Trauma Awareness Month Is Almost Here – Test Your Knowledge with Genitourinary Trauma Question April 18, 2019


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A patient suffering blunt abdominal trauma complains of suprapubic pain and has gross hematuria. Initial CT of the abdomen and pelvis with IV contrast is normal. Do yo know the answer?

For trauma patients in the ED, life- and limb-threatening injuries take priority, but renal and genitourinary injury can have long-term consequences for patients, including chronic kidney disease, erectile dysfunction, incontinence, and other serious problems.


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

The correct answer: A.

Check out the issue on Emergency Management of Renal and Genitourinary Trauma: Best Practices Update to brush up on the subject.Plus earn CME for this topic by purchasing this issue. 

Clinical Pathway for Management of Sexually Transmitted Diseases in the Emergency Department April 15, 2019


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Sexually transmitted disease can cause severe outcomes for patients, their partners, and their unborn babies, and swift and accurate diagnosis and treatment is essential to reduce morbidity and minimize the potential public health risks.

Sexually transmitted diseases are a growing threat to public health, but are often underrecognized, due to the often nonspecific (or absent) signs and symptoms, the myriad diseases, and the possibility of co-infection. Emergency clinicians play a critical role in improving healthcare outcomes for both patients and their partners. Optimizing the history and physical examination, ordering appropriate testing, and prescribing antimicrobial therapies, when required, will improve outcomes for men, women, and pregnant women and their babies.

This clinical pathway will help you improve care in the management of patients with sexually transmitted diseases. Download now.

Clinical Pathway for Management of Sexually Transmitted Diseases in the Emergency Department

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 , 3 comments

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.

Earn CME for this topic by purchasing this issue. 

A 25 weeks’ pregnant patient presents with a blood pressure of 180/120 mm Hg. — Brain Teaser. Do you know the answer? February 24, 2019


Posted by Andy Jagoda, MD in: Brain Tease , 2 comments

Test your knowledge and see how much you know about treating and managing life-threatening headaches in the ED.

survey services


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

The correct answer: B.

Earn CME for this topic by purchasing this issue. 

 

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.

Using anti-D immune globulin in first trimest of pregnancy — Brain Teaser. Do you know the answer? January 24, 2019


Posted by Andy Jagoda, MD in: Brain Tease , 1 comment so far

Test your knowledge and see how much you know about treating and managing first trimester pregnancies in the ED.

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

The correct answer: D.

Earn CME for this topic by purchasing this issue. 

 

Treatment Pathway for Emergency Department Management of Nausea and Vomiting of Pregnancy January 17, 2019


Posted by Andy Jagoda, MD in: Feature Update , 2 comments

Timely management of patients presenting to the ED while in their first trimester of pregnancy can improve outcomes for both the patient and the fetus. Common obstetric problems encountered include vaginal bleeding and miscarriage, ectopic pregnancy and pregnancy of undetermined location, and nausea and vomiting of pregnancy, including hyperemesis gravidarum.

This clinical pathway will help you improve care in the management of patients who preset with nausea and vomiting in the first trimester. Download now

Treatment Pathway for Emergency Department Management of Nausea and Vomiting of PregnancyTreatment Pathway for Emergency Department Management of Nausea and Vomiting of Pregnancy

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Intrauterine pregnancy presenting with fever. What do you do? — First Trimester Pregnancy Emergencies in the ED January 12, 2019


Posted by Andy Jagoda, MD in: What's Your Diagnosis , add a comment

Case Recap:
Late in your shift, you evaluate a 26-year-old woman who has a confirmed intrauterine pregnancy at 11 weeks’ gestation and presents for fever, dysuria, and right flank pain. An ultrasound was performed in triage that showed bilateral mild hydronephrosis.

Several questions flood your mind. What do you make of that finding, which antibiotics would be safe for treatment, and can she be managed as an outpatient?

Case Conclusion:
You diagnosed your patient with pyelonephritis. Since there are not good data supporting routine outpatient management of pyelonephritis in pregnancy, you consulted her obstetrician to discuss admission. She received ceftriaxone 1 g IV, was admitted to the hospital, and recovered uneventfully. The hydronephrosis was symmetric and bilateral, which is typical during pregnancy, so no further workup for this was undertaken. She was discharged on cephalexin after sensitivities resulted.

 

Intrauterine pregnancy presenting with fever. What do you do? — First Trimester Pregnancy Emergencies in the ED January 5, 2019


Posted by Andy Jagoda, MD in: What's Your Diagnosis , 18 comments

Late in your shift, you evaluate a 26-year-old woman who has a confirmed intrauterine pregnancy at 11 weeks’ gestation and presents for fever, dysuria, and right flank pain. An ultrasound was performed in triage that showed bilateral mild hydronephrosis.

Several questions flood your mind. What do you make of that finding, which antibiotics would be safe for treatment, and can she be managed as an outpatient?