CASE SCENARIO

A 16-year-old male patient (Patient PR), with no past medical history presents to the
emergency room at 9:45am with chief complaint of abdominal pain. He stated he began to feel
diffuse, vague abdominal discomfort two days ago. However, no medications were taken nor
consultation to a medical expert was made. The following morning, the pain worsened in
intensity, rated at 10/10, sharp and was localized to the right lower quadrant. He also had 1
vomiting episode of previously ingested food. Furthermore, he claimed to have loss of appetite
and general body weakness, which prompted him to seek consultation to the nearest health
care facility.

Upon arrival to the Emergency room, his vital signs were noted as follows: BP=110/70, PR= 89
bpm, RR= 21, Temp=37 degrees Celsius. On examination, his abdomen is focally tender to
palpation in the right lower quadrant. Furthermore, palpation of the left lower quadrant
reproduces pain on the right. He was also noted having voluntary guarding of his abdomen, and
cries in pain upon movement. His lab works (CBC, Urinalysis) were unremarkable with the
exception of a mild leukocytosis to 22.4 x 10 9/L and the patient was immediately advised for
admission and scheduled for an emergency appendectomy. He was also tested for SARS COV
and results revealed negative.

At 10:30 am, the patient’s mother consented for the operation. The surgeon included orders
such as nothing per orem, initiation of intravenous fluid of lactated ringer’s 1L to run for 8
hours, administration of cefoxitin 2grams IV and ranitidine 50mg IV 1 hour prior to OR. The
patient was also referred to Anesthesiologist on duty for preoperative preparation. He was also
seen, examined and cleared (PS II) by Pedia for his operation.

Immediately after clearance, he was transported to the Operating room for the procedure. At
the operating room, the NOD ensures the sterility, and performed surgery safety checklist. The
anesthesiologist safely inducted spinal anesthesia. The procedure took 1 hour with minimum
blood loss noted. The patient was then transferred to PACU for further monitoring. He was
given post op medications such as ketorolac 30 mg IVP every 8 hours, Ranitidine 50 mg IV every
8 hours, and Cefoxitin 1 gram IV every 8 hours. Intravenous fluid was replaced to Dextrose 5%
in Lactated Ringers Solution to run at 30 drops per min. He was also advised to maintain on
nothing per orem and maintain flat on bed for 6 hours. He was closely monitored for 2 hours in
the PACU for signs of bleeding and any untoward response from the surgery, and then
transferred to the surgical ward for continuous post op management.

24 hours Post-op, the patient develop fever noted at 38 degrees Celsius, he also complains pain
in the surgical site rated at 8/10. Upon assessment of the surgical wound, it is noted to be
reddish, with intact sutures, well approximated with minimal drainage noted on his surgical
dressing.