Background: Unintentional injuries remain the leading cause of mortality in children. While traumatic brain injuries and thoracic traumas are the top two causes of mortality and morbidity, abdominal traumas are the third most common cause. 

Additionally, children are at higher risk for clinically significant intra-abdominal (IAI) injuries as a result of their anatomy in comparison to adults. Therefore, it is critical that emergency clinicians accurately diagnose IAI that requires intervention. Given the sensitivity of abdominal CTs for detecting IAI, emergency clinicians may be susceptible to overuse. Unfortunately, CTs expose patients to high doses of ionizing radiation, placing children at increased risk of developing radiation-induced malignancies. The data now shows that solid organ cancers occur in one out of every 300 to 390 girls and one out of every 670 to 690 boys undergoing abdominal CT.

The emergency medicine clinician must balance ruling out deadly diagnoses against the risk of potential radiation-induced malignancy. Prior research derived a clinical decision instrument (CDI) to support emergency clinicians using a one-way rule (Holmes 2013). According to the instrument, clinically significant injury is ruled out if none of the seven criteria are present (Table 1). However, further validation of the CDI is an essential next step

Background: Dyspepsia and epigastric pain are common emergency department (ED) complaints affecting one in four adults annually. Twenty percent of these patients have an organic cause while 80% have functional dyspepsia (Moayyedi 2017). Antacids are often a first-line treatment in relieving the discomfort of dyspepsia and epigastric pain (Salisbury 2021). Antacids can be paired with other medications to create the “GI cocktail.” The combination often includes a mixture of antacid, viscous lidocaine, and anticholinergic medication. The belief is that lidocaine will help anesthetize gastric mucosa giving time for the antacid to decrease stomach acidity, while the anticholinergic medications decrease motility and GI secretions. The efficacy of one approach over another, giving an antacid with or without lidocaine or other medications,  is unknown.