The EM Educator Series: Post-Partum Complications…

Author: Alex Koyfman, MD (@EMHighAK) // Editor: Brit Long, MD (@long_brit)

Welcome to this week’s EM Educator Series. These posts provide brief mini-cases followed by key questions to consider while working. The featured questions provide important learning points for those working with you, as well as vital items to consider in the evaluation and management of the specific condition discussed. This post discusses several components of sepsis evaluation and management in the ED, followed by key references.

Mini-case #1: I’m post-partum and don’t feel right

A 25-year-old female two weeks post-partum presents with vision changes, severe headache, and right upper quadrant pain. She is hypertensive and appears in pain.

Considerations:

1) Post-partum complications presenting to ED setting: red flags to look for

2) Identification and management of pre-eclampsia / eclampsia

3) Identification and management of peripartum cardiomyopathy

4) Are postpartum patients at higher risk for venous thromboembolic disease? The thoughtful approach and work-up.

5) Infectious diseases affecting the post-partum patient

Suggested resources:

http://www.emdocs.net/hellp-pregnancy-complications-postpartum-period/

1) Pre-eclampsia/eclampsia

http://www.emdocs.net/preeclampsia-and-eclampsia-common-pitfalls-in-diagnosis-and-management/

https://coreem.net/podcast/episode-113-0/

https://coreem.net/core/preeclampsia-and-eclampsia/

2) Peripartum cardiomyopathy

https://lifeinthefastlane.com/ccc/peripartum-cardiomyopathy/

https://wikem.org/wiki/Peripartum_cardiomyopathy

3) Thromboembolic disease

http://www.emcurious.com/blog-1/2014/10/2/pulmonary-embolism-in-pregnancy

https://emergencymedicinecases.com/episode-7-medical-and-surgical-emergencies-in-pregnancy/

http://blog.ercast.org/pulmonary-embolism-in-pregnancy/

4) Infectious

http://www.emdocs.net/sepsis-in-pregnancy-searching-for-answers-in-a-land-of-unknowns/ 

http://www.emdocs.net/hellp-pregnancy-complications-postpartum-period/

http://www.emdocs.net/postpartum-endometritis-ed-setting-presentation-evaluation-management/