Vital signs

Heart Rate (types in)

Respiratory Rate (types in)

Temperature (types in)

History

• Onset - gradual or sudden
• Duration - <24hrs, 24-48hrs, 3-7d, >7d
• Related symptoms

Fever - Y N

Rash - Y N

Cough Y N

Rhinorrhea Y N

Hoarseness Y N

Difficulty swallowing Y N

Difficulty breathing Y N

Abdominal pain/nausea/vomiting Y N

Other (type in)

• Exposure to others with sore throat or known GABHS pharyngitis Y N
• How treated (at home): tylenol or fluids or throat lozenges

Has home treatment helped: Y N

General Impression

• Alert or listless?
• Active or lethargic?
• In distress or no apparent distress
• Toxic (sick looking) Y N

Physical Examination

• Eyes (drainage) Y N

amount - copious or large or moderate or small or minimal

color - clear or yellow/green or white

consistency - thin or thick

• Ears

external canal - clear or erythema

tympanic membrane

color - grey or pink or red

translucency - landmarks seen or opaque

light reflection - present or diffuse or absent

fluid visualized - Y N

retracted - Y N

mobility - Y or N or diminished

tympanometer findings - Type A or Type B or Type C

• Nose (rhinorrhea)

amount - copious or large or moderate or small or minimal

color - clear or yellow/green or white

consistency - thick or thin

• Mouth - ulcers and/or vesicles and/or palatal petechiae
• Throat

color - pink or red

tonsil size - 2+ or 3+ or 4+

tonsils symmetrical? Y N

uvula - midline or displaced

exudate Y N

amount - large or moderate or small or minimal

color - grey or yellow/green or white

postnasal discharge Y N

ulcers or vesicles Y N

• Neck

supple Y N

anterior cervical nodes Y N

posterior cervical nodes Y N

occipital nodes Y N

• Chest

adventitious breath sounds Y N

crackles Y N

wheezes Y N

rhonchi Y N

transmitted upper airway sounds Y N

air entry - good or fair or decreased

Skin rash

location - chest and/or back and/or face and/or extremities

number - few or many or too numerous to count

pattern - discrete or confluent or annular

size - <1mm or 1-5mm or >5mm

quality - macular or papular or macular-papular or vesicular or pustular or scarlitinaform

• Abdomen

soft Y N

distention Y N

organomegaly Y N

inguinal nodes Y N

Plan

1. No consult necessary if (all criteria met)

Sore throat is accompanied by signs of a cold (nasal congestion, postnasal discharge, cough)

Fever is absent or low grade

Throat is negative or minimal for exudate

Duration is less than 7 days

Viral etiology is probable and no consult is necessary. If sore throat persists for more than one week, child should be seen for follow-up/consult with NP. Health teaching: information sheet on viral pharyngitis

2. Consult with nurse practitioner if any of the following are present:

Sore throat is the primary complaint and other signs of an upper airway infection are absent

Fever >38.5

Nausea/vomiting/abdominal pain

Evidence of lower respiratory infection (adventitious breath sounds)

Generalized lymphadenopathy

Oral vesicles and or ulcers

Palatal petechiae

Duration >6days

4. Refer immediately to MD

• Unilateral bulging of tonsil with prominant anterior pillar, soft palate and uvula edematous (on prominent side), displacement of uvula away from enlarged tonsil
• Asymmetry of tonsils/displacement of uvula; with prominent swelling of posterior pharyngeal wall (stops at midline); dysphagia, stridor

3. Refer immediately to ED

• dyspnea or difficulty breathing