Emergency Medicine SOAP Note Example: Acute Appendicitis
An ED note built around medical decision-making: which dangerous diagnoses were considered, how each was addressed, and where the patient goes next.
By Francisco Sanchez, BSN, RN · ER nurse and FNP student · Updated October 2026
Setting: Emergency department notePatient: Fictional patient: 24-year-old woman, previously healthy
SSubjective
Chief complaint
"My stomach hurts on the right side." Onset about 18 hours before arrival.
HPI
Dull periumbilical pain that moved to the right lower quadrant over 8 hours and became sharp and constant, 7/10, worse with walking and with bumps on the drive in. Anorexia since last night, nausea, one episode of nonbloody, nonbilious vomiting. Subjective fever. No diarrhea, dysuria, vaginal bleeding or discharge. Last menstrual period 2 weeks ago, regular. Sexually active, uses condoms.
Source
Patient.
PMH / meds / allergies
No medical or surgical history. No medications. No known drug allergies.
OObjective
Triage vitals
T 38.1 °C, HR 104, BP 122/76, RR 18, SpO2 99% on room air. Repeat at 14:30 after treatment: HR 88, pain 3/10.
Exam
Uncomfortable, lying still. Abdomen soft and nondistended with focal tenderness at McBurney's point, voluntary guarding, positive Rovsing sign; no rigidity. Pelvic exam: no cervical motion tenderness, adnexal tenderness or discharge. No CVA tenderness.
ED results
Urine hCG negative (12:50). WBC 14.6 with neutrophil predominance; lipase normal; urinalysis without blood, leukocyte esterase or nitrites. CT abdomen/pelvis with IV contrast (13:55): appendix dilated to 11 mm with surrounding fat stranding; no abscess, free air or perforation; ovaries normal; no hydronephrosis or stones.
ED course
1 L lactated Ringer's, ondansetron 4 mg IV and morphine 4 mg IV at 13:00. Reassessed at 14:30: pain improved, abdominal exam unchanged. Ceftriaxone 2 g IV and metronidazole 500 mg IV given at 14:45.
AAssessment
Medical decision-making
24-year-old woman with migratory periumbilical-to-right-lower-quadrant pain, anorexia, fever and leukocytosis; CT confirms acute appendicitis without perforation or abscess. Must-not-miss diagnoses: ectopic pregnancy excluded by negative hCG; ovarian torsion and tubo-ovarian abscess unlikely given benign pelvic exam and normal ovaries on CT; pyelonephritis and kidney stone unlikely with a normal urinalysis and no hydronephrosis.
Diagnosis
Acute uncomplicated appendicitis.
PPlan
Interventions
IV fluids, antiemetic, analgesia and preoperative antibiotics as above. NPO.
Disposition
General surgery consulted at 14:20 and evaluated the patient; plan laparoscopic appendectomy tonight. Admitted to general surgery.
Discharge instructions
Not applicable (admitted). Patient updated on the diagnosis and plan and agrees.
Fictional patient, written for learning. Follow your program's and facility's documentation standards.
Why this note works
It records times: onset, results and treatments, because ED decisions depend on them.
Each must-not-miss diagnosis is named with the specific finding that addressed it.
It documents reassessment after treatment, which students often leave out.
The disposition is explicit: who was consulted, when, and which service the patient was admitted to.
What students often miss
Reassessment after treatment
Why a dangerous diagnosis was not pursued
Clear return precautions
Emergency Medicine SOAP note template
Rule out what's dangerous, treat what's urgent, and decide where the patient goes next.
SSubjective
Chief complaint
With time of onset.
HPI
OLDCARTS, context, pertinent negatives for dangerous causes.
Source
Patient, family, EMS: name it.
PMH / meds / allergies
OObjective
Triage vitals
And repeat vitals.
Exam
Focused; document pertinent normals.
ED results
Labs, imaging, ECG with times.
ED course
Treatments given, response, reassessment.
AAssessment
Medical decision-making
Differential with must-not-miss diagnoses and how each was addressed; risk.
Diagnosis
Or "undifferentiated" with reasoning.
PPlan
Interventions
What was done in the ED.
Disposition
Admit (service, level of care), discharge, transfer.
Reading examples helps. Writing your own note and seeing exactly what you missed is what makes you better. SOAPy gives you a realistic case and checks your note section by section.