PIMS
You are a doctor of the emergency ward at Children's University Hospital where a 15-year-old boy, Ondra Nový arrives accompanied by his parents. You take history (see help) and perform a physical examination. The patient is conscious and communicating. He complains of having abdominal pain for several days. He localizes the pain mainly to the area of the right hypogastrium. The mother states, that her son suffers from nausea, diarrhea, and has fever above 38°C for about 3 days without response to analgesics. The patient is sweaty, hypotensive, tachypneic. He has tachycardia and mottled skin.

How would you proceed?
Help
I indicate laboratory tests and US examinations of the abdomen. I administer antibiotic therapy empirically and provide fluid bolus. I call for a surgical consultation.
I administer antibiotic therapy empirically and I provide fluid resuscitation. I indicate CRP sampling referring the patient to his paediatric GP the next morning.
I will consult the surgeon. Ondra is indicated for an acute surgical revision for the suspicion of acute abdomen and transported directly to the operating room.
I indicate US examination and monitor patient's vital signs on the observation bed.
15
years
RR
22 /min
HR
130 /min
BP
90/70 (77) mmHg
temperature
38 °C
CRT
5 s