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Once the emergency provider is certain that the airway can be controlled and
the circulation is adequate, relief of pain can be accomplished by using narcotic
agents (e.g., morphine 0.1 mg/kg). The patient’s fever can usually be controlled
by antipyretics or a cooling blanket. In very ill children or those with ongoing
vomiting, a nasogastric tube should be placed to evacuate the contents of the
stomach and to drain ongoing gastric secretions.
Children with perforated appendicitis can deteriorate quickly. Therefore,
emergency resuscitation should be quickly followed by operative intervention in
extremely ill patients. For patients with a perforated appendicitis with minimal
systemic signs, abscesses may be treated with antibiotics and possibly drained
percutaneously by interventional radiology—with the expectation of a delayed
appendectomy.

ACUTE INTESTINAL OBSTRUCTION
Goals of Treatment
When intestinal obstruction is suspected, early surgical consultation should be
obtained. Signs of obstruction with shock or evidence of ischemic bowel is a
surgical emergency. Although diagnostic studies to identify the exact etiology of
obstruction are generally valuable to direct management, a fraction of cases need
emergent exploratory surgery to rescue the bowel and prevent further
deterioration of the patient.
CLINICAL PEARLS AND PITFALLS
Bilious emesis in a neonate should be considered a surgical
emergency
Although diagnostic studies are helpful to identify the cause of
obstruction, critically ill patients or those with evidence of ischemic
bowel may need exploratory surgery
Tachycardia, blood per rectum, and acidosis are potential indicators of
ischemic bowel