17 yo girl, 24 weeks pregnant, is brought to the ED with an overbearing, controlling, and older boyfriend (BF). The chief complaint is abdominal discomfort and vaginal spotting. The patient is initially reluctant and quiet, but then gets hysterical as the case progresses. Upon questioning, the patient admits that she took cocaine prior to arrival to induce an abortion, because her BF is married and does not want her to keep the baby.
The patient becomes altered and goes into a shock state from significant vaginal bleeding. Blood work shows significant anemia, acute renal failure, and coagulopathy. The team needs to recognize cocaine toxicity, discuss and manage placental abruption, intubate the patient, control acute hemorrhage, and get a stat OB consult to take the patient to OR for management of placenta abruption and emergent c-section. The team needs to recognize signs of domestic violence and consult the social worker.
Case Writer: Nikita Joshi, MD
Keywords: Cocaine toxicity, placental abruption, domestic violence
UPDATE: 6-22-23 – The PDF is no longer available.
- Recognize and manage cocaine toxicity
- Identify causes of 2nd trimester vaginal bleeding
- Manage emergency airway
- Recognize signs and symptoms of domestic violence