October 16, 2017

Background: First trimester vaginal bleeding is a common complaint seen in the emergency department.  Patients are obviously stressed about the possibility of miscarriage while providers are stressed about missing diagnoses such as ectopic pregnancies.  There have been multiple studies questioning the interrater reliability of the pelvic examination. A more important question however, is does the pelvic examination provide any benefit to these patients by enhancing management and decreasing morbidity?

May 22, 2017

Background: Post-partum hemorrhage (PPH) is the leading cause of maternal death worldwide. It is typically defined as > 500 ml of blood loss within 24 hours of giving birth. However, PPH encompasses a broad spectrum of disease from mild oozing over hours to rapid exsanguination and death. The burden of mortality from PPH is shouldered mainly by developing countries thus requiring cost-effective treatment modalities. Tranexamic acid (TXA) is one such possibly modality. TXA works by inhibiting the breakdown of fibrinogen and fibrin by plasmin. In essence, it stabilizes clot that the body naturally forms. TXA has a well established role in reducing death in trauma patients as demonstrated in the CRASH-2 trial (CRASH-2 2010) and is already used by many performing resuscitations in resource strapped locations due to its availability and low cost. Whether early TXA in post-partum hemorrhage reduces mortality while avoiding significant clotting complications (DVT, PE, ACS, CVA) is unknown.

August 10, 2015

  You have just intubated a seizing eclamptic woman who is 34 weeks pregnant. As she is being prepped for transfer to the OB unit for an emergent C-section your nurse asks you what medications you would like for post intubation analgesia and sedation. You have limited recollection of whether Propofol crosses the placenta, and have legitimate concerns about Fentanyl’s chances of producing a ‘floppy baby’ for the OB team on delivery. The literature on the most appropriate post intubation analgesia / sedation package for late pregnancy patients is limited. The agents we are the most familiar with in the emergency department for post intubation sedation and analgesia are Fentanyl and Propofol. One reliable mantra for post intubation analgesia and sedation is 'Fentanyl is the sauce, and Propofol is the oregano', it would be great to be able to apply this mantra to the pregnant population also.

January 30, 2014

Women with undifferentiated abdominal pain and/or vaginal bleeding commonly present to the emergency department.  Many textbooks advocate for the pelvic exam as an essential part of the history and physical exam. Performance of this portion of the exam is time consuming to the physician and uncomfortable for the patient. It is with great regularity that emergency medicine physicians make clinical decisions based on information derived from it, but is this information reliable and does it effect the clinical plan of patients?

REBEL Review 3: Medications in Pregnancy

Created October 30, 2013 | Obstetrics and Gynecology | DOWNLOAD