Month: April 2017

1st Trimester Vaginal Bleeding

April 30, 2017 / Zack

Five Important Tests in 1st Trimester Vaginal Bleeding

CBC
- Hemoglobin/Hematocrit
  - Mild anemia in pregnancy is physiologic and normal
- Thrombocytopenia
Type and Screen
- Required for blood transfusion
- Determines if patient needs RhoGAM
  - Rho(D) immune globulin
    - Binds fetal Rh antigens from a fetus so that mother doesn’t develop antibodies against future Rh positive children
    - Prevents hemolytic disease of the newborn
    - Give to Rh negative mothers to protect future Rh positive children
Quantitative hCG
- hCG >1500
  - “Cutoff” where definitive pregnancy should be seen on ultrasound
  - If no pregnancy is seen, highly concerning for ectopic pregnancy
- hCG <1500
  - Ectopic pregnancy still possible
  - Common for healthy early pregnancies to not be visualized below this level
Urinalysis (UA)
- Treat asymptomatic bacteriuria in pregnant patients
  - One of the only times UTI should be treated in asymptomatic patients
  - Theoretical increased risk of miscarriage
Pelvic ultrasound
- Evaluates for ectopic pregnancy
- Subchorionic hemorrhage
- Miscarriage

Additional Reading

April 23, 2017 / Zack

Common Causes of Constipation

Lifestyle
- Low fiber diet
- Minimal water intake
- Poor exercise
Medications
- Especially opiates
Endocrine/electrolytes
- Hypothyroidism
- Hypercalcemia
Bowel obstruction
- Delayed colonoscopy
- Unintentional weight loss
- Previous abdominal surgeries
Rectal problems
- Anal fissures
- Fecal impaction
- Masses

How to Treat Constipation

Fiber (ex. Metamucil, Citrucel)
- Adds structure to the stool
Water (polyethylene glycol/miralax)
- Hydrates the stool
Fat (colace)
- Softens the stool
Stimulants (Senna)
- Increases intestinal activity
- Decreases transit time
Suppositories (Glycerine, Dulcolax, Fleet)
- Stimulate rectum and cause reflexive bowel movements

Additional Reading

April 2, 2017 / Zack

Signs and Symptoms

Step 1: Test for DIABETIC-KETO-ACIDOSIS

Diabetes
- Blood sugar
  - Typically notably elevated (>250 mg/dL)
  - Can be normal in certain circumstances
Ketones
- Easiest test is a urinalysis
- Serum ketones also can be obtained
Acidosis
- Blood gas (arterial or venous)
  - pH <7.3

Step 2: Check Potassium Level

Step 3: Replace Potassium

If potassium <3.3, do not give insulin
- Replace potassium prior to insulin
If potassium >3.3 but <5.5
- Consider supplementing potassium at this point
- May continue insulin

Step 4: Give Fluids

Step 5: Start an Insulin Drip

This accomplishes 2 things…
- It decreases blood sugar
- It also decreases acid production

Additional Reading