In this episode on Appendicitis Controversies, we have the continuation of our discussion on abdominal pain emergencies with Dr. Brian Steinhart & Dr. David Dushenski. We kick off the discussion with key clinical pearls and pitfalls in the history and physical exam with their respective liklihood ratios when assessing patients with abdominal pain for appendicitis - a diagnosis that is still sometimes missed despite its prevalence. Dr. Dushenski hacks apart the Alvarado and Appendicitis Inflammatory Response Scores and we discuss the value of WBC, CRP and urinalysis in the work-up of appendicitis. Next up are the controversies of imaging algorithms using ultrasound and CT abdomen, as well as the factors affecting which imaging algorithm you might pursue. We wrap up the discussion on Appendicitis Controversies with a critical look at the value of antibiotics in the ED for appendicitis and which patients might be appropriate for non-surgical management.
In Part 1 of this Episode on Pediatric Abdominal Pain, Dr. Anna Jarvis, "the mother of pediatric emergency medicine" & Dr. Stephen Freedman, one of the world's pre-eminent pediatric EM researchers, discuss the nuances of the history, physical and work up of Pediatric Abdominal Pain & Appendicitis and key pearls on how to distinguish serious surgical causes from the very common diagnosis of gastroenteritis. An in-depth discussion on the pearls of the history, physical exam, lab tests, imaging including serial ultrasounds vs CT abdomen, clinical decision rules such as the Alvarado Score, best analgesics and antibiotics in pediatric appendicitis follows.
The whole playing field changes with pregnant patients in the emergency department. When you're faced with one of the Medical and Surgical Emergencies in Pregnancy that we'll cover in this episode, there are added challenges and considerations. Dr. Shirley Lee and Dr. Dominick Shelton discuss a challenging case of a pregnant patient presenting to the emergency department with shortness of breath and chest pain. They review those diagnoses that the pregnant patient is at risk for and discuss the challenges of lab test interpretation and imaging algorithms in the pregnant patient. Next, they walk us through the management of cardiac arrest in the pregnant patient. In another case of a pregnant patient who presents with abdominal pain and fever, they discuss strategies to minimize delays in diagnosis to prevent serious morbidity and mortality. The pros and cons of abdominal ultrasound, CT and MRI are reviewed as well as the management of appendicitis, pyelonephritis and septic abortion in pregnant patients.