Page 241 - ATP-P 11th Ed

HEAD AND NECK INFECTION PROTOCOL
(INCLUDES EPIGLOTTITIS AND PERITONSILLAR ABSCESS)

SPECIAL CONSIDERATIONS
1. Most common causes in young healthy patients include odontogenic (dental ori-
gin) cutaneous sources or post-injury (wound or fracture) infections.
2. These infections may progress rapidly from minor to airway/life-threatening.

Signs and Symptoms SECTION 2
1. Pain, fever and malaise
2. Intra/extra oral swelling
3. Difficulty opening mouth
4. Pus
5. Difficulty swallowing
6. Airway compromise
Management
1. Manage airway and breathing first!
2. Place patient in position of comfort.
3. Monitor pulse oximetry.
4. Oxygen prn
5. IV access
6. Amoxicillin/clavulanic acid (Augmentin ) 875mg PO bid for 7 days OR ceftri-
®
®
axone (Rocephin ) 1g IV/IM daily for 7 days
7. Treat per Pain Management Protocol.
8. Consider dexamethasone (Decadron ) 10mg IV for any airway involvement.
®
9. Avoid airway manipulation unless absolutely necessary.
10. Have cricothyroidotomy kit available BEFORE ATTEMPTING INTUBATION.
11. If airway intervention is indicated, make a single attempt at intubation if feasible.
12. If intubation is attempted, do not make any repeat attempts. If intubation has failed,
the next step is a cricothyroidotomy (using lidocaine if conscious).

Disposition
1. Urgent evacuation if any airway compromise is present.
2. Routine evacuation if no airway compromise and the infection is not widespread.

230 SECTION 2 TACTICAL MEDICAL EMERGENCY PROTOCOLS (TMEPs) ATP-P Handbook 11th Edition 231