This issue includes 4 hours of ACEP/AMA category 1 CME credit.
Authors: Robert D. Acton, MD, Mara Antonoff, MD, and Thao T. Marquez, MD
Peer Reviewers: Paula J. Whiteman, MD, FACEP, FAAP, and Michael Witt, MD, MPH, FACEP, FAAP
Publication Date: December 1, 2008
Excerpt from the issue… A young couple brings in their 18-month-old daughter who has been ill for the past 36 hours. They recount symptoms of fevers as high as 101.9°, vomiting, one episode of diarrhea, and abdominal pain. Other than intermittent bouts of fast breathing and “grunting” noises, she has not had cough or other cold symptoms. An older sibling recently had an upper respiratory infection, with no gastrointestinal symptoms. The child is otherwise in good health with up-to-date immunizations. She currently has a low-grade temperature of 100.4°, with otherwise age-appropriate vital signs. She is not tachypneic. You perform an examination on the tired but alert child and note a slightly distended abdomen and diffuse tenderness with guarding. The chest examination is clear to auscultation. You wonder how to further evaluate this child. Then you grab the order sheet and explain to the parents the tests you are ordering.
Conclusion to the above case study... You order a WBC and an ultrasound to further evaluate this child. She has a leukocytosis of 11,100/μl and the ultrasound reveals an easily visualized appendix, which has inflammation suspicious for appendicitis per the radiologist. You obtain a pediatric surgical consult to confirm. The surgeon agrees that she indeed likely has appendicitis and explains the next step of surgical intervention to the parents. You administer additional pain medications to keep the child comfortable while the child is prepared for her appendectomy.
About this article: This article reviews the current literature in the evaluation, diagnosis, and management of children with suspected appendicitis.
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