Appencicitis

Question 1

First ?

Answer 1

Dynamic risk assessment ( SMART).
Patient assessment triangle.

Question 2

Signs and symptoms ?

Answer 2

Periumbilical pain.
Migration of pain > left quadrant.
Pain for 24-48 hours
Nausea / vomiting.
Absent bowel movement
Tachycardia
Urianary frequent / urgently
Anorexia
Loss of appetite
Constipation

Question 3

Primary survey (ABCDE) ?

Answer 3

Airways > talking
Breathing > resp rate , sp02
Circulation > pulse rate, BP ECG (4lead)
Disability > GCS , temp, BM
Examine> make sure patient is as comfortable as possible

Question 5

History taking ?

Answer 5

Consent from patient.
Presenting complaint.
Socrates
Past medical
Family > abdominal conditions
Social > alcohol, diet
Lifestyle , diet activity
Risk factors > diet ,alcohol,
Pain score (1-10)

Question 6

Observations ?

Answer 6

BM ( monitor and record if required) ( administer IV fluid ).
Sats ( 94 % and above )
BM (hypo/ hyperglycaemia.
Temp (looking for fever)
4 lead ECG
IV for administering drugs

Question 7

Abdominal assessment ?

Answer 7

Patient is supine.
Inspect for abnormalities
6FS, fetus, fat, fluid, flatus , faeces, fulminant mass.
Palpate all 4 quadrants with light and deep palpation.
Percuss for hypo/ hyperresonance.
Auscultate listening for hypo/hyperactive bowel movement.

Question 8

Assessment guarding / rebound tenderness ?

Answer 8

Tension of abdominal muscles on palpitation.
Rebound tenderness worsens on release of pressure.
Tenderness in LLQ with rebound tenderness.

Question 9

Management medicine (oxygen) ?

Answer 9

Consider oxygen if sp02 is less than 94%.
If patient is showing signs of septic shock consider oxygen therapy.
Dose > 2-6 liters per minute
moderate levels of oxygen nasal canuale are recommended in preference to face mask as they offer a more flexible dose.

Question 10

Management medicine (IV fluids) ?

Answer 10

Admin > IV
Dose > 250ml repeat as required up to maximum of 2 liters.

Question 11

Management medicine (analgesia , entonox) ?

Answer 11

Admin > self administered via face make or mouth piece.
Take 3-5 mins to be effective but it may take you to 5-10 mins before maximum .

Question 12

Management medication (paracetamol) ?

Answer 12

Admin > oral tablet
Dose > adults 50kg and over. Give 500 milligrams (1g)
Repeat same dose interval 4-6 hrs . ( max dose 2-4grams in 24hrs).

Admin > IV
Dose > 1g adults 50kg and over ( given over 15 mins)
Repeat same dose .

Ensure daily dose hasn’t been taken.
Ensure alternative product hasn’t been taken.

Question 13

Management medicine ( morphine )?

Answer 13

IV adults 50kg and over 10 milligrams ( same repeat dose).
Rate of 2 milligrams per min.
Observe patient for 5 mins after completion of initial dose before repeating.

Oral morphine :
Adults 10-20 milligrams.
Repeat dose of 20 milligrams.
Only oral route if Iv access isn’t accessible.

Question 15

Management medicine (NSAIDS) ?

Answer 15

Route > oral
Dose > adults 400 milligrams.
Dose interval 8 hours

Question 16

Management ?

Answer 16

Transport patient promptly to the nearest medical facility equipped for surgical emergencies ( appendectomy).
Pre alert patient to hospital with a suspected diagnosis of appendicitis.

Question 17

Further management ?

Answer 17

Position patient for their comfort.
Reassurance.
Explain what is happening to the patient.
Be honest and companionate .