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Peritonsillar abscess (quinsy)
This is an abscess that can follow tonsillitis. It forms normally round one tonsil, and the swelling pushes the tonsil downwards into the mouth. The patient may find it so difficult and painful to swallow that he may refuse to eat. He may have earache on the affected side. The swelling on the tonsil will be extremely tender, and a finger pressing gently inwards just below and behind the angle of the jaw will cause pain. There is usually fever, sometimes quite high (up to 40 °C). The throat will be red and a swelling will be seen above the tonsil on the affected side.
General treatment
The patient should be put to bed and his temperature, pulse, and respiration taken and recorded every 4 hours. Give a liquid diet or minced food in a sauce, as solids are usually painful to swallow. Ice-cold drinks are much appreciated as they dull the pain and thus allow some fluid and nourishment to be taken.
Specific treatment
Give the patient one intramuscular injection of 600 000 units of procaine benzylpenicillin unless the patient is allergic to penicillin, and immediately start the standard antibiotic treatment.
If the patient cannot swallow whole tablets he may be able to take them ground up in water or in a teaspoonful of honey. If swallowing is impossible and the patient is not allergic to penicillin, give procaine benzylpenicillin, 600 000 units intramuscularly, every day for 5 days.
Give 2 acetylsalicylic acid or paracetamol tablets every 6 hours to relieve the pain.
Subsequent management
A peritonsillar abscess may settle down with treatment, or it may burst. The patient should be told that the abscess will be very painful before it bursts, and that when the abscess does break there will be severe pain, followed by a discharge of pus, which should be spat out. The patient should be given a mouthwash of water to gargle with after the abscess breaks. Soon after the abscess has broken, the patient will feel much better and he can be allowed up when his temperature has remained normal for 24 hours.
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II. Tell what is the general treatment for sore throat
Stroke and paralysis (cerebrovascular accident)
Stroke
A stroke occurs when the blood supply to some part of the brain is interrupted. This is generally caused by:
· a blood clot forming in the blood vessel (cerebral thrombosis)
· a rupture of the blood vessel wall (cerebral haemorrhage)
· obstruction of a cerebral blood vessel by a clot or other material from another part of the vascular system (cerebral embolism)
· pressure on a blood vessel, e.g., by a tumour.
A stroke can be a complication of high blood pressure.
A stroke generally occurs suddenly, usually in middle-aged or old people, without warning signs. In more severe cases, there is a rapidly developing loss of consciousness and a flabby, relaxed paralysis of the affected side of the body. Headache, nausea, vomiting, and convulsions may be present. The face is usually flushed, but may become pale or ashen. The pupils of the eyes are often unequal in size. The pulse is usually full and rapid, and breathing is laboured and irregular. The mouth may be drawn to one side and often there is difficulty in speaking and swallowing.
The specific symptoms will vary with the site of the lesion and the extent ofbrain damage. In mild cases, there may be no loss of consciousness and paralysis may be limited to weakness on one side of the body.
In a severe stroke there is loss of consciousness, the breathing is heavy and laboured, and the patient may lapse into a coma and die.
The outcome of a stroke will depend upon the degree of brain compression or damage. When it is fatal, death usually occurs in 2-14 days and seldom at the time of the attack. Most patients with first or second attacks recover, but recurrent attacks are likely. The extent of permanent paralysis will not be determined for at least 6 months.
Treatment
Good nursing care is essential after a stroke. The patient should be undressed as gently as possible and placed in bed with the trunk of the body, shoulders, and head elevated slightly on pillows. An attendant should be assigned to stay with the patient. Extra care should be taken to prevent the patient from choking on saliva or vomit. The patient's head should be turned to one side so that fluids can flow out of the mouth. Mucus and food debris should be removed from the mouth with a piece of cloth wrapped round a finger. If there is fever, cold compresses should be applied to the forehead. If the patient is conscious and able to swallow, liquid and soft foods may be given. To prevent bedsores the patient should be kept clean and turned to a different position in bed every 3-4 hours. Bowel regularity should be maintained.
RADIO MEDICAL ADVICE must be obtained, and early evacuation to hospital should be anticipated.
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II. Speak on your actions if someone on board has a cerebrovascular accident.