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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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    Outpatient PE treatment

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    Editor's note: This post was listed in the LITFL Review 153's "Best of #FOAMed" category. Venous thromboembolism (VTE) (deep vein thrombosis or pulmonary embolism) has an incidence of roughly 1 in 1,000 with an incidence of PE with or without DVT of 2.3 per 10,000. One major factor to
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    Ultrasound for Pediatric Skull Fractures

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    Diagnose important traumatic injuries quickly, avoid unnecessary ionizing radiation in kids, and do so with an extremely easy ultrasound application to learn. Moreover, skull fracture found to be more predictive than scalp swelling or vomiting for traumatic brain injury, increasing likelihood by 4-fold to 20-fold.
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    Intern Report Collection

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    Our ongoing intern report series is the product of first-year EM residents at UT Southwestern exploring clinical questions they have found to be particularly intriguing. For med students & junior residents - if you haven't encountered these issues yet, you will!
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    Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Pediatric Population

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    Etiologies, Clinical Course, Diagnosis, Management...and ED PEARLS
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    Ask Me Anything with Scott Weingart, MD (@emcrit)

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    Live Blog Ask Me Anything with Scott Weingart
     
    window.cilAsyncInit = function() {cilEmbedManager.init()};(function() {if (window.cilVwRand === undefined) { window.cilVwRand = Math.floor(Math.random()*10000000); }var e = document.createElement('script');e.async = true;var domain = (document.location.protocol == 'http:' || document.location.protocol == 'file:') ? 'http://cdnsl.coveritlive.com' : 'https://cdnslssl.coveritlive.com';e.src = domain + '/vw.js?v=' + window.cilVwRand;e.id
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    D-List Superbugs: Influenza

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    Influenza is spread primarily through large respiratory droplets or contamination of surfaces. About 4 days after exposure patients will typically start to develop an abrupt onset of fever, headache, myalgias or dry cough—generally this presentation will be considered an uncomplicated influenza illness. Symptoms usually resolve after 3-7 days from onset.
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    SVT Treatment Options

    If unstable -> cardioversion; may attempt modified Valsalva while prepping for cardioversion

     

    Stable -> modified Valsalva while prepping meds: adenosine, CCB, or BB

     

    CCB has similar efficacy and fewer side effects compared to adenosine

     

    If using adenosine, go with 12 mg; tell patient about expected symptoms (and that means it’s working!)

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