Sore Throat

You must know the FOUR emergent causes of sore throat! Step 1: Apply the Centor Criteria * Determines if patients is at risk for Group A strep (“strep throat”)* 4 Criteria* Fever* No cough* Tonsiller exudates* Lymphadenopathy* Interpretation* If patient has ALL of the criteria* Treat for strep throat* If patient has NONE of the criteria* Don’t even test for strep throat* If patient has SOME of the criteria* Consider testing for strep throat Step 2: Prescribe Antibiotics * B-lactams work best* Penicillin* Amoxicillin* If patient has allergy, consider alternative agent* Azithromycin* Clindamycin Step 3: Pain Control * NSAIDS* Steroids Step 4: Consider EBV (Epstein-Barr Virus) * Consider in patients not getting better on antibiotics* Examine for splenomegaly* If present, no contact sports Step 5: Consider the FOUR Emergent Causes of Sore Throat * Ludwigs angina* Airway emergency* Infection UNDER the tongue* Peritonsillar abscess (PTA)* Complication of bacterial pharyngitis* Causes “trismus” (difficulty opening mouth)* Frequently need to be drained* Retropharyngeal abscess* Airway emergency* Difficult to diagnose by exam alone* Infection is BEHIND airway* Seen on lateral neck xray* Epiglottitis* Airway Emergency* “The Triad”* Drooling* Dysphagia* Distress (respiratory)* Lateral neck xray shows “thumbprint sign” Additional Reading * Peds O- Oxygen, Airway, and Respiratory Disorders (EM Clerkship)* Airway Infectious Disease Emergencies (UNM)