Friday, 20 February 2015

Reflection: Would you call 999 for Tonsillitis?

So I'm back out on the road working on the Rapid Response Vehicle (those Ambulance marked cars you see zipping around your local city).

We received a call - Green 2 for difficulty breathing, partial airway obstruction, ?tonsillitis. It was originally graded as a Green 4 call but as it's allotted 4 hour response time had elapsed it had upgraded to Green 2 and we were asked to attend - the call had originated from NHS 111. At this stage it's safe to say my mentor and I let out a little groan as we made our way to the address, talking through the options available to us for this type of call - our impression at this stage is that it really didn't warrant an emergency Ambulance response.

However, it wasn't quite what it seemed! Read on to find out what happened next and a humbling lesson learnt for me.

We arrived at the address and took in our full kit bag and defibrillator as per our SOPs (Standard Operating Procedures) - despite any preconceptions we had about this job it's never a good idea to wander from the basics and anticipating the worse.

We were greeted by a young child at the door who hurriedly ushered us into the living room to his parent that had made the call - it was only these two in the house. As I was attending I wanted to rule out severe allergic reactions as a cause so my questions were all allergy, change in food and previous history of anything like this happening before rather than jump straight in at tonsillitis - my gradually developing history taking routine is to rule out the most serious implications of the complaint then work backwards.

My patient was visibly distressed and was unable to swallow and make any effort at talking aside from grunts, groans, nods and shakes. Satisfied that nothing in their immediate history suggested a reaction of any sort I asked to look inside of their mouth and was presented with a large mass coming from the soft palette that had almost entirely occluded the upper airway, the uvula (the dangly bit at the back of your throat) was deviated almost entirely to one side.

Generic Google Image - NOT my Patient!

Immediately out of my depth I handed the reigns over to my Mentor as I'd never seen this. The patient was a blue light admission to Casualty. Afterwards I learnt that the mass was a "Peritonsillar Abscess" - also known as 'Quinsy'. Quite simply it's a puss filled mass that, if not lanced and drained, can actually occlude the patients upper airway entirely.

Quinsy - NHS Choices

So, my lesson learnt here was to not pre-judge jobs based off of what comes up on the screen in the vehicle or that they came from a 111 referral or even that they were graded as a low priority call. It's also taught me the importance of understanding ENT examinations - they aren't routinely taught in all Universities, I'm lucky that in mine they are. If you are studying on a course that doesn't include an Urgent/Primary Care/Assessing The Out of Hospital Patient module then please have a read around life threatening ENT issues - you'd be suprised at what you can find pre-hospitally with minimal specialist equipment.

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