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You are seeing a 16 year old boy with sore throat, worse on the left side, dysphagia, low-grade fever, difficulty fully opening jaw (trismus), and muffled voice. You diagnose peritonsillar abscess and plan to perform a needle drainage procedure.
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October 8, 2019 at 3:20 pm
A) The superomedial aspect of the PTA since the carotid artery is posterolateral
Peritonsillar abscess presents not uncommonly to the ED, typically as a patient with sore throat, odynophagia, dysphonia, and on exam, a visible swelling in the peritonsillar space. Trismus and uvular deviation away from the PTA may be present. Treatment includes drainage of any purulence, antibiotics, and there is some evidence to support steroid usage also. Drainage done by emergency physicians is usually with a needle with a sheath guard to prevent entering too deep; incision & drainage with a scalpel is often left for ENT consultants. The best first location for attempted drainage is superomedial in order to avoid the carotid artery, which tends to be posterolateral to the PTA. Ultrasound can be useful in characterizing the abscess and its relation to the carotid artery. An excellent overview can be found at http://www.emdocs.net/unlocking-common-ed-procedures-peritonsillar-abscess-drainage/