WASHINGTON, D.C.—Most sore throats are minor in nature and physicians often refer them to fast track or even try to take care of them quickly, according to Tracy G. Sanson, MD, FACEP, associate professor of emergency medicine at the University of Central Florida College of Medicine in Orlando and Team Health’s division of medical leadership education and professional liaison. However, there are several presentations that merit rapid identification and intervention because of their potential severity.
Illnesses such as diphtheria and botulism are on the rise. Patients appear toxic, are lethargic, and, more ominously, whisper rather than talk. In diphtheria, a gray membrane covers the tonsils and throat. Both require the appropriate antitoxin for definitive treatment.
Threats to airway patency, such as Ludwig’s angina and epiglottitis, may require nasal or oral intubation in the awake patient. Dr. Sanson offers a few tips in preparing the airway, including coating the laryngoscope with viscous lidocaine, nebulizing lidocaine, or combining lidocaine with Neo-Synephrine and spraying it in the nare. Follow the lidocaine with a size 32 nasal trumpet, allowing it to stay in place while vasoconstriction and anesthesia takes place.