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)