Pediatric emergency medicine trisk 3745 3745

TABLE 116.2
PEDIATRIC APPENDICITIS SCORE
Clinical finding

Point

Anorexia
Nausea or emesis
Migration of pain
Fever >38°C
Pain with cough,
percussion, or
hopping
Right lower
quadrant
tenderness
White blood cell
count
>10,000/mm3
Absolute band
count
>7,500/mm3
Total

1
1
1
1
2

2

1

1

10

At this time, nonperforated pediatric appendicitis primarily is managed
surgically although there are ongoing trials of nonoperative treatment with
antibiotics for selective cases of early, uncomplicated appendicitis. The
preoperative preparation of a patient with acute appendicitis should include
electrolytes if the patient has been vomiting or has had poor fluid intake for more
than a few hours. IV fluids should be started with the goal of rapid intravascular
expansion and then correction of further fluid deficits. Protracted GI losses, as
with vomiting, may lead to potassium depletion. Initial fluids should include a
bolus of isotonic fluid (20 cc/kg), then changed to D5–0.5NS with 10 to 20
mEq/L of potassium. These fluids can then be altered, if necessary, once the
serum chemistries are known. Antibiotics should be administered as soon as the
appendicitis is confirmed by imaging or sooner if there are signs of critical illness
or peritonitis.