supplies setup in image):
	~~[[file:Peritonsillar_abscess_setup.jpg\|right]]~~
	*#An 18 gauge 3 ½ inch spinal needle is prepared by removal of the trochar and cutting off 1 cm from the plastic sheath surrounding the needle.		*#An 18 gauge 3 ½ inch spinal needle is prepared by removal of the trochar and cutting off 1 cm from the plastic sheath surrounding the needle.
	*#Attach prepared 18 gauge needle to a 10-20 cc syringe.		*#Attach prepared 18 gauge needle to a 10-20 cc syringe.

JenniferH at 19:54, 31 May 2022

2022-05-31T19:54:46Z

← Older revision		Revision as of 19:54, 31 May 2022
Line 5:		Line 5:
	===Technique===		===Technique===
	*Due to the proximity of major vessels of the neck and the lack of vascular surgery at this facility, scalpel I&D of peritonsillar abscesses is ''not recommended'' at YKHC.		*Due to the proximity of major vessels of the neck and the lack of vascular surgery at this facility, scalpel I&D of peritonsillar abscesses is ''not recommended'' at YKHC.
	*Needle drainage is performed as follows (see supplies setup in image ~~below~~):		*Needle drainage is performed as follows (see supplies setup in image):
			[[file:Peritonsillar_abscess_setup.jpg\|right]]
	*#An 18 gauge 3 ½ inch spinal needle is prepared by removal of the trochar and cutting off 1 cm from the plastic sheath surrounding the needle.		*#An 18 gauge 3 ½ inch spinal needle is prepared by removal of the trochar and cutting off 1 cm from the plastic sheath surrounding the needle.
	*#Attach prepared 18 gauge needle to a 10-20 cc syringe.		*#Attach prepared 18 gauge needle to a 10-20 cc syringe.
Line 14:		Line 15:
	*# Send any purulent fluid drained for culture to guide antibiotic management.		*# Send any purulent fluid drained for culture to guide antibiotic management.
	*There is typically scant bleeding following the procedure that resolves without intervention. Any persistent bleeding or concern for vascular trauma should be discussed immediately with ENT and vascular surgery.		*There is typically scant bleeding following the procedure that resolves without intervention. Any persistent bleeding or concern for vascular trauma should be discussed immediately with ENT and vascular surgery.

	~~[[file:Peritonsillar_abscess_setup.jpg]]~~

	===Resources/References===		===Resources/References===

JenniferH: /* Resources/References */

2022-05-31T19:51:31Z

Resources/References

← Older revision		Revision as of 19:51, 31 May 2022
Line 18:		Line 18:

	===Resources/References===		===Resources/References===
	*Galioto NJ. [https://www.aafp.org/afp/2017/0415/p501.html\| Peritonsillar Abscess]. Am Fam Physician. 2017 Apr 15;95(8):501-506. PMID: 28409615.		*Galioto NJ. [https://www.aafp.org/afp/2017/0415/p501.html Peritonsillar Abscess]. Am Fam Physician. 2017 Apr 15;95(8):501-506. PMID: 28409615.
	*[[Peritonsillar Abscess]] (YKHC Common/Unique Diagnoses)		*[[Peritonsillar Abscess]] (YKHC Common/Unique Diagnoses)
	*[[media:Peritonsillar_abscess_guideline.pdf\|Peritonsillar Abscess Evaluation & Treatment YKHC Clinical Guideline]]		*[[media:Peritonsillar_abscess_guideline.pdf\|Peritonsillar Abscess Evaluation & Treatment YKHC Clinical Guideline]]

	[[Common ED Procedures]]		[[Common ED Procedures]]

JenniferH: /* Resources/References */

2022-05-31T19:50:16Z

Resources/References

← Older revision		Revision as of 19:50, 31 May 2022
Line 18:		Line 18:

	===Resources/References===		===Resources/References===
	*Galioto NJ. [https://www.aafp.org/afp/2017/0415/p501.html\| Peritonsillar Abscess.] Am Fam Physician. 2017 Apr 15;95(8):501-506. PMID: 28409615.		*Galioto NJ. [https://www.aafp.org/afp/2017/0415/p501.html\| Peritonsillar Abscess]. Am Fam Physician. 2017 Apr 15;95(8):501-506. PMID: 28409615.
	*[[Peritonsillar Abscess]] (YKHC Common/Unique Diagnoses)		*[[Peritonsillar Abscess]] (YKHC Common/Unique Diagnoses)
	*[[media:Peritonsillar_abscess_guideline.pdf\|Peritonsillar Abscess Evaluation & Treatment YKHC Clinical Guideline]]		*[[media:Peritonsillar_abscess_guideline.pdf\|Peritonsillar Abscess Evaluation & Treatment YKHC Clinical Guideline]]

	[[Common ED Procedures]]		[[Common ED Procedures]]

JenniferH: /* Resources/References */

2022-05-31T19:49:15Z

Resources/References

← Older revision		Revision as of 19:49, 31 May 2022
Line 18:		Line 18:

