Hello, med students. My name is Zach Olson and thank you for downloading this week's episode of the EM

Clerkship Podcast. Big, big topic this week. You think you know about appendicitis. But here's what

you need to understand. To be successful on your clerkship, it's not just about the test questions.

You need to understand how your attendings think because you want them to think that you're

smart and you're on the same page with them. And in all of medicine in real life, the truth is,

attendings are super scared of appendicitis.

Appendicitis is one of the single biggest malpractice cases brought against emergency physicians.

It's the most common cause of acute attraumatic abdominal pain in kids over a year old.

It's the most common non-obstentric surgical emergency and pregnancy.

It used, at least to represent 25% of all

acute abdominal pain in the emergency department. It's really common, really important,

and really hard to diagnose. Because in real life, appendicitis starts as about 12 hours of gastroenteritis. That's that generalized

visceral pain phase that you've learned about. These patients get triaged to you as a level

three gastroenteritis every time. But that's early appendicitis. Chief complaint vomiting.

Maybe some generalized nononspecific abdominal cramping, they'll say.

Nothing impressive, nothing that makes you think appendicitis, and it always just screams.

This is just gastroenteritis.

That's what early visceral appendicitis looks like.

This is why we don't ever officially diagnose gastroenteritis in the ED.

Then in phase two, patients get that somatic, direct irritation pain that you've learned about.

But here's the problem in real life.

The appendix only lays interagrade in that right

...