First aid and care of peritonsillar abscess
Peritonsillar abscess (peritonsillar abscess) is a purulent inflammation in the peri-tonsillar space. Cellulitis (called peritonsillitis) occurs early, followed by abscess formation. It occurs in young adults.
Etiology and clinical manifestations
Etiology
Most of the cases are secondary to acute tonsillitis, especially in those with recurrent acute attacks of chronic tonsillitis. As the tonsillar crypt, especially the superior tonsillar crypt, is blocked and poorly drained, the bacteria or inflammatory products in it destroy the epithelial tissue, develop deeper into the crypt, penetrate the tonsillar envelope, and enter the peri-tonsillar space.
Common causative organisms include Staphylococcus aureus, Streptococcus hemolyticus type B, and Streptococcus straw green type A. Anaerobic bacteria can also cause this disease.
Clinical manifestations
3-4 days after the onset of acute tonsillitis, the fever still persists or worsens, the pain in one side of the throat increases, especially when swallowing, and even dare not swallow, and the pain often radiates to the ipsilateral ear or teeth. The patient has an acute appearance, with painful expression, head tilted to the affected side, saliva dripping, slurred speech, seeming to have something in the mouth, and drinking water returning from the nasal cavity. In severe cases, there is difficulty in opening the mouth due to the involvement of the internal pterygoid muscle. Because of the pain in the affected side of the neck, the patient holds it with his hand to relieve the pain. The ipsilateral mandibular angle lymph nodes are often enlarged.
Complications
If the inflammation spreads to the parapharyngeal space, a parapharyngeal abscess may occur; if it spreads downward, laryngitis and laryngeal edema may occur, and respiratory distress may occur rapidly. In a few cases, internal jugular vein thrombosis, purulent cervical lymphadenitis, sepsis or septicemia may occur.
Indications of critical illness
Patients with acute illness, painful expressions and severe sore throat may have difficulty swallowing and salivation. Speech is slurred and nasal, and drinking water is refluxed to the nasal cavity. When the inflammation invades the parapharyngeal space, there is difficulty in opening the mouth or closing the teeth, abscesses, and even respiratory distress.
Pre-hospital self-care
Patients with acute tonsillitis should be isolated to prevent transmission by droplet or contact.
Pay attention to rest, drink more water, and eat a liquid diet.
Local medications and gargles, such as compound borax solution, 1:5000 furacilin solution gargle; chlorhexidine tablets, iodine-containing laryngeal tablets, etc.
Paracetamol and ibuprofen can be given to febrile patients.
Antibiotics are applied systemically to control infection.
Hot compresses on the swollen areas of both jaws can help with the anti-inflammatory effect.
If the symptoms do not relieve and have a tendency to worsen, promptly come to the hospital for consultation and, if necessary, surgical treatment.
Treatment
Treatment before abscess formation: treat as acute tonsillitis, give sufficient antibiotics to control inflammation, and give infusion and symptomatic treatment.
Treatment after abscess formation.
Puncture and pus extraction: it can clarify whether abscess is formed and the abscess site. When puncturing, attention should be paid to the orientation and not to penetrate too deeply so as not to accidentally injure the large blood vessels in the parapharyngeal space. The needle enters the abscess cavity and the pus is extracted.
Incision and drainage of pus: For anterosuperior type, incision and drainage of pus is made at the most elevated part of the abscess. For the posterosuperior type, the pus is drained at the palatopharyngeal arch. The wound is reviewed the day after surgery, and if necessary, a vascular clamp is used to open and drain the abscess again.
Tonsillectomy: As the disease is prone to recurrence, tonsillectomy should be performed two weeks after the inflammation has subsided.
Care
Patients are often anxious and fearful due to pain and even difficulty in breathing, so nurses should do a good job of psychological care after receiving patients and explain to them medical knowledge about tonsils to relax their spirits and reduce their symptoms.
Symptomatic treatment. Patients with respiratory distress should be given oxygen inhalation, and patients with fever can be physically cooled.
Open intravenous access for the patient as prescribed by the doctor and give sufficient antibiotics to control inflammation.
Closely observe the patient’s vital signs and changes in condition, such as whether the patient’s pharyngeal pain is relieved, whether the swallowing condition is improved, and whether the symptoms of airway obstruction are relieved.
If necessary, cooperate with the doctor to perform tonsil aspiration or excision to drain the pus.
Prevention
Patients with chronic tonsillitis should develop good living habits, ensure sufficient sleep time, and add and remove clothes in time with weather changes to prevent colds. Remove moist indoor air to reduce triggers.
For sick children, they should develop good eating habits of not picking and overeating.
Insist on exercising to improve the body’s ability to resist diseases, do not overwork, and adjust rest in time if you are tired after exertion. Quit smoking and drinking is an important point to prevent chronic tonsillitis.
Acute inflammation of the tonsils should be completely cured so as not to leave any residual problems.
Prevent all kinds of infectious diseases and epidemics.