The 4 T’s of Postpartum Hemorrhage

Blood transfusion Drip Chamber

A 28-year-old G4P3 at 41 weeks presents to the ED via EMS. She is in active labor. On exam, a neonatal head is visible. Two minutes later, you deliver a healthy vigorous baby boy and hand him to your colleague. You notice persistent bleeding from her vaginal canal. Her tachycardia climbs to 110 bpm and her latest blood pressure is 78/48 mm Hg. We review postpartum hemorrhage (PPH) and the 4 T’s – a memory aid to help ED providers manage this life-threatening presentation.

(more…)
By |2019-03-29T19:00:18-07:00Feb 6, 2019|Critical Care/ Resus, Ob/Gyn|

ALiEMU AIR Obstetrics and Gynecology Module

Welcome to the Obstetrics and Gynecology (Ob/Gyn) Module! After carefully reviewing all relevant posts from the top 50 sites of the Social Media Index, the ALiEM AIR Team is proud to present the highest quality online content related to Ob/Gyn emergencies. 10 blog posts within the past 12 months (as of July 2018) met our standard of online excellence and were curated and approved for residency training by the AIR Series Board. We identified 2 AIR and 8 Honorable Mentions. We recommend programs give 4 hours (about 25 minutes per article) of III credit for this module.

(more…)

Trick: Linear Ultrasound Transducers in Intrauterine Pregnancy Evaluation

Ultrasound in Intrauterine PregnancyThe volume of women presenting to the emergency department (ED) with newly diagnosed first-trimester pregnancies and suspected ectopic pregnancies sometimes seems like an infinitely growing number. As ED physicians, proper identification of an intrauterine pregnancy (IUP) in these patients is of paramount importance and the initial imaging test of choice for many has become bedside point-of-care ultrasound (POCUS).

(more…)

By |2019-11-10T21:32:28-08:00Jun 4, 2017|Ob/Gyn, Tricks of the Trade, Ultrasound|

Ultrasound For The Win! – 20F with First Trimester Vaginal Bleeding #US4TW

Welcome to another ultrasound-based case, part of the “Ultrasound For The Win!” (#US4TW) Case Series. In this case series, we focus on a real clinical case where point-of-care ultrasound changed the management of a patient’s care or aided in the diagnosis. In this case, a 20-year-old woman presents with first-trimester vaginal bleeding.

(more…)

By |2019-11-10T23:20:22-08:00May 15, 2017|Ob/Gyn, Ultrasound, Ultrasound for the Win|

4 Pitfalls of Bedside Ultrasonography During First Trimester Pregnancy

Pregnancy ultrasound canstockphoto11678805One of the more common indications for the use of bedside ultrasound (US) is to evaluate patients who present to the emergency department (ED) with pain or bleeding during the first trimester of pregnancy. When performing this study, providers should be aware of several potential pitfalls that pose significant risk to both the patient and the provider.

(more…)

AIR Series: Ob/Gyn Module 2015

Welcome to the seventh ALiEM Approved Instructional Resources (AIR) Module! In an effort to reward our residents for the reading and learning they are already doing online we have created an Individual Interactive Instruction (III) opportunity utilizing FOAM resources for U.S. Emergency Medicine residents. For each module, the AIR board curates and scores a list of blogs and podcasts. A quiz is available to complete after each module to obtain residency conference credit. Once completed, your name and institution will be logged into our private database, which participating residency program directors can access to provide proof of completion.

(more…)

PV Card: Focused 1st Trimester Pregnancy Transvaginal Ultrasound

Intrauterine pregnancy ultrasound first trimester transvaginal endocavitaryEarly 1st trimester pregnancies can be challenging to risk stratify when patient present with bleeding or pain. The pregnancy may be still too early for transabdominal ultrasonography, which was covered in last week’s PV card. The same authors, Drs. Matt Lipton, Mike Mallon, and Mike Stone provide a great bedside clinical reference tool on performing the focused transvaginal ultrasound in pregnancy.

 

PV: Focused 1st Trimester Pregnancy Transvaginal Ultrasound


Adapted from [1, 2]

 

References

  1. Tayal V, Cohen H, Norton H. Outcome of patients with an indeterminate emergency department first-trimester pelvic ultrasound to rule out ectopic pregnancy. Acad Emerg Med. 2004;11(9):912-917. [PubMed]
  2. Wang R, Reynolds T, West H, et al. Use of a β-hCG discriminatory zone with bedside pelvic ultrasonography. Ann Emerg Med. 2011;58(1):12-20. [PubMed]
By |2021-10-05T12:59:40-07:00Mar 4, 2015|ALiEM Cards, Ob/Gyn, Ultrasound|
Go to Top