Category: Sepsis

Sore Throat

Background

Acute sore throats are often caused by a virus, last about a week and get better without antibiotics. withholding antibiotics rarely causes complications. Antibiotic stewardship is everyone’s responsibility to prevent resistance developing.

Assessment

Are there any concerns regarding airway compromise?  – If yes – transfer to resus, give high flow Oxygen, IV steroids, IV antibiotics, Nebulised adrenaline 1:1000, IV fluids, take bloods and refer to both anaesthetics and ENT registrar.

Otherwise:

Assess all under 5s  with a temperature as per the NICE fever guidelines

Assess the patient for signs of severe sepsis – if present use the severe sepsis guidelines

If no signs of sepsis assess patient, exclude Quinsey (unilateral swelling, paina nd trismus) and calculate the FeverPAIN score and Centor score

FeverPAIN = 1 point for each of –

  • Fever
  • Purulent tonsillar exudate
  • Attendance within 3 days of onset
  • severely Inflamed tonsils
  • No cough/coryza

Centor = 1 point for each of –

  • Tonsillar exudate
  • Tender anterior cervical lymphadenopathy or lymphadenititis
  • History of fever >38
  • No cough

Treatment

Can the aptient swallow fluids and medication – if not give a stat dose of IV Dexametasone, IV antibiotics, IV fluids and analgesia – review in 2 hours. If they can swallow at this time then you can consider discharge with a patient information leaflet.

  • FeverPAIN = 0 or 1/ Centor = 0,1 or 2 – no antibiotics, self care advice
  • FeverPAIN = 2 or3 – no antibiotics or a script for 3-5 days time if no better, self care advice
  • FeverPAIN = 4 or 5 / Centor 3 or 4 = give Antibiotics immediately, self care advice

Patients to seek medical advice if become more unwell or not improving after 1 week

Self care advice – Paracetamol, Ibuporfen, Adequate fluids, Medicated lozenges

 

Antibiotics –

Phenoxymethylpenicillin 5-10 days

If Penicillin allergy – Clarithromycin or Erythromycin 5 days

Tonsillitis Patient Information Leaflet

Full NICE Guidance

 

Search: tonsillitis

Antibiotics Guides

Sepsis – Click Here

Suspected Covid-19 – Click Here

Site Specific – Click Here

Paediatric – Click Here

Using APP: Sepsis PDF HERE

Ideally use the above links

Covid-19 antibiotic regime no different  – unless confirmed or not responding then add: Flucloxacillin 2g IV QDS or Linezolid 60mg IV/PO BD

 

Can’t find it in our drug cupboard

try the Emergency Drug Cupboard

COVID-19 (X-Ray learning resource)

British Society of Thoracic Imaging (BSTI) have released a free learning resource containing CXR and CT of confirmed Covid-19 cases, will short history including time image was taken from onset of symptoms.

From the China experience CXR/CT doesn’t seem to be a rule out strategy in ED at the moment – However, its a useful resource to help recognition of Covid-19 CXR’s

BSTI Covid-19 image bank