<< Diagnostic Emergency Ultrasound: Assessment Techniques In The Pediatric Patient

Case Presentations and Conclusions

Case Presentations

You are working in a small community ED on an overnight shift. It is 2:00 AM, and an 8-year-old boy with no significant past medical history arrives with his parents after 2 days of abdominal pain and vomiting that has worsened over the past 24 hours. They deny fever or a change in his bowel movements. His triage vital signs are normal, other than a temperature of 37.8°C. He is lying on the stretcher, reluctant to move. His head and neck, cardiac, respiratory, and skin examinations are all normal. His abdominal examination reveals a soft abdomen, with tenderness at McBurney point and a positive Rovsing sign. You believe your patient has appendicitis. Your practice is to send the patient for an ultrasound as the first diagnostic test; however, ultrasound is not available overnight at your hospital. You want to avoid radiation exposure for this child, but you also want to quickly disposition the patient to the operating room if appendicitis is confirmed. You order basic laboratory work, a urinalysis, intravenous morphine, ondansetron, and normal saline to relieve the patient’s symptoms. You consider performing a bedside emergency ultrasound…

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