Annals of emergency medicine
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To assess the diagnostic value of abdominal and pelvic ultrasound to the emergency physician, we followed 43 patients who required ultrasound out of 1,010 patients who presented to the emergency department with abdominal pain and/or vaginal bleeding during the 33-week study period. Ultrasound confirmed the preliminary diagnosis in 12 patients, was supportive in eight patients, and ruled out the preliminary diagnosis in 23 patients. Ultrasound often shortened the evaluation process by narrowing the differential diagnosis or by excluding potentially serious conditions, thus eliminating the need for additional testing and frequently allowing for safe discharge of the patient. We found ultrasound to be helpful, as well as cost-effective, in certain patients with abdominal pain and/or vaginal bleeding in whom an emergency department evaluation without ultrasound could not exclude a condition necessitating admission or urgent surgery.
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A patient at 42 weeks of pregnancy called the emergency department complaining of painful uterine contractions for six hours. She was advised to come to the hospital immediately. An episode of vomiting caused a 60-minute delay in her arrival. ⋯ Resuscitation attempts and agonal caesarean section failed. Autopsy revealed massive pulmonary amniotic fluid emboli. Amniotic fluid embolus must be considered in the differential diagnosis of pregnant patients with complaints of shortness of breath and signs of shock with bradycardia.