speculum exam in AMS pregnant patient?

[MedicinePowder]

won't go into details cause of hippa and all. but pregnant women approx (7months) brought in s/p seizure with AMS. awake but not verbally responsive. no high BP, no edema, no proteinuria. w/u left no rock unturned, including ct head, LP, ob consult.

was a vaginal speculum exam waranted in ED? nl vitals, external exam no blood. US by ob showed normal IUP gestation.

patient doing well, but just in hindsight wondering when are speculum exams indicated other than in abd pain/bleeding.

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[WallowaWanderer]

won't go into details cause of hippa and all. but pregnant women approx (7months) brought in s/p seizure with AMS. awake but not verbally responsive. no high BP, no edema, no proteinuria. w/u left no rock unturned, including ct head, LP, ob consult.

was a vaginal speculum exam waranted in ED? nl vitals, external exam no blood. US by ob showed normal IUP gestation.

I think you would need more info (but not pushing you to share it) . . . i.e. fever, pulse, d stick, EKG, witnesses to seizure, seizure history, history of injestion, ETOH, substance abuse, history of trauma, Ob history, diabetes, etc. But I would say you've got one and possibly two sick patients so I would say do the pelvic. Get a cath UA at the same time tox screen, GC, Chlamydia, wet prep, look at cervix, etc.

 

[MedicinePowder]

I think you would need more info (but not pushing you to share it) . . . i.e. fever, pulse, d stick, EKG, witnesses to seizure, seizure history, history of injestion, ETOH, substance abuse, history of trauma, Ob history, diabetes, etc. But I would say you've got one and possibly two sick patients so I would say do the pelvic. Get a cath UA at the same time tox screen, GC, Chlamydia, wet prep, look at cervix, etc.

Thanks for the reply.

Everything was done and everything was panning out normal. Including EKG, utox, blood tox. On foley placement by nurse, no blood on external exam. No past med hx.

Yes, two patients here, OB US shows normal IUP with good FHR.

The question is if a speculum exam was indicated. Ob didn't do speculum exam, only transabdominal US.

 

[CueDoc]

I think the key here is what you would be looking for on Spec exam. Typically you spec and check preg patients for r/o rupture(pooling, nitrazine, ferning). I think in this patient it is warranted. The biggest issue with this patient is whether or not she abrupted thus the transabdominal U/S. You would have also had to use a sterile speculum on this patient which we dont have in our ED

 

[totalbodypain]

You never know.....I pulled a 100 dollar bill out of a gorked out frequent flyer (known prostitute) my first year.....Right before xmas too.....

 

[WallowaWanderer]

You never know.....I pulled a 100 dollar bill out of a gorked out frequent flyer (known prostitute) my first year.....Right before xmas too.....

Yeah, I was going to say to look foreign body but I couldn't bring myself to it.

 

[totalbodypain]

Yeah, I was going to say to look foreign body but I couldn't bring myself to it.

I know how you feel. I still have nightmares.....

 

[kungfufishing]

that is probably my least favorite ED smell.

 

[WallowaWanderer]

I know how you feel. I still have nightmares.....

What did you do with the new-found cash? You're supposed to return it to it's rightful owner, but who knows who that is!

 

[sleepymed]

What did you do with the new-found cash? You're supposed to return it to it's rightful owner, but who knows who that is!

finders keepers.. losers weepers

 

[nocallaochicas]

finders keepers.. losers weepers

my grandmother always said money was dirty...in a couple of ways, but i don't think she was thinking about this

i think i will try to wash my hands after handling money often and will definately think about this story when I reach for my next $100 bill (which, thankfully or not, is not often)

 

[totalbodypain]

my grandmother always said money was dirty...in a couple of ways, but i don't think she was thinking about this

i think i will try to wash my hands after handling money often and will definately think about this story when I reach for my next $100 bill (which, thankfully or not, is not often)

I have to say that I was not tempted by that cash in the least.

 

[Dr. Dukes]

What did you do with the new-found cash? You're supposed to return it to it's rightful owner, but who knows who that is!

Boil it...twice. And then autoclave it. And then deposit it in the bank so you never have to hold it again...

 

[JackBauERfan]

You never know.....I pulled a 100 dollar bill out of a gorked out frequent flyer (known prostitute) my first year.....Right before xmas too.....

you know you just pocketed it haha...prob gave it to your girlfriend for xmas...