Insussception algo v1

  • Child 6mo-6yr with clinical suspicion for intussusception
    • Order AXR: Supine and left lateral decubitus
      • Low clinical suspicion
        • AXR Radiology Reading
          • Negative = air in cecum
            • If clinical suspicion for intussusception remains low
              • Yes
                • Discharge if tolerating fluids
              • No
                • Consider alternate diagnoses (off algorithm)
            • If moderate or high clinical suspicion, proceed to U/S
              • Proceed to U/S
                • U/S Radiology Reading
                  • U/S +
                    • Steps
                      • Order air contrast enema
                      • PIV
                      • IVF if dehydrated
                      • Surgery consult if patient not already seen
                    • Air enema with surgery resident present
                      • Checks
                        • Pt should be on full monitors during this time with ED RN
                        • Repeat ED clinical assessment prior to going up for enema
                        • ED RN to go with patient on full monitors to radiology
                      • Successful reduction
                        • Admit to Surgery for 24 hr observation
                      • Unsuccessful reduction
                        • Consult radiology and surgery for further management
                  • U/S -
                    • Assess other causes and ability to tolerate fluids (off algorithm)
          • Non-diagnostic
            • Re-evaluate, if still concerned for intussusception, proceed to ultrasound.
              • Proceed to U/S
                • U/S Radiology Reading
                  • U/S +
                    • Steps
                      • Order air contrast enema
                      • PIV
                      • IVF if dehydrated
                      • Surgery consult if patient not already seen
                    • Air enema with surgery resident present
                      • Checks
                        • Pt should be on full monitors during this time with ED RN
                        • Repeat ED clinical assessment prior to going up for enema
                        • ED RN to go with patient on full monitors to radiology
                      • Successful reduction
                        • Admit to Surgery for 24 hr observation
                      • Unsuccessful reduction
                        • Consult radiology and surgery for further management
                  • U/S -
                    • Assess other causes and ability to tolerate fluids (off algorithm)
          • Free air
            • Consult surgery Stat
          • Positive =
            • Checks
              • Mass
              • Obscured liver edge
              • Lateralization of ileum
              • Nonvisualization of air in cecum/ascending colon
            • Next steps
              • Place PIV
              • Order air contrast enema
              • Page surgery
            • Air enema with surgery resident present
              • Checks
                • Pt should be on full monitors during this time with ED RN
                • Repeat ED clinical assessment prior to going up for enema
                • ED RN to go with patient on full monitors to radiology
              • Successful reduction
                • Admit to Surgery for 24 hr observation
              • Unsuccessful reduction
                • Consult radiology and surgery for further management
      • Moderate to high clinical suspicion
        • Order U/S abdomen for intussusception only. Consider early surgical consult if:
          • check
            • Gross rectal bleeding
            • Bilious emesis
            • Abdominal distension
            • Symptoms > 48 hours
            • Ill appearing
          • AXR Radiology Reading
            • Negative = air in cecum
              • If clinical suspicion for intussusception remains low
                • Yes
                  • Discharge if tolerating fluids
                • No
                  • Consider alternate diagnoses (off algorithm)
              • If moderate or high clinical suspicion, proceed to U/S
                • Proceed to U/S
                  • U/S Radiology Reading
                    • U/S +
                      • Steps
                        • Order air contrast enema
                        • PIV
                        • IVF if dehydrated
                        • Surgery consult if patient not already seen
                      • Air enema with surgery resident present
                        • Checks
                          • Pt should be on full monitors during this time with ED RN
                          • Repeat ED clinical assessment prior to going up for enema
                          • ED RN to go with patient on full monitors to radiology
                        • Successful reduction
                          • Admit to Surgery for 24 hr observation
                        • Unsuccessful reduction
                          • Consult radiology and surgery for further management
                    • U/S -
                      • Assess other causes and ability to tolerate fluids (off algorithm)
            • Non-diagnostic
              • Re-evaluate, if still concerned for intussusception, proceed to ultrasound.
                • Proceed to U/S
                  • U/S Radiology Reading
                    • U/S +
                      • Steps
                        • Order air contrast enema
                        • PIV
                        • IVF if dehydrated
                        • Surgery consult if patient not already seen
                      • Air enema with surgery resident present
                        • Checks
                          • Pt should be on full monitors during this time with ED RN
                          • Repeat ED clinical assessment prior to going up for enema
                          • ED RN to go with patient on full monitors to radiology
                        • Successful reduction
                          • Admit to Surgery for 24 hr observation
                        • Unsuccessful reduction
                          • Consult radiology and surgery for further management
                    • U/S -
                      • Assess other causes and ability to tolerate fluids (off algorithm)
            • Free air
              • Consult surgery Stat
            • Positive =
              • Checks
                • Mass
                • Obscured liver edge
                • Lateralization of ileum
                • Nonvisualization of air in cecum/ascending colon
              • Next steps
                • Place PIV
                • Order air contrast enema
                • Page surgery
              • Air enema with surgery resident present
                • Checks
                  • Pt should be on full monitors during this time with ED RN
                  • Repeat ED clinical assessment prior to going up for enema
                  • ED RN to go with patient on full monitors to radiology
                • Successful reduction
                  • Admit to Surgery for 24 hr observation
                • Unsuccessful reduction
                  • Consult radiology and surgery for further management

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