Page 121 - PJ MED OPS Handbook 8th Ed

Head and Neck Infection (Includes Epiglottitis and Peritonsillar Abscess)

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

Signs and Symptoms:
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. Ertapenem IV (Invanz®) 1g IV, over 30 minutes
7. Treat per Pain Management Protocol
8. Consider dexamethasone (Decadron) 10mg IV for any airway involvement
9. Avoid airway manipulation unless absolutely necessary

CAUTION: Have cricothyroidotomy kit available BEFORE ATTEMPTING INTUBATION.

10. If airway intervention is indicated, make a single attempt at intubation if feasible
11. If intubation is attempted, do not make any repeat attempts. If intubation has failed, the
next step is a cricothyroidotomy (using local anesthetic and Procedural Sedation Protocol 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.

Chapter 8. Tactical Medical Emergency Protocols (TMEPs) n 119