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EM Clerkship

Tummy Ache

EM Clerkship

Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD

Health & Fitness, Science, Education, Medicine, Life Sciences

4.9816 Ratings

🗓️ 3 May 2016

⏱️ 10 minutes

🧾️ Download transcript

Summary


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)

Transcript

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0:00.0

Hello, med students. This episode has been sponsored by Freed AI. Do you dread the thought of

0:07.1

endless charting once you become a doctor? Do you think that doctors should be spending more

0:11.9

time with our patients and less time mindlessly writing notes? Freed AI is the product for you. It is a

0:20.4

secure, hippocompliant scribe that anybody can use.

0:24.7

Focus your energy on what matters, providing good patient care.

0:29.5

Use coupon code EM50 to save 50% the first month you try it,

0:34.1

and you can cancel at any time if you decide it's not right for you. You can learn more

0:38.9

at www.gitfreed.a.i. Hello, med students. My name is Zach Olson, and today I'm going to give

0:50.4

you the approach to tummyache, the approach to pediatric abdomen, nausea, vomiting, diarrhea, constipation, pain, abdominal

1:01.4

distension, all of the important GI stuff in kids.

1:06.0

We're just going to lump all of that together as tummy ache.

1:10.1

Crying baby with a big distended abdomen?

1:12.5

Tummy ache. Vomiting? Tummyache. Diarrhea? Tummy ache. It's all the same approach.

1:20.2

Now, I know that I haven't even done an episode on adult abdominal pain yet, and that core topic

1:26.2

will come soon, I promise. But I actually think that

1:30.0

PEDs GI is a better place to start. And here's why. Kids are trickier. They can't articulate

1:36.6

things well. They're very vulnerable. And for numerous reasons, we have to be very selective

1:42.9

with our testing. And so you can't just slack off.

1:47.1

You really have to think through kids. And so if you can master tummy ache, adult abdominal pain

1:53.2

is going to be super easy. Plus, PEDS GI stuff is all over step two because it covers

1:58.8

peds and it covers family medicine and it covers surgery.

2:02.5

And so you really just need to pay attention today, even if you only see adults on your

...

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