Acute Appendicitis
🃏 Order set for ADHF (Acute Decompensated Heart Failure) — CHAMP Triage, Decongestion, Diuretic Resistance & Cardiogenic Shock
- Alvarado Score: Migration pain + Anorexia + N/V + RIF tenderness + Rebound + Temp >37.3 + Leukocytosis + Left-shift (0-10); <7=low, 7-8=moderate, >=9=high
- Imaging: US first (sensitivity 86%) → CT abdomen if US inconclusive (sensitivity 94%)
- Perforation signs: fever >38.5, WBC >18,000, peritonitis, CT phlegmon/abscess/free air
- Complicated vs Uncomplicated: uncomplicated = surgery within 24h; complicated = IV ATB ± interval appendectomy
🕐 One-Day Orders
🔬 Investigation
- CBC + CRP — leukocytosis + left shift; CRP elevated in perforation
- BUN, Cr, electrolytes, LFT — surgical baseline
- UPT — ผู้หญิงวัยเจริญพันธุ์ (ectopic pregnancy DDx)
- UA — UTI/stone DDx
- US abdomen/pelvis stat — non-compressible appendix >6 mm = appendicitis
- CT abdomen-pelvis with contrast ถ้า US inconclusive
- Blood group + crossmatch ก่อน surgery
- PT/INR — surgical baseline
💊 Medication
- NPO stat (surgical patient)
- IV NSS 1-2 L (bowel rest + resuscitation)
- Paracetamol 1 g IV q6h — analgesia (opioid PRN; ไม่ mask diagnosis ถ้าวินิจฉัยแล้ว)
- Surgical consult stat — appendectomy (laparoscopic preferred)
- Pre-op prophylactic ATB (เริ่มก่อน incision 60 min):
- Cefazolin 2 g IV (uncomplicated) — single dose
- Complicated (perforation): Pip-Tazo 4.5 g IV q6h หรือ Meropenem ถ้า severe
🔁 Continuous Orders
🔬 Investigation
- Post-op CBC + CRP day 1 — confirm resolution
- Pathology ชิ้นเนื้อ appendix — ยืนยัน diagnosis
💊 Medication
- [Uncomplicated — post appendectomy]:
- หยุด ATB หลัง op; oral diet เมื่อ tolerating; discharge day 1-2
- [Complicated — perforation/abscess]:
- IV ATB ต่อ Pip-Tazo 4.5 g IV q6h หรือ Metronidazole + Ceftriaxone x 3-5 วัน → PO ถ้า improving
- Total ATB 5-7 วัน (ตาม IDSA)
- Pain control: Paracetamol ± NSAIDs (ถ้า renal OK); Tramadol PRN
- Early mobilization day 1