MDM //

Patient with abdominal pain and vomiting, now resolved_. No peritoneal signs with low suspicion for acute intraabdominal process including torsion, SBO, intussusception or atypical appendicitis. Serial abdominal exams throughout course without increase in pain or migration of pain. Tolerating PO in ED. US appendix inconclusive_. After extensive discussion with family regarding observation versus CT versus return for recheck in 8-12 hours if not resolved and risks and benefits of options, mutual decision making to return for recheck given relative improvement and well appearing child with alternative diagnoses (_) for fever and malaise and not pursue further workup at this time. Patient tolerating PO, continue to be at baseline and well appearing. As above, does not have signs of peritoneal involvement. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed. Family agreeing to bring patient back if any concern including if patient with recurrent vomiting, increase in abdominal pain, or altered behavior. Will discuss prompt follow up with PMD and strict return precautions discussed.



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