Emergency medicine clinics of North America
-
The scope of gynecologic infections presenting to the emergency department is quite diverse. This article presents an update on the current literature for vaginitis, cervicitis, pelvic inflammatory disease, tubo-ovarian abscesses, the Fitz-Hugh-Curtis syndrome, herpes, and syphilis. Inadequate identification or treatment of these diseases can result is significant morbidity or mortality for the patient and for the fetus.
-
Vaginal bleeding is a common complaint in most emergency departments. Abnormal vaginal bleeding causes many patients a great deal of stress and inconvenience. Although treatment of most cases is straightforward, vaginal bleeding can herald serious occult disease including cancer, coagulopathy, and systemic illness. ⋯ From an emergency medicine perspective, vaginal bleeding should be approached in terms of whether the patient is stable or not. Subsequent evaluation should exclude or treat problems that might cause the patient's condition to deteriorate. The emergency physician is able to provide initial therapy for most causes of vaginal bleeding, and in most cases the patient must be referred to a gynecologist for further evaluation and treatment.
-
The emergency department is a suboptimal location for delivery, and the greater prevalence of complicated presentations and emergency deliveries results in higher morbidity and mortality. Any woman greater than 20 weeks' gestation in labor is considered medically unstable and should be triaged quickly. Fetal viability occurs after 24 to 26 weeks' gestation. ⋯ Perimortum cesarean delivery is performed with gestational age greater than 24 to 26 weeks. The supine position can lead to aortocaval compression. Perimortum cesarean delivery should be performed within 4 minutes of maternal cardiopulmonary arrest.
-
Ectopic pregnancy is a high-risk diagnosis that is increasing in frequency and is still commonly missed in the emergency department. The emergency physician needs a high index of suspicion and must understand that the history, physical examination, and a single quantitative beta-hCG level cannot reliably rule out an ectopic pregnancy. Most pregnant patients who present to the emergency department during the first trimester with abdominal or pelvic pain, regardless of the presence of vaginal bleeding, should undergo further evaluation with ultrasonography. Ultrasound findings in conjunction with quantitative beta-hCG levels guide the management of the patient.
-
The lungs can be an efficient means for the absorption of inhaled toxicants, resulting in airway and pulmonary injury or systemic toxicity. Although a few specific antidotes exist for inhaled toxicants, the syndrome of acute inhalation injury and clinical therapeutics are linked by common pathways of pathophysiology. Understanding the mechanisms of inhalation injury and occupation- or situation-specific toxicants can simplify the decision-making process for the out-of-hospital emergency responder and the emergency physician when confronted with a patient and the myriad of potential inhaled toxicants.