Podcast: Play in new window | Download
Think A-B-C-P (Airway, Breathing, Circulation, Pregnancy Test) in ALL Women of Child-Bearing Age!
- It changes the differential diagnosis
- It changes the medications you can give
- It changes the tests you can order
Vaginal Bleeding Pearls
- Non-pregnant vaginal bleeding
- Order a pelvic ultrasound (for structural causes)
- Order a CBC and coagulation panel (for anemia and coagulopathy)
- Pregnant vaginal bleeding
- If sick…
- Think ectopic pregnancy (early pregnancy)
- Think uterine rupture (late established pregnancy)
- Think placental abruption (recent trauma or cocaine)
- Don’t forget to order a type and screen
- Rh- mothers will need RhoGam
- If patient is unstable and you can’t wait for blood type…
- Transfuse type O negative blood
- If sick…
- Postpartum vaginal bleeding
- Most common cause is retained products of conception
- Order an ultrasound
- Consider endometritis if patient also has fever
- Treat with clindamycin and gentamycin
- Most common cause is retained products of conception
Vaginal Discharge Pearls
- Cervical motion tenderness?
- Pelvic Inflammatory Disease (PID)
- Thin, grey, and smells like fish?
- Bacterial vaginosis (BV)
- Treat with metronidazole
- Warn patient not to mix metronidazole with alcohol
- Bacterial vaginosis (BV)
- Thick like cottage cheese?
- Vulvovaginal candidiasis
- Diagnosis with KOH prep
- Look for yeast and pseudohyphae
- Treat with fluconazole
- Diagnosis with KOH prep
- Vulvovaginal candidiasis
- Thin Yellow/Green and “frothy”?
- Trichomoniasis
- Diagnose with wet prep
- Look for mobile organisms
- Treat with metronidazole
- Partners should be checked and treated too
- Trichomoniasis
Ovarian Torsion
Severe and sudden pain
- Can be intermittent
- Diagnose with Pelvic ultrasound with Doppler
- PITFALL: Frequently has normal arterial flow (dual blood supply to ovary)
Additional Reading
- Approach to Non-Pregnant Vaginal Bleeding (EM Clerkship)
- Approach to 1st Trimester Vaginal Bleeding (EM Clerkship)
Just wanted to say thanks for putting this on and for all of your hard work! It has been super helpful. I really enjoyed the question and answer review format as well. Many podcasts just talk about topics; however, when questions are asked it helps to engage the listeners more and improve retention of the material. I wish there were more podcasts that followed a similar format so learners could quiz themselves on the go.
Thank you for making these podcasts and review handouts. I was coming off of a 3 month vacation due to COVID 19 and your content made it easy to get back into the swing of things. I’m currently going over your board review sessions before taking the SAEM M4 clerkship exam and I have found them to be really helpful.
Awesome, we’re glad you are finding it useful. More to come!
I’m in my third year of med school and currently completing my EM rotation. This podcast has been so amazing to listen to and I’m looking forward to finishing up the many other episodes I haven’t listened to yet. I really enjoyed Mike’s NBME Shelf Review series and am using them to help prepare for my upcoming exam. Thank you guys so much!
You’re welcome, Good luck with your exam!