- Peritonsillar abscess
- Strep Pharyngitis
- Otitis Media
- Progressive inflammation of the epiglottitis and surrounding supraglottic structures, potentially leading to airway compromise
- Typically occurs due to Haemophilus influenzae type B infection in unvaccinated children.
- Classically “3 D’s” (dysphagia, drooling, respiratory distress)
- Other symptoms include fever, inspiratory stridor, cough
- Lateral neck X-ray (will show “thumbprint” sign, indicating enlarged epiglottis)
- Airway management (consider early intubation). Consult ENT
- IV antibiotics (Ceftriaxone +/- MRSA coverage)
*Deep Dive: Epiglottitis (Core EM)
- Nose bleeding; further divided into anterior epistaxis (most common) and posterior epistaxis (most serious). May cause life-threatening hemorrhage
- Commonly caused by digital manipulation (nose-picking), dryness, cocaine, and hypertension.
- Mild-severe bleeding, nasal obstruction, respiratory distress
- Posterior bleeds are more likely to drain from both nares
- Clinical diagnosis
- Direct pressure, lean forward, topical decongestants (oxymetazoline, phenylephrine)
- Severe bleeds may require cautery, nasal packing, or balloon tamponade
- Peritonsillar abscess is the accumulation of a purulent fluid collection in the tonsillar pillar. Typically a complication of strep pharyngitis.
- Painful swallowing, drooling, fever
- “Hot potato voice”, (+) uvular deviation, (+) trismus.
- Clinical diagnosis
- Ultrasound can help identify depth of abscess/neck vasculature
- I&D or needle aspiration
- Antibiotics (ex. amoxicillin, clindamycin)
*Deep Dive: Peritonsillar Abscess (Core EM)
- Infection and inflammation of the pharynx caused by group A streptococcus.
- Typically occurs in children 5-15 years of age
- Fever, sore throat, cervical lymphadenopathy, absence of cough, tonsillar exudates
- Rapid strep test (if meet Centor criteria)
- Gold standard is throat culture
- Antibiotics (penicillin, amoxicillin, azithromycin)
*Deep Dive: Streptococcal Pharyngitis (WikEM)
- Bacterial or viral infection of the middle ear, usually associated with an upper respiratory infection and/or eustachian tube dysfunction. If bacterial, S. pneumoniae is the most common cause.
- Most common in children 6-36 months
- Otalgia +/- systemic symptoms (N/V, diarrhea, fever)
- Significant erythema and/or bulging of TM
- Clinical diagnosis based on otoscopy
- Antibiotics (ex. amoxicillin)
- Recurrent ear infections may require tympanostomy or tympanocentesis
*Deep Dive: Acute Otitis Media (Core EM)