扁桃体周围脓肿切排

347

© Springer Science+Business Media New York 2016

L. Ganti (ed.), Atlas of Emergency Medicine Procedures , DOI 10.1007/978-1-4939-2507-0_59

I ncision and Drainage of Peritonsillar Abscess M elinda W .F ernandez and B obby K .D esai 59.1 I ndications • P eritonsillar abscess 59.2 C ontraindications

• A bsolute

–M alignancy –V ascular malformations • R elative

–P ediatric patient –S evere trismus –U ncooperative patient 59.3 M aterials and Medications • #11 or #15 scalpel • 27-gauge 1.5-inch needle, 18- to 20-gauge 1.5-inch or longer needle • 5-mL syringe, 10- to 20-mL syringe • T ape • T rauma shears • V iscous lidocaine • L idocaine 1 % with epinephrine • L aryngoscope with MAC 3 or 4 o r tongue blade(s) and headlamp or other light source • S uction setup with Frazier or tonsil suction tip 59.4 P rocedure: Aspiration

1. I nformed consent may be required.

2. R aise head of bed to at least 60° and place a pillow or

other support behind the patient’s head. 3. P repare an 18- to 20-gauge 1.5-inch needle on a 10- to 20-mL syringe with a needle guard.• T his can be accomplished by using trauma shears to cut 1–1.5 cm off the distal plastic needle cover and replacing the cover over the needle. • T his now creates a guard to prevent deep penetration into vascular structures (Fig. 59.1).

4. T opically anesthetize area with viscous lidocaine (alterna-tively, can use Cetacaine [benzocaine, tetracaine hydro-chloride, and butamben] spray)

5. U sing lidocaine 1 % with epinephrine and a 27-gauge

1.5-inch needle on a 5-mL syringe, infi ltrate 1–2 mL

into the area. Blanching should be apparent.

6. P alpate the oropharynx with the gloved fi nger to evalu-ate for fluctuance.

7. A ssemble a MAC 3 or 4 intubation blade on a laryngo-scope handle and open into the light-on position. Insert the blade into the patient’s mouth, and advance the blade as far posteriorly as possible without inducing gagging. Have the patient hold the laryngoscope handle. Alternatively, use a tongue blade and head lamp or other light source, but the laryngoscope technique allows for an unobstructed view of the area and the weight of the handle helps hold the patient’s mouth open.

8. U sing the previously prepared needle guard on the long

18- to 20-gauge needle on a 12-mL syringe, insert the needle into the most fl uctuant area (as determined from the previous examination), aspirating as the needle advances (Fig.

59.2 ). The most fl uctuant area will usu-ally be located in the superior pole of the tonsil.

• I t is very important to be careful not to angle the needle

laterally toward the carotid artery. Also remember, this is a peritonsillar abscess so do not aspirate the tonsil itself. M . W . F ernandez ,M D D epartment of Emergency Medicine , U niversity of Florida Health , G ainesville ,F L ,U SA e

-mail: mindyfernandez@ufl .edu B . K . D esai ,M D (*)

D epartment of Emergency Medicine , U niversity of Florida Health

Shands Hospital ,G ainesville ,F L ,U SA e -mail: bdesai@ufl

.edu

59