Trick of the Trade: No pelvic bed? No problem

Pelvic SpeculumOften finding a pelvic examination bed for a female patient needing a speculum exam can be challenging. Without the elevated foot stirrups, the bed under the patient’s buttocks obstructs the pelvic speculum handle so that it can’t rotate completely into a 6 o’clock position.
Some people place an upside-down bed pan to elevate the patient’s buttocks slightly in order to create more space for the speculum. Not only is the position uncomfortable for the patient, it seems a waste of a perfectly good bed pan. Fortunately there is an alternative approach.
2019-01-28T22:00:26-07:00

PE in pregnancy: which diagnostic tests do you use?

Pulmonary embolism (PE) can be a deadly disease and one of the most challenging diagnosis to make in a pregnant patient. Patients may present with signs and symptoms that might also be present in a normal uncomplicated pregnancy. Even in nonpregnant patients, the diagnosis of venous thromboembolism (VTE) such as PE can be quite challenging.

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2017-03-05T14:18:48-07:00

Trick of the Trade: Urine pregnancy test without urine

pregnancy_tests_in_bulkA 25 year old woman presents to the Emergency Department having syncopized in the waiting room, where she was triaged with the chief complaint of abdominal pain. Ectopic pregnancy immediately bubbles to the top of your differential diagnosis. The patient is too dizzy to walk to the bathroom to give you a urine specimen to check a urine pregnancy test. Plus, she admits that she just urinated in the waiting room bathroom a few minutes ago – so no urine now.

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Paucis Verbis: Methotrexate for ectopic pregnancy

EctopicEctopic pregnancies account for as many as 18% of patients who present with first-trimester bleeding or abdominal pain in the Emergency Department. This Paucis Verbis card summarizes the 2008 American College of Obstetricians and Gynecologists (ACOG) guidelines on the use of methotrexate (MTX) for ectopic pregnancies. Not all ectopic pregnancies require operative management.

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2017-08-01T23:55:06-07:00