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

E M Pearl, May 24

A 32F who is 14 weeks pregnant presents with intermittent shortness of breath x 1 day. She has no h/o DVT/PE. Vitals 98.9 100  105/70  18  99% on RA.  Clear lungs, no calf asymmetry on exam. You are concerned about PE. How should you proceed? If she needs imaging, CTA or V/Q?Read more

Em Pearl, 5/8/12

Thank you to Adam Vella for inspiring this clinical question.   What’s the deal with NSAIDs in pregnancy? Ibuprofen and naproxen are category B drugs in the 1st and 2nd trimesters. Catergory D in the 3rd. (aspirin is category D throughout pregnancy) We know NSAIDs are bad in the last trimester. They affect the kidneyRead more

Daily Em Pearl, 5/1/12

A middle-aged G3P2 presents at 19wks gestation c/o abd pain that started early this AM. She had some nausea but no vomiting, a subjective fever and no loose or frequent stools. Your differential is broad but at the top is appendicitis. You d/w OB/GYN and radiology. You all agree that the patient needs imaging toRead more

Daily Em Pearl, 4/28/12

A teenaged woman presents at 32weeks gestation, c/o fingertip pain after experiencing a brief electric shock at home. How do you evaluate and care for this patient?  Read more

Daily Em Pearl, 4/25/12

How do you evaluate for an ectopic pregnancy (versus an intrauterine pregnancy)?  Read more

Daily EM Pearl 4/4

Inspired by Tali Porat’s M&M What is the most consistant ultrasound finding in an ovarian torsion? . . . Answer: Unilateral ovarian enlargement (>4cm). Up to 73% of these has a complex adnexal or pelvoabdominal mass, which can be predominantly cystic, solid, or both. Albayram F, Hamper UM. Ovarian and adnexal torsion: spectrum of sonographic findings with pathologic correlation.Read more