APPENDICITIS

[KYARNP]

I am curious how your ED treats appendicitits. As a clinician I have my owns set of orders, but curious as to what yours are.

My orders are as follows.

Saline Lock,LR 1 L,MORPHINE 2 MG,ZOFRAN,VANCOMYCIN IV,ANC SURGERY CONSULT.

[KelRN215, BSN, RN]

This is what we use too. It seems like 2mg of Morphine is under medicating to me too. The normal dosing is 0.1-0.15mg/kg so for most folks that is at least 6mg. A hot appendix HURTS!!

m

I used to give 2 mg of morphine q 2hrs to kids who weighed 20 kg so, I agree, for an adult that's nothing.

[That Guy, BSN, RN, EMT-B]

I used to give 2 mg of morphine q 2hrs to kids who weighed 20 kg so, I agree, for an adult that's nothing.

Our and pain protocol only allows us to go to 2mg then we have to have doctors orders to go higher/use other meds.

[NurseGirl525, ASN, RN]

I just have a quick question concerning vancomycin. I thought that vanco was like a last resort antibiotic. I was just wondering about that. Because I know there are some vanco resistant strains of infection out there and from my understanding that was a very bad thing. Also isn't vanco also dangerous for the body and should only be used in extreme cases? That was justy understanding of it.

I had also never heard of appendicitis being treated with just antibiotics. That's interesting. Do you find good outcomes with that or do most people end up getting it taken out at a later date? I guess I would like to see some studies and outcomes on that. I always thought if you didn't take it out, it would rupture and then you had a real problem. Mine ruptured and I was in the hospital for awhile trying to get rid of the infection.

[psu_213, BSN, RN]

I just have a quick question concerning vancomycin. I thought that vanco was like a last resort antibiotic.

I too learned it was a "last resort" ABX, however, in practice, that does not seem to be true. In my ED, Vanco is given frequently for cellulitis and PNA, even if the infections are not overwhelming. Personally, I think it is overused, but that is just an opinion.

[nuangel1, BSN, RN]

IV,labs ,dilaudid,zofran,NS,IV contrast CT ,once confirmed appy surgeon is consulted ,zoszyn usually.admit off to OR.

[toomuchbaloney]

In uncomplicated appendicitis we use only antibiotics initially, a portion of those will require surgery but for the majority antibiotics is the only treatment required.Appendicitis Treatment with Antibiotics by Dr. Marks on MedicineNet.com

I have a friend that went to her teaching hospital ED in the midwest for acute appendicitis. She was scheduled for same day surgery (she is in her mid 50's I suppose). Results of surgery? Very rare appendicial cancer with 5 year survival rate ~5%. That survival rate is low because it is often NOT differentially diagnosed outside of surgical removal and when that it delayed the aggressive cancer spreads very quickly.

In her case, a preliminary antibiotic regime could have cost her valuable time and possibly her life.

[BrooklynRN11201]

I believe we do labs, IV, NS, Zofran, Zantac, Morphine 4mg (initially), CT, Cipro, Zosyn, Flagyl or combination of those, Sx consult.

[turnforthenurse, MSN, NP]

Line, labs, meds (usually morphine & Zofran but it depends on the provider + NS) and yes, Flagyl, Levaquin or Zosyn. Vanc is overkill. Abdominal CT and if the appy is confirmed, then a surgical consult is done.