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.

[Altra, BSN, RN]

I use Vancomycin as it is our surgeons #1 choice for appendicitis.

Then aren't the surgeons ordering it ... you know, after they see the patient, confirm that it is a surgical case, and accept the patient?

This is not making a whole lot of sense to me, coming from a provider.

[Christy1019, ASN, RN]

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 suddenly feel quite dumb, but in 6.5yrs I don't think I've had an appedicitis pt that DIDN'T get surgery. I didn't realize it was ever soley treated with antibiotics.

[MunoRN, RN]

I suddenly feel quite dumb, but in 6.5yrs I don't think I've had an appedicitis pt that DIDN'T get surgery. I didn't realize it was ever soley treated with antibiotics.

Do you work at a teaching hospital by any chance?

[Christy1019, ASN, RN]

Do you work at a teaching hospital by any chance?

I used to and I get where your going with that, but now I'm at a small community ED that definitely diesnt have surgeons on staff 24/7 and I still see my appy pts go for surgery.

[Sassy5d]

I always scratch my head when 'providers' come here to inquire how nurses treat diagnosis.. No offense

[vintagemother, BSN, CNA, LVN, RN]

Thanks for the information.

[psu_213, BSN, RN]

I agree that going straight to vanco seems like overkill. For colon issues (appy, diverticulitis, etc.) it is almost always Cipro and Flagyl for us. Most get a surgical consult, but few go right from the ER to the OR. Getting a CT on every possible appy is a bit of a pet peeve for some general surgeons.

[KelRN215, BSN, RN]

I suddenly feel quite dumb, but in 6.5yrs I don't think I've had an appedicitis pt that DIDN'T get surgery. I didn't realize it was ever soley treated with antibiotics.

In home care, I see appy patients coming home (no surgery) to complete a 7-10 day course of IV Zosyn q 8hr. This seems like the standard of care nowadays, at least with the pediatric hospital that is my primary referral source.

[Christy1019, ASN, RN]

In home care, I see appy patients coming home (no surgery) to complete a 7-10 day course of IV Zosyn q 8hr. This seems like the standard of care nowadays, at least with the pediatric hospital that is my primary referral source.

Well I guess I learned something new. How do they determine who needs surgery vs those just needing antibiotics?

[Anna Flaxis, BSN, RN]

Well I guess I learned something new. How do they determine who needs surgery vs those just needing antibiotics?

I recall reading about this a couple of years ago, where the move was more toward letting it play out a bit first- that many cases would resolve on their own without complications. More of a watchful waiting than just immediate surgical intervention. At my small community hospital, they still do surgery on every appy. I was just thinking about this topic the other day, in fact!

[KelRN215, BSN, RN]

Well I guess I learned something new. How do they determine who needs surgery vs those just needing antibiotics?

Honestly I'm not sure about that, I just see the kids when they come home to complete their IV Zosyn course.

[DayDreamin ER CRNP]

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!!

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