Pediatric emergency medicine trisk 3750 3750

MRI is being used by some centers in cases of suspected periappendiceal abscess,
although once identified, US is generally used to track resolution or postsurgical
complications.
Management
Initially, therapy should be directed toward proper resuscitation with assessment
and management of the airway, breathing, and circulation. Extremely ill children
may require endotracheal intubation in cases of shock. Hypovolemia should be
rapidly corrected with normal saline or Ringer’s lactate solution. An initial bolus
of fluid starting at 20 to 60 mL/kg is given rapidly until vital signs are improved
and the patient produces urine. Vasopressor therapy should be considered for
patients who do not have sufficient response to 60 to 80 mL/kg of isotonic fluids.
Broad-spectrum antibiotics targeting bowel flora (gram-negative enterics as well
as anaerobes) should be given. Immediate surgical consultation is necessary.
Placement of a bladder catheter and central venous access with measurement of
central venous pressure may be necessary to monitor response to therapy. Once
the patient is more stable, the surgeons generally request advanced radiologic
imaging to guide next steps.

FIGURE 116.4 CT scan of perforated appendix with abscess.