Resources and Memory //

This is an otherwise healthy, well appearing patient presenting with uncomplicated pharyngitis. [***I have low clinical suspicion for peritonsillar abscess, epiglottitis, retropharyngeal abscess or other deep space infection of the neck.] Patient has the following clinical criteria for bacterial pharyngitis (1 point each): [***Tonsillar exudate] [***Anterior Cervical Adenopathy] [***Fever > 38C (100.4)] [***Lack of cough] [***Age 3-14] [***Age >45, subtract 1 point] [***Patient has a score 0-1, no testing or antibiotics are indicated.] [***Patient has a score 2-3, rapid strep testing is indicated.] [***Rapid test is negative, no antibiotics indicated at this time.] [***Rapid test is positive, antibiotics (penicillin preferred) and one-time dose of dexamethasone are indicated]. [***Patient has a score of >4, testing, antibiotics (penicillin preferred) and one-time dose of dexamethasone are indicated.] [***Mononucleosis was considered for symptoms lasting >1 week.] Prior to discharge all questions answered. [***] Agree with treatment plan and I discussed strict return precautions for worsening of symptoms, increased respiratory effort, signs of CNS infection including but not limited to changes in mental status or vomiting, or fever for more than 5 days. Recommended to follow up with pediatrician in 24-48 hours for recheck. If unable to arrange follow-up, patient is instructed to return to the ED for reassessment. [***] Given verbal and written discharge instructions and acknowledge understanding.



[Back to Main Menu]