Page 134 - Journal of Special Operations Medicine - Winter 2014

An Ongoing Series

Sore Throat

Joshua Banting, Tony Meriano, MD

CONCEPT AND OBJECTIVES
The series objective is to review various clinical con- immeasurable gains toward the trust and cooperation of
ditions/presentations, including the latest evidence on the local populace. Small team operations are “ambas-
management, and to dispel common myths. In the pro- sadors,” and their actions or inactions shape relation-
cess, core knowledge and management principles are ships for better or worse. If you decide to treat, it is
enhanced. A clinical case will be presented. Cases will important to “own” that patient and take all reasonable
be drawn from real life but phrased in a context that is steps to ensure a positive outcome as you and your team
applicable to the Special Operations Forces (SOF) or will be held responsible for those outcomes in the eyes
tactical emergency medical support (TEMS) environ- of those around you.
ment. Details will be presented in such a way that the
reader can follow along and identify how they would What else do you want to know?
manage the case clinically depending on their experi- An appropriate history should include onset of symp-
ence and environment situation. Commentary will be toms and what exactly he is experiencing. Include the
provided by currently serving military medical techni- location, severity, and alleviating aggravating factors.
cians. The medics and author will draw on their SOF
experience to communicate relevant clinical concepts Other key questions should include; is there difficulty in
pertinent to different operational environments includ- breathing or swallowing? Is there pain with neck move-
ing SOF and TEMS. Commentary and input from ac- ment, or recent dental issues or fever? Does he have any
tive special operations medical technicians will be part other medical conditions? This may be particularly im-
of the feature.
portant if you are in a region with a high prevalence of
HIV infection. Has there been any trauma? Where does
Keywords: sore throat, ENT, procedures
it hurt exactly?

He tells you that his throat has been sore for 3 to 4 days
CASE PRESENTATION: SORE THROAT but has dramatically worsened. It hurts to swallow, and
he has noticed a change in his voice. The pain is in his
posterior pharynx, and he has had a fever for 2 days. He
SITUATION has no history of trauma or other medical conditions.
You are a clinician working with a 10-man team in a
village stability operation. It is a semipermissive envi- You are concerned by this story and take a mental re-
ronment but very remote. You have helicopter support view of some of the concerning causes of throat pain.
in case of emergency but road travel is very limited due What is your differential diagnosis?
to road conditions and threat. You are approached by a
21-year-old local that has been previously quite helpful • Tonsillitis
to your team. Through the interpreter you hear that he • Peritonsillar cellulitis/abscess (PTC/PTA)
has felt sick and has a sore throat. • Epiglottitis
• Retropharyngeal abscess
To diagnose and treat medical issues that arise within an • Ludwig’s angina
indigenous population may not be on the forefront of • Deep space neck infection
mission objectives. However, these actions can provide • Odontogenic infections

124