First 5 minutes for the critical patient
›Airway first workflow
›Continuous pulse oximetry
›Cardiac monitoring if toxic or unstable
›Two large bore IV if moderate or high airway risk
›Supplemental oxygen if hypoxic
›Airway backup readiness
›Early anesthesia involvement if stridor or drooling
›Early ENT involvement if suspected deep neck infection
›Testing sequence
›GAS testing guided by Centor or McIsaac risk
›Viral testing per local protocol and infection control needs
›CBC and BMP if toxic, dehydrated, or deep infection concern
›CT neck with IV contrast if deep neck space infection concern
Therapeutic plan for uncomplicated sore throat
›Symptom control
›Acetaminophen PO 1000 mg once
›Maximum 3000 mg per day local protocol dependent
›Lower maximum with chronic liver disease
›Ibuprofen PO 400 mg once
›Avoid with significant renal impairment
›Avoid with active GI bleeding
›Dexamethasone PO or IM 10 mg once local protocol dependent
›Avoid if concern for untreated deep space infection with airway compromise without definitive plan
›Hyperglycemia risk counseling
›Topical anesthetic local protocol dependent
›Viscous lidocaine caution with aspiration risk
›Avoid excessive dosing
Antibiotics when indicated
›GAS treatment options local protocol dependent
›Penicillin V PO 500 mg twice daily for 10 days
›Preferred when no allergy
›Adherence importance
›Amoxicillin PO 500 mg twice daily for 10 days
›Avoid if EBV likely
›Rash risk with EBV
›Cephalexin PO 500 mg twice daily for 10 days
›Avoid in immediate anaphylaxis type penicillin allergy
›Alternative for non anaphylactic reactions
›Azithromycin PO 500 mg day 1
›Then 250 mg daily days 2 to 5
›Macrolide resistance local protocol dependent
Peritonsillar abscess and deep infection
›Escalation treatment local protocol dependent
›IV antibiotics for deep infection concern
›Ampicillin sulbactam IV 3 g every 6 hours
›If penicillin anaphylaxis, clindamycin IV 600 mg every 8 hours
›Drainage pathway for PTA when stable
›Needle aspiration by trained clinician
›ENT drainage if difficult anatomy or complications
›IV fluids for dehydration
›Balanced crystalloid 20 mL per kg bolus if hypotension
›Reassess after bolus
›Time based reassessment
›Recheck airway and voice within 30 to 60 minutes after analgesia
›Recheck PO tolerance after symptom control
›Repeat vitals after fluids or antipyretics
›Escalate imaging and consult if worsening