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Early Appy in Kids

Mike Weinstock, MD and Mizuho Morrison, DO
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Children present with appendicitis atypically and decision to workup a child should take age/presentation into consideration.


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Miriam M. -

Love the section on Cannibinoid Hyperemesis syndrome, I saw a guy recently in Greymouth ED with CHARF -"cannabinoid hyperemesis acute renal failure", said he had vomited 40X+ in the previous 2-3 days. He is the first patient though that swore by a cold pack rather than hot pack, however, had classical history and resolved +++ with olanzapine. I hear that some people also use haloperidol. I had not heard of topical capsaicin cream 0.075% so will get the ED stock it in the after hours medications. Has been in a couple of times now so advice has not sunken in. I printed him out the wiki page -I also find this page to be considered reputable from the patients point of view!

Mike W., MD -

Thx for your comments - it's always funny w the temperature thing, like w low back pain; heat... ice... just not room temperature! Keep up the great work!

Amber L. -

Crud! I just missed an appy in a 3 yo female who had decreased appetite, vomiting and fever- no localized pain and negative psoas. Came back 2 days later with increased abdominal pain, per the return precautions. She had a ruptured appy so here I am soaking up all the appy info that's available, figuring out what could I have done better..

Mike W., MD -

HI Amber, classic appy is easy - my neighbor can figure it out. Which is why WE are there. I have missed an appy as I guessing have most experienced clinicians - the trick is to not start scanning and CBCing everyone as that will cause more hard than good. The most important teaching point I give is the aftercare instructions to reliable parents; return immediately w fever, increased pain, vomiting and return for a recheck in 8-12 hours if still symptomatic at all. Tough case as often at this age, the nonspecific initial symptoms are nondiagnostic

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A Disposition Conundrum?! Full episode audio for MD edition 207:57 min - 98 MB - M4AHippo Urgent Care RAP - June 2017 Summary 283 KB - PDF