Tummy Ache

Don’t forget to do a thorough GU exam!



Step 1: Write Out Your Differential Diagnosis



* Remember 2-4-2-4* (2) In the upper abdomen* Pyloric stenosis* Pneumonia* (4) In the lower abdomen* Hirschsprung’s disease* Intussusception* Appendicitis* Hernia* (2) Genitourinary* UTI* Testicular/Ovarian torsion* (4) Generalized* Volvulus* Necrotizing enterocolitis* Henoch Schonlein Purpura* Diabetic ketoacidosis



Step 2: Do Pediatric History and Exam



* Pediatric assessment triangle* Appearance* Breathing* Color* Birth history* Gestational age* Complications* Eating/drinking/peeing/pooping* Immunizations* Physical exam* Don’t forget GU exam!



Step 3: Five Important Tests



* Finger stick blood glucose* Urinalysis* Chest x-ray* Abdominal x-ray* Abdominal ultrasound



Step 4: Common Treatments



* Fever/Pain* Acetaminophen* Vomiting* Zofran* Diarrhea* NOTHING* Dehydration* Pedialyte



Additional Reading



* Pediatrics History (EM Clerkship)* Pediatrics Exam (EM Clerkship)