Trick: Peritonsillar abscess drainage 3.0 | All the steps with added variations

Peritonsillar abscess drainage pelvic speculum

A 25-year-old medical student comes in with a muffled voice, sore throat and trismus. You look at the back of her throat and you see the uvula deviated to the right. You astutely diagnosed a peritonsillar abscess (PTA). You consider aspirating and want to check for tips on how to successfully do this.

Dr. Michelle Lin and Dr. Demian Szyld have created great guides for the common and important emergency medicine procedure of draining a PTA (laryngoscope lighting and spinal needle for aspiration; ultrasound localization and spinal needle guard; avoiding awkward one-handed needle aspiration). This update reviews these tricks as well as some additional techniques for optimal success in draining a PTA, while avoiding the ultimate feared complication of puncturing the carotid artery.

(more…)

By Margaret Davis|2020-08-13T11:15:27-07:00Aug 9, 2019|ENT, Tricks of the Trade, Ultrasound|

Sore throat accounts for a whopping 7.3 million outpatient pediatric visits. Group A Streptococcus (GAS) accounts for 20-30% of pharyngitis cases with the rest being primarily viral in etiology. However, clinically differentiating viral versus bacterial causes of pharyngitis is difficult and we, as providers, often don’t get it right. In addition, antimicrobial resistance is increasing.. So who do we test and when do we treat for strep throat? The 2012 Infectious Diseases Society of America (IDSA) guideline on GAS pharyngitis helps answer these questions.

(more…)

By Shannon Flood, MD|2021-08-15T10:21:49-07:00Jul 15, 2019|ENT, Guideline Review, Infectious Disease, Pediatrics|

ACMT Toxicology Visual Pearls: Toxic Mouth Pain

A middle-aged Asian female presents to the emergency department complaining of 2-3 days of mouth pain. She has chewed betel nut for a number of years. Which of the following is true regarding her presentation and management?

Debridement should be avoided.
Metronidazole is contraindicated due to the potential of a disulfiram-like reaction.
Oral secretagogues should be used due to the anticholinergic effects.
The patient is at increased risk of oral cancer.

(more…)

By Heather A. Borek, MD|2019-11-12T19:05:57-08:00Aug 30, 2018|ACMT Visual Pearls, ENT, Tox & Medications|

ALiEM AIR Series: Ear, Nose, and Throat (ENT) Module

Welcome to the Ear, Nose, and Throat (ENT) Module! After carefully reviewing all relevant posts from the top 50 sites of the Social Media Index, the ALiEM AIR Team is proud to present the highest quality online content related to ENT emergencies. 8 blog posts within the past 12 months (as of December 2017) met our standard of online excellence and were curated and approved for residency training by the AIR Series Board. We identified 1 AIR and 7 Honorable Mentions. We recommend programs give 3 hours (about 20 minutes per article) of III credit for this module.
(more…)

By Andrew Grock, MD|2020-09-03T21:45:24-07:00Apr 12, 2018|ALiEMU, Approved Instructional Resources (AIR series), ENT|

PEM Pearls: Regional Facial Nerve Blocks

Regional nerve blocks of the face and ear can be a wonderful choice of analgesia in a child, particularly for wounds that need to be repaired. The benefits include fewer local injections, improved cosmesis due to less wound margin distortion, and improved analgesia within the nerve region.^1,2 The following blog post and brief video tutorial review the key elements of this technique.

(more…)

By Ashley Foster, MD|2018-01-21T21:11:01-08:00Jan 22, 2018|ENT, Pediatrics, PEM Pearls|

PEM Pearls: Search & Rescue of Ear Foreign Bodies – Picking the Right Tool

While ear foreign bodies can happen at any age, the majority occur in children less than 7 years of age.¹ The younger the patient, the less likely they are cooperative with the exam and, therefore, the less chance of successful foreign body removal. The first attempt at removal is the best, so it is important to make it count. Similarly, different types of foreign bodies call for different “tools” for removal. It is important to understand when to attempt removal in the emergency department (ED) and what tools are available. This blog post will help you optimize your first pass success at foreign body removal by understanding what tools are at your disposal.

(more…)

By Josh Bukowski, MD|2017-10-26T14:32:51-07:00May 8, 2017|ENT, Pediatrics, PEM Pearls|

Epistaxis Management in the Emergency Department: A Helpful Mnemonic

Epistaxis is a common presentation to the emergency department (ED)¹ that can be challenging and time consuming. Knowledge of the pearls, pitfalls, and troubleshooting tips around managing nosebleeds often can be the difference between a frustrating versus straightforward ED stay for patients. Use the EPISTAXIS mnemonic to help you remember these points.