Page 144 - 2022 Ranger Medic Handbook

Pharyngitis
(Oral Pharyngeal Infections Including Viral,
Strep, Epiglottitis, Peritonsillar Abscess, Mononucleosis)
DEFINITION: Inflammation of the fauces and pharynx leading to sore throat or discomfort swallowing and/or talking
due to multiple etiologies. Most common causes in young healthy patients include viral URIs, group A beta-hemolytic
strep (GABHS) pharyngitis, odontogenic (dental origin), cutaneous sources or postinjury (wound or fracture) infections.
S/Sx:
GABHS Pharyngitis: Pain, fever, malaise, absence of cough, odynophagia, tonsillar exudates, tender cervical adenopathy.
Peritonsillar Abscess: Pain, possibly unilateral sore throat, fever, malaise, trismus, odynophagia, muffled voice (hot
potato voice), unilateral tonsillar enlargement, unilateral uvula deviation to unaffected side.
SECTION 3 Epiglottitis: Sore throat, odynophagia, fever, muffled voice, drooling, stridor, hoarseness, dyspnea (less common in
adults), tripoding/sniffing position, oral cavity/oropharynx normal in most patients, pooled secretions, laryngotracheal
complex tender to palpation (particularly in the hyoid region).
Mononucleosis: triad of fever/tonsillar pharyngitis/lymphadenopathy; fatigue and possibly LUQ pain to splenomegaly
(seen in 50–60% of patients).
Viral (Non-GABHS): S/Sx of URTI with no red flags of other etiologies.
MANAGEMENT:
GABHS Pharyngitis:
1. Evaluate and treat IAW CENTOR Criteria (Exudate on Tonsils, Fever, No Cough, Anterior Cervical Lymphadenopathy).
2. Treat empirically for 3 or greater S/Sx CENTOR criteria with benzathine penicillin G
3. 2 million units IM once (if available) OR penicillin 500mg PO qid × 10 days. If 2 or less S/Sx CENTOR criteria, then
treat symptomatically per non-GABHS management.
Peritonsillar Abscess:
1. If potential for airway compromise, Urgent evacuation for surgical intervention.
2. Needle aspiration IF TRAINED with priority evacuation. If not trained, and no airway compromise, then Priority evacu-
ation. Continue to treat symptomatically and with clindamycin 450mg PO tid OR amoxicillin/clavulanate 875mg bid
× 10 days.
Epiglottitis:
1. Manage airway and breathing first IAW Airway Management Protocol (avoid airway manipulation if possible).
2. Place patient in position of comfort.
3. Monitor pulse oximetry.
4. Oxygen prn if possible.
5. Gain IV access.
6. Ceftriaxone 1g IV/IM qd × 7 days AND clindamycin 600mg IV q6hr OR clindamycin 300–450mg PO q6hr × 7 days.
7. Treat per Pain Management Protocol.
8. Consider dexamethasone 10mg IV for any airway involvement.
Mononucleosis:
1. Treat per URI Protocol.
2. Profile for no high-impact physical training, sports, jumping/FRIES × 6 weeks if able to confirm no splenomegaly on
ultrasound to prevent splenic rupture; no corticosteroids.
Viral (Non-GABHS): Treat per Upper Respiratory Tract Infection.
DISPOSITION: Urgent evacuation if any airway compromise is present. Routine evacuation if no airway compromise
and the infection is not widespread.
SPECIAL CONSIDERATIONS:
1. These infections may progress rapidly from minor to airway/life-threatening.

130 SECTION 3 TACTICAL MEDICAL EMERGENCY PROTOCOLS (TMEPs) & SICK CALL