Evaluation of abscess involving the upper airway- oral, facial, pharyngeal with :

  • Endoscopy

  • Possible bedside incision and drainage

Equipment and Supplies for Dr. Lansford

 

Patient care to coordinate with primary service:

  • Hold blood “thinners,” if medically able, including anticoagulants, NSAIDs, etc. Use SCDs if needed for DVT prophylaxis.

  • Imaging: Obtain relevant outside images and radiologist’s report, if possible

    • If diagnosis is in doubt, a neck CT with contrast is the typical diagnostic scan

  • CBC with differential

  • Consider testing for mononucleosis, if indicated

  • Consider I.V. antibiotics for bacterial infection. Unasyn is first-line if not allergic.

  • Consider continuous pulse oximetry. Notify surgeon for airway compromise.

  • Avoid corticosteroids unless mandated by airway compromise

Initial treatment:

  • Hook up suction tubing and Yankauer suction tip at bedside for patient use as needed.

Drugs to obtain from pharmacy: (Order stat unless procedure is planned for later)

  • Afrin (oxymetazoline) Administer 2 sprays in each nostril in preparation for possible scope

  • 5 mL of lidocaine with epinephrine, drawn up in a 5 mL syringe with a 1.5 inch needle, about 27 gauge. (The lidocaine may be 1% or 2% and the epinephrine may be 1:200,000 to 1:100,000)

  • Morphine 2 mg for IV push prior to procedure

  • Lorazepam 1-2 mg for IV push prior to procedure (if indicated)

  • Cetacaine spray, or equivalent, ordered from pharmacy

Supplies and equipment from the O.R. or E.D.:

At BroMenn, the OR charge nurse can obtain these during normal business hours. (309) 556-8757

At BroMenn, the After Hours Clinical Coordinator can obtain these on nights and weekends. (309) 268-5389

  • Tonsillectomy tray

  • Three 14 gauge angiocatheters

  • Betadine (swabs or solution)

  • 11 blade scalpel (E.D. and O.R. usually stock these)

  • Surgeon’s headlight and light source. At Bromenn, these may be found in the equipment storage room in the northwest corner of the OR halls.

  • Flexible nasoscope. At Bromenn, this is found in central supply, not in the scope rack, but in the ENT cart. Rack 10, row 2, labeled “flex ENT rhino; Steered NX 100 Flex”

Consent: