Ectopic Pregnancy #1

Ectopic Pregnancy #1

21 yr old female self presented to A&E with 6 hour history of abdominal pain and vomiting. She had 2 loose stools. Assessment bay obs revealed EWS of 5. She has been moved to Resus with ? Sepsis. No history of PV bleed. LMP 2 weeks ago. Not on OCP but denies sexual contact.
— PMH: none, NKDA

Observations

A – Clear and self maintained

B – Rate 26, SpO2 98%.

C – Pulse 110, BP 89/60.

D – GCS 15 pupils equal reactive

E – Temp 36.9°C

Clinical Findings

  • Tender Abdomen

  • Localised guarding to LIF

  • Bowel sounds present


Why We Simulated

"Emergencies in Pregnancy are very challenging. Patients’ symptoms can be misleading or confused with normal pregnancy, their vital signs are normally altered, the physical exam can often be more difficult, their lab values are harder to interpret and imaging algorithms for pregnant patients are very complicated.”

– http://emergencymedicinecases.com

Not to mention that the patient may not know they are pregnant or may not wish to disclose they could be.

Don't forget to check our Lightning Learning on pregnancy problems!

Positive Feedback

  • Recognised the acuity of the patient.

  • Considered possibility of pregnancy early on.

  • Asked for senior review when needed.

Learning Points

  1. It is reasonable to think ahead to a most likely diagnosis or worst case scenario, however by keeping to an "ABCD" structure you are less likely to miss things.

  2. Keeping to a structure can also allow you to assess a patient even if you are feeling out of your depth.

  3. Imaging may have a role in the investigation of abdo pain, however in this case AXR and CXR should only be considered if they will affect management.

Edit & Peer Review by Rebecca Prest
Evidence Update (October 2015)

Evidence Update (October 2015)

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