Dr. Jess Mason reviews how to drain a peritonsillar abscess (PTA), first by needle aspiration and then by scalpel incision and drainage.
I like to use a control syringe and I nebulize 4% topical lidocaine (3cc at 6 liters/min flow rate to obtain large droplet size that stays in the mouth and less in the lungs). In my shop we have enough beds so I also start with IVF, IV decadron (can be given PO), IV pain meds and antibiotics. If you have the luxury of waiting an hour or two (the time it takes to infuse a couple of liters in these dehydrated patients), then much of their trismus will be gone and then you can start the Neb and I&D.
I love the Video Laryngo illumination - other tool i've used is a disposable lighted vaginal speculum!Scalpel technique seemed rather aggressive and left the wound gaping wide.
I'd usually make a small poke with scalpel or an 18G spinal needle, and then bluntly expand that hole with mosquitoes (not the Kelly's that were used in the videos). You just don't want to leave any potential new cavities for food particles to get lodge in...
Yes the lighted vag spec is another good technique!
Thanks for the vag spec idea, great. Don’t have disposable blades.
In the second part of the video, could an alternative have been to expose 2in on a spinal needle instead of I&D? Feel like needle drainage would be better tolerated
That sounds like another option and it's provider dependent. For her, we felt we had poked her enough times with the needle and I&D was warranted.
Curious: why use antibiotics after I&D (needle or scalpel)?
Presumably there is a cellulitis component as well that won't benefit from I&D alone.
Anecdotal but I've rarely put them on antibiotics and have only had 1 bounceback in 10 years practice of which I'm aware. Not sure if there are any studies.
Your videos are great by the way,
What are your thoughts on cutting in a more vertical orientation from upper to middle pole instead of horizontally across upper pole? It seems like this would be safer in maintaining that medial orientation away from the lateral carotid.
Which ultrasound probe did you use? And where exactly did you place it?
What you do matters.