Clinical suspicion

    Swollen/red peritonsillar region causing uvular shift

    Fluctuance of area

 Interim treatment for peritonsillar closed space infection until tonsillectomy

CONTRAINDICATIONS

 Extension into the deep neck tissue

 Septicemia/toxic appearance

 Airway obstruction

 Severe trismus

 Coagulopathy

LANDMARKS

 Superior lateral border of affected tonsil, or area of most fluctuance

 Aspirate peritonsillar abscess’ (PTA’s) superior pole first, then middle pole, and finally the inferior pole (FIGURE 76.1)

TECHNIQUE

 Patient Preparation

    Cooperative patient sitting upright in a chair with occipital support

    Consider intravenous analgesia or sedation

    Digital exam key: Must feel abscess!

    Use ultrasound (endocavitary probe) to assess volume, location, and relationship to the carotid artery (FIGURE 76.2)

 Needle Aspiration

    Anesthetize with benzocaine spray or have patient gargle viscous lidocaine

    Have patient depress own tongue by holding laryngoscope, insert as you would for intubation. Patient will be less likely to trigger own gag reflex while pulling down on blade (FIGURE 76.3)

    Anesthetize locally with 1 to 2 mL of 1% lidocaine via 27-gauge needle

    Use a long spinal needle so visualization is not obscured by syringe

    Cut the distal 1 cm off of the needle cover and recap the needle, thereby preventing the needle from penetrating >1 cm (FIGURE 76.4)

    Insert spinal needle at area of greatest fluctuance (usually the superior pole) and aspirate the pus

Related posts:

Delayed Sequence Intubation Reduction of Nursemaid’s Elbow (Radial Head Subluxation) No Desat: Maximally Aggressive Preoxygenation Skin and Soft-Tissue Ultrasound Video Laryngoscopy Wrist (Radiocarpal) Arthrocentesis