› ! Appendicitis → › ! Ovarian torsion → › Ectopic pregnancy → Approach to critical patient
› First 5 minutes
› Continuous monitoring
› SpO2
› Cardiac monitor
› BP cycling
› IV access
› Two large bore IV if unstable
› IO if no access and unstable
› Fluids
› Crystalloid bolus 20 mL/kg if shock physiology
› Reassess after each bolus
› Antibiotics
› If sepsis physiology or perforation concern, start within 60 minutes
› Local protocol dependent selection
Analgesia and antiemetics
› Analgesia
› Acetaminophen PO or IV 1000 mg once
› Ketorolac IV 15 mg once
› Hydromorphone IV 0.2 mg to 0.5 mg once
› Antiemetic
› Ondansetron IV 4 mg once
› Metoclopramide IV 10 mg once
Antibiotics when indicated
› Uncomplicated appendicitis pathway
› Ceftriaxone IV 2 g once
› Metronidazole IV 500 mg once
› Perforation or abscess concern pathway
› Piperacillin tazobactam IV 3.375 g once
› Local protocol dependent alternatives
Imaging and consultation sequencing
› Imaging selection by population
› Pediatrics first line ultrasound
› Pregnancy first line ultrasound then MRI if needed
› Adult CT with IV contrast if appropriate
› Consultation
› General surgery early for high probability
› OB GYN early if pregnancy related emergency concern
› Timing
› Recheck pain and vitals every 30 to 60 minutes
› Repeat abdominal exam after analgesia
› Escalation triggers
› New peritonitis signs
› Rising lactate
› Worsening hypotension
Show 20 more ▾