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Core Content: Critical actions for the preeclamptic patient

Tl;dr: (1) Don’t forget to order a uric acid with the labs as it increases the specificity in diagnosing preeclampsia. (2) If the pt is preeclamptic with severe features (see below), then give 4g IV Mg followed by 1-2gr/hr infusion for 24hrs. (3) Unlike other hypertensive emergencies, start with push dose meds rather than ourRead more

IUDs and the risk for ectopic pregnancy

17 yo female with progestin secreting IUD, LMP 9/22/17, no prior medical problems presents to the ED with bilateral lower abdominal pain for the last day. She also notes that she has had some intermittent vaginal bleeding for the last 3 weeks. Her HR is 98, BP 130/99, RR16, sat 100% on RA. On examRead more

Fitz-Hugh-Curtis Syndrome

Don’t forget to consider Fitz-Hugh-Curtis Syndrome in your right upper quadrant pain differential!   Fits-Hugh-Curtis Syndrome is a rare disease process characterized by perihepatitis as a complication of pelvic inflammatory disease (PID). Patients usually present with severe and sudden onset pain in the right upper quadrant. Movement will typically worsen the pain. The patient mayRead more

Good news you’re pregnant… Now what?

Clinical Scenario: A 28-year-old G0P0, last menstrual period November 2, presents with amenorrhea. Urine pregnancy test is positive. Examination is normal. Bedside ultrasound demonstrates an early intrauterine pregnancy. After being given follow-up information and return precautions she asks for advice in order to have a healthy pregnancy. What do you tell her?   Foods toRead more

Postpartum Hemorrhage Pearls

Here are some very-quick and easy-to-read pearls to remember for the dangerous immediate postpartum complication of postpartum hemorrhage.   Most common causes Uterine atony (by far) Trauma (i.e. lacerations, surgical incisions, uterine rupture) Coagulopathy (persistent heavy bleeding can lead to consumption of clotting factors) Management Uterine massage. Tamponade bleeding from uterine cavity. Two large-bore IV lines. MakeRead more

Pregnancy Pain

A 29 y/o F 20 weeks pregnant presents with fever, dysuria, and left flank pain. She has some CVA tenderness on the right. WBC is elevated to 15. UA shows both blood and leukocytes in the urine. You are concerned about pyelonephritis vs. and infected stone. What are the risks of imaging this patient?Read more

Meconium Staining

26 yoF 36 weeks by dates presents to the ED in labor, and has a precipitous birth in the resus area.  The infant is covered with a greenish liquid the consistency of split-pea soup. How do you address this?Read more

Ob-gyn Mcq

1. What is a not a common risk factor for PID (pelvic inflammatory disease)? (a) smoking (b) tampon use (c) multiple partners (d) young age (e) IUD 2. A 19 y/o G1 presents at 34 weeks gestation with BP 170/110, headache, and mild abdominal discomfort. She has no vaginal bleeding. You initiate a magnesium drip,Read more

22 y/o F 35 weeks gestation being treated with magnesium sulfate for preeclampsia in your ED awaiting transfer to nearby hospital for definitive care. You go to re-evaluate the patient and find her somnolent, decreased respiratory drive and decreased deep tendon reflexes. After managing the airway what is the next step in management: Dexamethasone LidocaineRead more

E M Pearl, May 25

Thank you to Papa Hernandez for this fascinating case.   37F 10 weeks pregnant (by LMP), asthma presents with 1-2 weeks of SOB. Extertional, +orthopnea, + bilateral LE edema. Has yet to initiate prenatal care. Her vitals at triage:  97.7  117  230/140  28   98%.  On exam, patient is tachypneic but not in distress.  HerRead more