Appendicitis
Pathophysiology:
The appendix is largely considered to be a vestigial organ, no longer of much use in the body. It houses bacteria and may have once aided in digestion, but we gradually evolved away from using it. In appendicitis, the lumen of the appendix becomes obstructed, usually by feces, and the bacteria inside overproliferate. This leads to inflammation of the appendix, and subsequent ischemia of the tissues that comprise it. Eventually the appendix itself becomes necrotic and bursts, spilling its contents into the peritoneal cavity. This leads to peritonitis, with the potential for sepsis.
Presentation:
Appendicitis usually begins with the gradual development of dull, aching pain in the periumbilical region. This is generally accompanied by fever, nausea, and anorexia. As the inflammation progresses, pain usually migrates to the RLQ, with tenderness at McBurney’s point. Tachycardia is usually present, and often is attributable to significant pain, however, tachycardia in the presence of hypotension may indicate appendiceal rupture. A change in LOA, or transition from localized pain to generalized discomfort may also indicate rupture with associated peritonitis. Rebound tenderness or pain provoked by movement, and alleviated with immobility further suggest this may be the case.
Prehospital management:
This is a surgical emergency and ultimately needs to be dealt with in the OR. Prehospital management should be aimed at management ABCs, symptom relief, and management of any associated hemodynamic instability. A general treatment modality would be as follows:
-Ensure a patent and protected airway
-Assess respirations and provide oxygen or ventilation as indicated.
-Establish IV access and provide fluid as indicated by patient condition.
-Provide appropriate analgesic if patient is not contraindicated
-Manage nausea/vomiting with antiemetic if indicated
-Provide rapid transport to a surgical suite
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