Emergency Department · CCS Case Walkthrough
Abdominal Pain — Acute Appendicitis
24-year-old male presents with 12 hours of periumbilical pain that has migrated to the right lower quadrant, low-grade fever, nausea, and anorexia.
Step-by-Step Approach
- Focused abdominal exam — check for McBurney point tenderness, rebound, guarding
- Order CBC (leukocytosis), BMP, urinalysis (rule out kidney stone/UTI), lipase
- CT abdomen/pelvis with IV contrast (gold standard for diagnosis)
- Make patient NPO
- IV fluids and pain management (ketorolac or morphine)
- Surgical consult for appendectomy once imaging confirms
- Start prophylactic antibiotics (cefoxitin or cefazolin + metronidazole) pre-op
- Advance clock to post-op, reassess, manage recovery
Common Orders Checklist
✓CBC with differential
✓BMP
✓Urinalysis
✓Lipase
✓CT abdomen/pelvis with IV contrast
✓NPO
✓IV NS
✓Ketorolac 30 mg IV
✓Morphine PRN
✓Ondansetron PRN
✓Surgery consult
✓Cefoxitin pre-op
✓Type and screen
Common Pitfalls
- ⚠Ordering ultrasound instead of CT in an adult male (US is first-line for pregnant/pediatric)
- ⚠Forgetting to make patient NPO before surgical consult
- ⚠Not ordering a pregnancy test in female patients of childbearing age
- ⚠Delaying surgical consult while waiting for imaging
- ⚠Missing peritonitis signs that indicate perforation — changes urgency
Related Topics
Small Bowel ObstructionDiverticulitisEctopic Pregnancy