Clinical Pathway for the Diagnosis of Appendicitis in Pediatric Patients
June 21, 2021


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Appendicitis is the most common condition in children requiring emergency abdominal surgery. Our recent issue Acute Appendicitis in Pediatric Patients: An Evidence-Based Review reviews key age-based historical and physical examination findings, as well as clinical scoring systems, that can help guide the workup of appendicitis in children. read more

Test Your Knowledge: Acute Appendicitis in Pediatric Patients
August 3, 2020


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Appendicitis is the most common condition in children requiring emergency abdominal surgery. Delayed or missed diagnosis in young children is common and is associated with increased rates of perforation. Although several scoring systems have been developed, there is still no consensus on clinical, laboratory, and imaging criteria for diagnosing appendicitis.  read more

Clinical Flowchart for the Diagnosis of Appendicitis in Pediatric Patients
September 10, 2019


Posted by Andy Jagoda, MD in: Feature Update , add a comment

Appendicitis is the most common condition in children requiring emergency abdominal surgery. Delayed or missed diagnosis in young children is common and is associated with increased rates of perforation. Although several scoring systems have been developed, there is still no consensus on clinical, laboratory, and imaging criteria for diagnosing appendicitis.

The dangers associated with misdiagnosis, delay, and perforation make quick and accurate diagnosis of appendicitis essential. This flowchart provides guidance for the management of children with appendicitis

Click the image to download your flowchart.

Clinical Pathway for the Diagnosis of Appendicitis in Pediatric Patients

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What’s Your Diagnosis? 11-year-old boy with acute abdominal pain
August 29, 2019


Posted by Andy Jagoda, MD in: What's Your Diagnosis , 5 comments

But before we begin, check out if you got last month’s case right, about the 8-year-old boy presenting to the ED after falling at a local playground. Click here to check out the answer! read more

Test Your Knowledge Management of Patients With Complications of Bariatric Surgery
August 22, 2019


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As bariatric procedures have become more common, more of these patients present to the emergency department postoperatively. The most common complaints in these patients are abdominal pain, nausea, and vomiting.

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Emergency Department Management of Patients With Complications of Bariatric Surgery read more

Clinical Pathway for Emergency Department Management of Patients With Bariatric Surgery Complications
August 14, 2019


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As bariatric procedures have become more common, more of these patients present to the emergency department postoperatively.

The most common complaints in these patients are abdominal pain, nausea, and vomiting, though each of the surgical procedures will present with specific complications, and management will vary according to the surgical procedure performed. Computed tomography is often the primary imaging modality, though it has it limits, and plain film imaging is appropriate in some cases.

This clinical pathway will help you improve care in the management of patients with bariatric surgery complications. Download now.

Clinical Pathway for Emergency Department Management of Patients With Bariatric Surgery Complications

Get access to more pathways with an individual or group subscription. Visit www.ebmedicine.net/EMPinfo to find out more!

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Test Your Knowledge on Assessing Abdominal Pain
July 17, 2019


Posted by Andy Jagoda, MD in: Brain Tease , 1 comment so far

Patients with abdominal pain are common in the ED, but you need a strategy for quickly identifying patients who are at high risk for life-threatening causes of pain.

The management of abdominal pain has changed significantly in the past 20 years, with increasing emphasis on identifying patients who are at high risk for occult pathology and worse outcomes. Test your knowledge of the most common causes of sudden-onset abdominal pain.

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Assessing Abdominal Pain in Adults: A Rational, Cost-Effective, and Evidence-Based Strategy read more

From the author of the very first issue of Emergency Medicine Practice
June 24, 2019


Posted by Andy Jagoda, MD in: Feature Update , add a comment

Stephen Colucciello, MD, FACEP
Professor of Emergency Medicine, University of North Carolina School of Medicine-Charlotte Campus,
Charlotte, NC

When we first published Emergency Medicine Practice 20 years ago, emergency clinicians were becoming skeptical of established dogma, which was often based on an ?expert? who defined best practices; otherwise known as ?eminence-based? medicine. For example, abdominal pain patients were never to get opioids, oral contrast should always be used for abdominal CT scans and the rectal exam was essential in the abdominal pain workup.

Instead of blindly accepting such ?textbook facts?, we created Emergency Medicine Practice to advance an evidence-based approach. Evidence-based medicine depends upon the best available evidence, while incorporating personal experience and individual patient values. The size and quality of the study, the research methodology, and the reproducibility of results matters in assessing practice validity.

For Emergency Medicine Practice?s 20th anniversary, we turn back to our roots and revisit and revive our very first issue on abdominal pain. I understand from EB Medicine that hundreds ? if not thousands ? of emergency clinicians have said this course has aided them in their training and practice in the 20 years since its publication. The editors tell me it is oft-referenced even to this day.

Abdominal pain is one of the complaints seen most frequently in the ED, and the degree of pathology runs from the mundane to catastrophic. Unfortunately, the severity of illness is easily overlooked, especially in the elderly and immunosuppressed. Identifying the high-risk patient is crucial to avoiding a life-threatening diagnostic mistake.

There are many changes in best practices for assessing patients with abdominal pain compared to 20 years ago. Bedside ultrasound by the emergency provider is certainly revolutionizing ED practice. Radiation-reduction strategies are also becoming more commonplace. MRI is a growing modality, especially in pregnant women with suspected appendicitis. In the past two decades, we have learned that oral contrast provides no additional benefit to IV contrast in abdominal CT scans (with some exceptions). We also have seen a dramatic decrease in abdominal plain films and a corresponding increase in abdominal CT scans, especially in the elderly.

In the end, all the thinking, research, peer reviewing, and thought-provoking discussions that go into each issue of Emergency Medicine Practice are to ensure that every topic makes a difference in your diagnostic or treatment routine. I would be honored if you change your daily practice after reading this new edition of ?Assessing Abdominal Pain In Adults.?

Sincerely,
Stephen Colucciello MD

Click here to read the updated version of our inaugural issue prepared specifically for our 20th anniversary this June! read more

Clinical Pathway for Patients Aged < 50 Years With Abdominal Pain
June 7, 2019


Posted by Andy Jagoda, MD in: Feature Update , add a comment

The management of abdominal pain has changed significantly in the past 20 years, with increasing emphasis on identifying patients who are at high risk for occult pathology and worse outcomes. With abdominal pain still the most common chief complaint seen in the emergency department, a new look at the evolution of assessment strategies is in order.

After an extensive workup, patients with severe pain may prove to have gastroenteritis, while those with a seemingly benign belly are hiding a surgical catastrophe.

This clinical pathway will help you improve care in the management of patients with abdominal pain and recognize a surgical abdomen. Download now.

Clinical Pathway for Patients Aged < 50 Years With Abdominal Pain

Get access to more pathways with an individual or group subscription. Visit www.ebmedicine.net/EMPinfo to find out more!

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Click here to review the issue!

68-year-old woman presents with severe abdominal pain
May 31, 2019


Posted by Andy Jagoda, MD in: What's Your Diagnosis , add a comment

Case Recap:
As you begin your shift, a 68-year-old woman presents with severe abdominal pain. She requires 4 mg of morphine before you can even talk to her. Surprisingly, her abdomen is soft, and not particularly tender. She is tachycardic to the 120s, and her pulse feels irregular. Her blood pressure is 100/50 mm Hg. It seems strange that her pain is so incongruent with her exam, and you wonder:

What is the best imaging study to help clarify things? read more