bigredBack in September of 2009 Michelle shared valuable Tricks of The Trade regarding drainage of peritonsillar abscesses. Today we revisit the topic and add two more tricks to avoid hitting “big red” a.k.a. the internal carotid artery.

Numero Uno: Don’t go in blind!

Ultrasound is a great adjunct in the diagnosis and treatment of skin and soft tissue infections. For PTA, after local anesthesia of the pharynx, the endocavitary probe a.k.a. transvaginal probe can be used to view the size and relationship of the abscess in question and the internal carotid artery.

peritonsillar abscess ultrasound

Numero Dos: Use a rubber bumper

In order to access the deep narrow cavity of the mouth without obscuring your many recommend a 3.5 inch 18-G spinal needle. An alternative to trimming the plastic sheath of the needle is to replace it all together with a rubber bumper- the top of a lavander-top-tube.



Demian Szyld is an Emergency Physician in Boston, MA and a guest blogger at Academic Life in Emergency Medicine.

Acknowledgments: I want to thank Suraj Puttanniah who told me that about the rubber bumper trick. He in turn heard it from our legendary attending David Gaieski. The US image is credited to Michael Blaivas, MD and can be found at


Demian Szyld, MD EdM

Demian Szyld, MD EdM

ALiEM Guest Contributor
Associate Medical Director
New York Simulation Center for the Health Sciences
New York University Langone Medical Center and City University of New York
Demian Szyld, MD EdM

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