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EM@3AM: Septic Abortion

A 24-year-old female G4P1 who is 9 weeks pregnant presents with abdominal pain and vaginal bleeding for 3 days. Vital signs include HR 115, BP 100/76, T 38.7, RR 13, SpO2 99% on RA. She is ill-appearing and has tenderness to palpation of the bilateral lower quadrants and suprapubic region. Pelvic exam reveals blood in the vaginal vault and foul-smelling discharge from the cervix with no other abnormalities. What is the likely diagnosis?

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    Articles

    Middle East Respiratory Syndrome (MERS-CoV): What have we learned?

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    The things you need to know about MERS...
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    • practice updates

    Intern Report Collection

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    For your Friday afternoon, here's another batch of excellent write-ups from the EM interns at UT Southwestern. Our ongoing intern report series is the product of first-year residents exploring clinical questions they have found to be particularly intriguing, with an intended audience of med students & junior residents. Enjoy! [Note:
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    Mesenteric Ischemia: A Power Review

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    It’s a typical busy afternoon ED shift for you. The rack seems to be overflowing, and 3 new patients have just checked in. All have abdominal pain. You have a systematic approach to your abdominal pain patients. But, does your approach keep one critical diagnosis in mind? [...]
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    The Low-Risk Chest Pain Conundrum: Part 1

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    [Editor's note: For a limited time, Tintinalli's is making their full chapter entitled "Chest Pain: Cardiac or Not?" available to emDocs readers.]

    Low-risk chest pain. Examining and challenging "standard of care."
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    • practice updates

    Ask Us Anything With Mike & Matt

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    Our AMA with Dr. Mike Mallin & Dr. Matt Dawson from the Ultrasound Podcast, held on Friday, November 14th from 2-3:30pm EST.
    Live Blog Ask Us Anything with Mike & Matt
     
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    The Wheeze That Wasn't – An Observation on Enterovirus D-68

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    These children are often a mixed picture of viral bronchitis/bronchiolitis PLUS an asthma exacerbation. Treatment with albuterol, ipratropium, magnesium sulfate, steroids, fluids, etc are all reasonable and prudent in this population. If they begin to clinically improve within 30 minutes then you can feel good about soothing their reactive airways.
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    Spinal Epidural Abscess

    Risk factors: recurrent vascular access, immunocompromise, spinal instrumentation; don’t forget diabetes and ESRD

    Triad (fever + back pain + neuro deficit) not reliable

     

    Evaluation: incorporate risk factors and exam (fever, neurologic deficit)

     

    Imaging: MRI whole spine with and without contrast; 15% have skip lesions

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