How should EMS approach pediatric abdominal pain suggesting possible appendicitis?

• A. Delay transport
• B. In-field ultrasound evaluation
• C. Withhold analgesia
• D. Focus on stabilization, monitor for peritoneal signs, expedite transport to pediatric surgical care; provide analgesia per protocol as tolerated

Answer: (D)

Abdominal pain in a child with possible appendicitis calls for a plan that keeps the patient stable while getting definitive care quickly. Focus on stabilization of airway, breathing, and circulation, and watch for signs that the illness is progressing or leaking into peritonitis (guarding, rebound tenderness, rigid abdomen, increasing pain, tachycardia, fever, dehydration). If these signs appear or vital signs worsen, transport should be expedited to a pediatric surgical center, with EMS communicating suspected appendicitis and any concerning findings to the receiving team.

Pain relief should be provided per protocol as tolerated to improve comfort and reduce stress, rather than withholding analgesia out of concern for masking symptoms. In-field ultrasound can be helpful in some systems, but it should not delay transfer or replace definitive surgical evaluation. The overall aim is to stabilize, monitor for deterioration, and get the child to appropriate surgical care promptly, with analgesia given as appropriate.