In a pregnant patient presenting with abdominal pain and suspected appendicitis, an initial ultrasound should be performed to exclude obstetric causes for abdominal pain. MRI may be a reasonable next study if it is immediately accessible and radiologists with expertise in MRI interpretation are available. Otherwise, CT should be utilized.

When faced with an equivocal appendix on ultrasound (US), use of secondary findings such as appendix diameter ≥ 7mm, presence of appendicolith, associated inflammatory changes, and WBC count greater than 10,000/mL can increase diagnostic certainty.

Trauma patients with blunt (and maybe penetrating) chest injury, who had a pneumothorax ≤35mm on CT did well without a thoracostomy tube, with only 9% failing observation only.

The PECARN rule for blunt abdominal trauma in children had high sensitivity, 99%, in this retrospective review. A prospective validation study would give us greater confidence to use this in clinical practice.

Don’t be falsely reassured if the appendix is not visualized on ultrasound in children, especially in boys, those with an elevated total WBC count, or elevated absolute neutrophil count.

It is important to see how trauma surgery has evolved regarding abdominal stab wounds. Know their algorithm, especially the caveats and when not send patients home.

In this systematic review and meta-analysis, no single aspect of the physical examination, imaging, or LRINEC score had high enough sensitivity to exclude necrotizing soft tissue infections. Contrast CT performed the best, but it was only 94.3% sensitive at best. If you have a high clinical suspicion, early surgical consultation is necessary for definitive diagnosis and management.