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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

    Bleeding in the Patient with Renal Failure

    • One Comment
    "Within the next decade, the incidence of CKD is expected to nearly double"
    In this article, Matt Smetana, DO describes the common manifestations of hemorrhage in uremic patients, and then outlines strategies to stop the bleeding.
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    • clinical cases

    Age, Abdominal Pain, and Gastroenteritis

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    "Weinstock describes gastroenteritis bluntly as 'the refuge of the intellectually destitute'"
    From the case records of     Janus General Hospital, we bring you the first in our series of bouncebacks. Tommy Swanson, MD describes the initial and subsequent visits of a 61 year old female with abdominal discomfort.
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    • practice updates

    Intubating the Critically Ill Patient

    • 16 Comments
    "Two independent variables associated with post-ETI arrest: Pre-induction shock index and weight"

    Intubating beyond the ABCs: Learn how to support your crashing patient while providing definitive airway management. Zach Radwine, MD covers identification of patients at risk for hypotension, dealing with hemodynamic instability, and how to address the numerous complications

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    • practice updates

    Push-Dose Pressors

    • 4 Comments
    "Despite the multitude of studies, the excellent results, and the commonplace use by anesthesiologists for decades, the use of push-dose pressors has not yet made its way into standard emergency medicine practice"
    For a patient in shock, or with anticipated instability during procedural sedation, push-dose pressors can be a lifesaver. Brendon
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    • Peds EM Morsels

    Rapid MRI for VP Shunt Evaluation

    • One Comment
    "Patients with hydrocephalus will have nearly 4 scans per year during childhood"

    For evaluation of VP shunts in children, the cost and study duration a rapid MRI is closer to CT than you might think (and without the ionizing radiation!). Best of all, the evidence comes from studies performed with populations

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    • practice updates

    Wellens’ Syndrome

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    "One of the essential instant recognition abnormalities on ECG"
    Knowing how to spot Wellens' morphology is crucial, but knowing when to expect those ECG changes is the other half of the battle. In this excellent article, Brendon Browning, DO covers the intricacies of this deadly entity, including diagnostic criteria, management pitfalls,
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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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