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3302009474200Post-Tonsillectomy Haemorrhage00Post-Tonsillectomy Haemorrhage161290094742001-6% incidence; due to sloughing of fibrinous debris from tonsillar bedPrimary: within 24 hours of surgerySecondary: >24hrs post-tonsillectomy; usually due to infection; usually occurs 5-10/7 after OTManagement: sit up, NBM, 1:100,000 local adrenaline injection if clear bleeding point, 1:10,000 adrenaline (or thrombin) ; soaked gauze pads, neb adrenaline (5mg in 5ml), cauterise with silver nitrate; 40% require return to OT; penicillin001-6% incidence; due to sloughing of fibrinous debris from tonsillar bedPrimary: within 24 hours of surgerySecondary: >24hrs post-tonsillectomy; usually due to infection; usually occurs 5-10/7 after OTManagement: sit up, NBM, 1:100,000 local adrenaline injection if clear bleeding point, 1:10,000 adrenaline (or thrombin) ; soaked gauze pads, neb adrenaline (5mg in 5ml), cauterise with silver nitrate; 40% require return to OT; penicillin3302008420100Quinsy00Quinsy16129008420100Peritonsillar abscess (between tonsillar capsule and muscles; due to infection of Weber’s glands); higher fever and more pain, trismus; treat with IV penicillin + metronidazole, or clindamycin; drainage with 19G needle ? way between base of uvular and alveolar ridge, inserted <1cm (internal carotid artery is lateral and posterior to post tonsil); needle vs I+D equally as good; admit if large or incompletely drained00Peritonsillar abscess (between tonsillar capsule and muscles; due to infection of Weber’s glands); higher fever and more pain, trismus; treat with IV penicillin + metronidazole, or clindamycin; drainage with 19G needle ? way between base of uvular and alveolar ridge, inserted <1cm (internal carotid artery is lateral and posterior to post tonsil); needle vs I+D equally as good; admit if large or incompletely drained16129006108700Antibiotics: ? symptom duration by ? day, ? severity of symptoms, shortens infectious period from 2/52 to 24hrs, ? risk of rheumatic fever by 70%, ? risk of otitis media by 70%, ? risk of quinsy by 85%, ? risk of sinusitis by 50%; no effect on incidence of post-strep glomerulonephritis; most will improve without treatment in 3-4/7 Give penicillin 10mg/kg BD for 10/7 (roxithromycin 4mg/kg (max 150mg) BD if penicillin allergy; augmentin if fails to respond / recurrent (more anaerobic and beta-lactamase cover) Indications for antibiotics: high incidence of rheumatic fever, PMH rheumatic fever, scarlet fever, systemically unwell, peritonsillar cellulitis / abscess, examination highly suggestive of bacterial Indications for admission: systemic toxicity, inadequate PO intake, airway obstruction, immunosuppression, severe pain00Antibiotics: ? symptom duration by ? day, ? severity of symptoms, shortens infectious period from 2/52 to 24hrs, ? risk of rheumatic fever by 70%, ? risk of otitis media by 70%, ? risk of quinsy by 85%, ? risk of sinusitis by 50%; no effect on incidence of post-strep glomerulonephritis; most will improve without treatment in 3-4/7 Give penicillin 10mg/kg BD for 10/7 (roxithromycin 4mg/kg (max 150mg) BD if penicillin allergy; augmentin if fails to respond / recurrent (more anaerobic and beta-lactamase cover) Indications for antibiotics: high incidence of rheumatic fever, PMH rheumatic fever, scarlet fever, systemically unwell, peritonsillar cellulitis / abscess, examination highly suggestive of bacterial Indications for admission: systemic toxicity, inadequate PO intake, airway obstruction, immunosuppression, severe pain3302006108700Management of Bacterial Pharyngitis00Management of Bacterial Pharyngitis3302005537200Investigation00Investigation16129005537200Throat culture (90% sensitivity; only indicated if resistant to standard treatment; asymptomatic carriage in 10%); rapid antigen testing (80-90% sensitivity)00Throat culture (90% sensitivity; only indicated if resistant to standard treatment; asymptomatic carriage in 10%); rapid antigen testing (80-90% sensitivity)16129004699000Can cause risk factors and post-strep glomerulonephritis, peri-tonsillar abscess, retropharygneal abscess, mediastinitis, erosion of carotid sheath haemorrhage00Can cause risk factors and post-strep glomerulonephritis, peri-tonsillar abscess, retropharygneal abscess, mediastinitis, erosion of carotid sheath haemorrhage3302004699000Complications of Bacterial Pharyngitis00Complications of Bacterial Pharyngitis3302002959100Assessment of Bacterial Pharyngitis00Assessment of Bacterial Pharyngitis16129002959100Bacterial: less likely if child has cough / coryza suggested by tonsillar exudate (present in up to 30% of non-bacterial causes also, therefore unhelpful in telling viral from grp A strep), scarlatiform rashCentor criteria: if 2-3 criteria, do rapid strep test; if 3-4 criteria, treat 1. Tonsillar exudate 2. Tender ant cervical adenopathy 3. No cough 4. Fever00Bacterial: less likely if child has cough / coryza suggested by tonsillar exudate (present in up to 30% of non-bacterial causes also, therefore unhelpful in telling viral from grp A strep), scarlatiform rashCentor criteria: if 2-3 criteria, do rapid strep test; if 3-4 criteria, treat 1. Tonsillar exudate 2. Tender ant cervical adenopathy 3. No cough 4. Fever330200965200Aetiology00Aetiology1612900965200Viral: 80-90% cases; rhinovirus, adenovirus, coronavirus, herpes virus 1, infectious mononucleosis, CMV; HIV seroconversion (90%)Bacterial: 30-40% occur in children 3-13yrs; 5-10% <3yrs; 5-15% adults Grp A strep pharyngitis: causes most bacterial pharyngitis; very uncommon <2yrs; found in 25% children >8yrs Grp C and G strep: 5%; foot and water borne outbreaks Diptheria: systemically very unwell; grey pharyngeal membrane which may bleed on removal; neuritis, carditis; treat with penicillin / erythromycin + antitoxin Gonococcal: often asymptomatic Others: arcanobacterium haemolyticum, mycoplasma, chlamydia, anaerobics00Viral: 80-90% cases; rhinovirus, adenovirus, coronavirus, herpes virus 1, infectious mononucleosis, CMV; HIV seroconversion (90%)Bacterial: 30-40% occur in children 3-13yrs; 5-10% <3yrs; 5-15% adults Grp A strep pharyngitis: causes most bacterial pharyngitis; very uncommon <2yrs; found in 25% children >8yrs Grp C and G strep: 5%; foot and water borne outbreaks Diptheria: systemically very unwell; grey pharyngeal membrane which may bleed on removal; neuritis, carditis; treat with penicillin / erythromycin + antitoxin Gonococcal: often asymptomatic Others: arcanobacterium haemolyticum, mycoplasma, chlamydia, anaerobics330200330200Pharyngitis00Pharyngitis ................
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