The American journal of emergency medicine
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Retained products of conception (RPOC) refers to residual intrauterine tissue in female patients after a recent birth, pregnancy termination, or miscarriage. Ultrasound is the primary diagnostic modality for RPOC, but the accuracy of point-of-care ultrasound (POCUS) has not been evaluated for this diagnosis. Our aim was to determine the test characteristics of POCUS in detecting RPOC, and to evaluate the management of RPOC in the Emergency Department. ⋯ POCUS demonstrated high specificity and low sensitivity for diagnosing RPOC in patients with a history concerning for RPOC. POCUS can be used to diagnose RPOC, but caution should be exercised when making the diagnosis in early pregnancy given the variable appearance of the endometrium on transabdominal POCUS during that timeframe.
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Critically ill ED patients on life support may undergo transition to comfort care as decided by the surrogate decision maker. When several hours are needed for loved ones to arrive and say farewell before initiating comfort care ("delayed comfort care"), these patients require prolonged ED stays or costly intensive care unit (ICU) admissions. ⋯ The EDOU-based delayed comfort care pathway is a feasible way to deliver compassionate end of life care for patients on life support. It can be considered in hospitals with an EDOU especially if their private ED beds and ICU resources are scarce.
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Trauma is the leading non obstetric cause of death in pregnant women. Pregnancy above 20 weeks falls under special considerations group in the Center for Disease Control and Prevention (CDC) field triage criteria. Trauma centers' designation level in the United States is based on available resources for care. ⋯ In this study, trauma center designation level did not impact survival of pregnant patients sustaining injuries. This provides further evidence that the CDC's field triage guidelines, including their specific considerations for pregnant patients are accurate and that the current practice seems to be effective.