Once the emergency provider is certain that the airway can be controlled and the circulation is adequate, relief of pain can be accomplished by using narcotic agents (e.g., morphine 0.1 mg/kg) The patient’s fever can usually be controlled by antipyretics or a cooling blanket In very ill children or those with ongoing vomiting, a nasogastric tube should be placed to evacuate the contents of the stomach and to drain ongoing gastric secretions Children with perforated appendicitis can deteriorate quickly Therefore, emergency resuscitation should be quickly followed by operative intervention in extremely ill patients For patients with a perforated appendicitis with minimal systemic signs, abscesses may be treated with antibiotics and possibly drained percutaneously by interventional radiology—with the expectation of a delayed appendectomy ACUTE INTESTINAL OBSTRUCTION Goals of Treatment When intestinal obstruction is suspected, early surgical consultation should be obtained Signs of obstruction with shock or evidence of ischemic bowel is a surgical emergency Although diagnostic studies to identify the exact etiology of obstruction are generally valuable to direct management, a fraction of cases need emergent exploratory surgery to rescue the bowel and prevent further deterioration of the patient CLINICAL PEARLS AND PITFALLS Bilious emesis in a neonate should be considered a surgical emergency Although diagnostic studies are helpful to identify the cause of obstruction, critically ill patients or those with evidence of ischemic bowel may need exploratory surgery Tachycardia, blood per rectum, and acidosis are potential indicators of ischemic bowel