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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

    • practice updates

    CT Versus Ultrasound for Kidney Stones

    • 4 Comments
    Diagnose your patients faster, improve ED flow, and avoid unnecessary ionizing radiation,
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    Ask Me Anything with Rob Rogers, MD, FACEP

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    Live Blog Ask Me Anything with Rob Rogers, MD, FACEP
     
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    Lyceum Bullets: DKA

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    Questions Addressed:

    • When you are suspicious for DKA do you obtain a VBG or an ABG? How good is a VBG for determining acid/base status?
    • Do you use serum or urine ketones to guide your diagnosis and treatment of DKA?
    • Do you use IV bicarbonate administration for the treatment of severe
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    Nuances in Resuscitation Part III: Diabetic Ketoacidosis

    • 6 Comments
    Thus far we have discussed resuscitation in trauma and sepsis. What distinguishes those two from the resuscitation goals in DKA is timing. In trauma and sepsis, it’s all about early recognition, aggressive and quick optimization, and understanding all the possible treatment options at your disposal. In the management of DKA,
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    Nuances in Resuscitation Part II: EGDT In Sepsis

    • 8 Comments
    In November 2001, Dr. Manny Rivers and his colleagues published an article in the New England Journal of Medicine on Early Goal Directed Therapy in Sepsis. At the time, sepsis was not a new concept, nor was the treatment of it. Where I believe the real genius in EGDT lies
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    Practical Nuances of Resuscitation – Part I: Not All Are Created Equal

    • 2 Comments
    One of my colleagues likes to tell our residents, “they don’t come to the ED to die, they come here to live.” It is our skill in identifying critically ill patients and successfully resuscitating them that defines us as emergency medicine physicians. Resuscitation in its simplest term means to revive
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    Non-convulsive status epilepticus

    Underdiagnosed and associated with significant morbidity/mortality

    Major risk factor is convulsive status/history of seizure

    Look at eyes, face, fingers, feet for subtle movements -> If present, patient seizing

    Be concerned if patient remains post ictal/does not improve for significant time

    Treatment: Benzos + anti-seizure meds
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