	===Resources/References===		===Resources/References===
	*Galioto NJ. [https://www.aafp.org/afp/2017/0415/p501.html\|Peritonsillar Abscess.] Am Fam Physician. 2017 Apr 15;95(8):501-506. PMID: 28409615.		*Galioto NJ. [https://www.aafp.org/afp/2017/0415/p501.html\| Peritonsillar Abscess.] Am Fam Physician. 2017 Apr 15;95(8):501-506. PMID: 28409615.
	*[[Peritonsillar Abscess]] (YKHC Common/Unique Diagnoses)		*[[Peritonsillar Abscess]] (YKHC Common/Unique Diagnoses)
	*[[media:Peritonsillar_abscess_guideline.pdf\|Peritonsillar Abscess Evaluation & Treatment YKHC Clinical Guideline]]		*[[media:Peritonsillar_abscess_guideline.pdf\|Peritonsillar Abscess Evaluation & Treatment YKHC Clinical Guideline]]

	[[Common ED Procedures]]		[[Common ED Procedures]]

JenniferH at 19:48, 31 May 2022

2022-05-31T19:48:56Z

← Older revision		Revision as of 19:48, 31 May 2022
Line 3:		Line 3:
	Peritonsillar abscess is an uncommon but not rare complication of bacterial pharyngitis and tonsillitis. It is distinguished from peritonsillar cellulitis by the presence of soft palate swelling and/or uvular deviation. If swelling is severe the airway can become impaired, thus peritonsillar abscess drainage is a vital skill. CT is not necessary to diagnose peritonsillar abscess though may be indicated to rule out deep space infection. Bedside US using a sheathed endocavitary (vaginal) probe may be used to assist in abscess localization, though is sometimes limited by trismus.		Peritonsillar abscess is an uncommon but not rare complication of bacterial pharyngitis and tonsillitis. It is distinguished from peritonsillar cellulitis by the presence of soft palate swelling and/or uvular deviation. If swelling is severe the airway can become impaired, thus peritonsillar abscess drainage is a vital skill. CT is not necessary to diagnose peritonsillar abscess though may be indicated to rule out deep space infection. Bedside US using a sheathed endocavitary (vaginal) probe may be used to assist in abscess localization, though is sometimes limited by trismus.

	~~[[file:Posterior_oropharynx.png\|right\|400px]]~~
	===Technique===		===Technique===
	*Due to the proximity of major vessels of the neck and the lack of vascular surgery at this facility, scalpel I&D of peritonsillar abscesses is ''not recommended'' at YKHC.		*Due to the proximity of major vessels of the neck and the lack of vascular surgery at this facility, scalpel I&D of peritonsillar abscesses is ''not recommended'' at YKHC.
Line 19:		Line 18:

	===Resources/References===		===Resources/References===
	*https://www.aafp.org/afp/2017/0415/p501.html		*Galioto NJ. [https://www.aafp.org/afp/2017/0415/p501.html\|Peritonsillar Abscess.] Am Fam Physician. 2017 Apr 15;95(8):501-506. PMID: 28409615.
	*[[Peritonsillar Abscess]] (YKHC Common/Unique Diagnoses)		*[[Peritonsillar Abscess]] (YKHC Common/Unique Diagnoses)
	*[[media:Peritonsillar_abscess_guideline.pdf\|Peritonsillar Abscess Evaluation & Treatment YKHC Clinical Guideline]]		*[[media:Peritonsillar_abscess_guideline.pdf\|Peritonsillar Abscess Evaluation & Treatment YKHC Clinical Guideline]]

	[[Common ED Procedures]]		[[Common ED Procedures]]

JenniferH at 17:57, 31 May 2022

2022-05-31T17:57:55Z

← Older revision		Revision as of 17:57, 31 May 2022
Line 6:		Line 6:
	===Technique===		===Technique===
	*Due to the proximity of major vessels of the neck and the lack of vascular surgery at this facility, scalpel I&D of peritonsillar abscesses is ''not recommended'' at YKHC.		*Due to the proximity of major vessels of the neck and the lack of vascular surgery at this facility, scalpel I&D of peritonsillar abscesses is ''not recommended'' at YKHC.
	*Needle drainage is performed as follows:		*Needle drainage is performed as follows (see supplies setup in image below):
	*#An 18 gauge 3 ½ inch spinal needle is prepared by removal of the trochar and cutting off 1 cm from the plastic sheath surrounding the needle.		*#An 18 gauge 3 ½ inch spinal needle is prepared by removal of the trochar and cutting off 1 cm from the plastic sheath surrounding the needle.
	*#Attach prepared 18 gauge needle to a 10-20 cc syringe.		*#Attach prepared 18 gauge needle to a 10-20 cc syringe.

JenniferH at 17:49, 31 May 2022

2022-05-31T17:49:40Z

← Older revision		Revision as of 17:49, 31 May 2022
Line 15:		Line 15:
	*# Send any purulent fluid drained for culture to guide antibiotic management.		*# Send any purulent fluid drained for culture to guide antibiotic management.
	*There is typically scant bleeding following the procedure that resolves without intervention. Any persistent bleeding or concern for vascular trauma should be discussed immediately with ENT and vascular surgery.		*There is typically scant bleeding following the procedure that resolves without intervention. Any persistent bleeding or concern for vascular trauma should be discussed immediately with ENT and vascular surgery.

			[[file:Peritonsillar_abscess_setup.jpg]]

	===Resources/References===		===Resources/References===