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15-year-old girl presents with irregular periods — Brain Teaser. Do you know the answer? February 26, 2019

Posted by Andy Jagoda, MD in : Brain Tease , 3comments

Test your knowledge and see how much you know about treating and managing adolescent gynecologic emergencies.

Did you get it right? Click here to find out!

The correct answer: A.

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Clinical Pathway for Emergency Department Management of Abnormal Uterine Bleeding in Adolescent Patients February 18, 2019

Posted by Andy Jagoda, MD in : Feature Update , 1 comment so far

In the emergency department, gynecologic complaints are common presentations for adolescent girls, who may present with abdominal pain, pelvic pain, vaginal discharge, and vaginal bleeding. The differential diagnosis for these presentations is broad, and further complicated by psychosocial factors, confidentiality concerns, and the need to recognize abuse and sexual assault.

This clinical pathway will help you improve care in the management of abnormal uterine bleeding in adolescent patients. Download now.

Clinical Pathway for Emergency Department Management of Abnormal Uterine Bleeding in Adolescent Patients

Adolescent Gynecologic Emergencies. What do you do? February 14, 2019

Posted by Andy Jagoda, MD in : What's Your Diagnosis , 1 comment so far

You are then called to the resuscitation room for a 17-year-old girl who was found unresponsive at home. On examination, she is ill-appearing, lethargic, has cool distal extremities, normal heart sounds, and clear lungs, and her abdomen is soft but tender in the left lower quadrant. Her vital signs are: blood pressure, 80/40 mm Hg; heart rate, 130 beats/min; respiratory rate, 25 breaths/min; and oxygen saturation, 95% on room air. What are the immediate first steps in managing this patient? What testing is needed for evaluation and management? What is the appropriate disposition?

Case Conclusion:
The 17-year-old girl presented in shock. IV access was obtained quickly for fluid resuscitation. Bedside abdominal ultrasound revealed free fluid on the suprapubic view. The following laboratory tests were sent: hCG, CBC, complete metabolic panel, type and screen, and blood culture. Her hCG resulted positive, raising concern for ectopic pregnancy. After she was resuscitated, gynecology was consulted and noted an empty uterus and free peritoneal fluid on ultrasound, in spite of a serum hCG of 10,000 mIU/mL. The patient was quickly transferred to the operating room where an ectopic pregnancy complicated by hemoperitoneum was found.

Would you have done it different? Tell us how you would have handled this case.

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