PELVIC PAIN Flashcards
MANAGEMENT
A - STRIDOR.
B - RESPIRATORY RATE. >/ 30, 02 sats 90% on Fi02 30%. Work of breathing. Tracheal Position. Chest wall crepitus / chest rise.
C - MOTTLED APPEARANCE. GCS. SKin Pallor. Diaphoresis / Clamminess. Cap Refill. Distal Pulses. Palpate Abdomen.
D - CHECK GLUCOSE. GCS, PERRLA, lateralizing signs
E - EXPOSURE, TAKE DOWN DRESSINGS
Monitor
O2 Target to 94%
Vitals
IV Access: 2 large bore IV
Equipment for Airway and ECG
POCUS: RUSH EXAM
INCLUDE PELVIC SCAN
H - Heart (four-chamber view and parasternal)
I - Inferior vena cava (check for volume status)
M - Morrison’s pouch/focused assessment with sonography in trauma exam (looking for free fluid)
A - Aorta (to identify AAA)
P - Pneumothorax (looking for tension pneumothorax)
GENERAL MANAGEMENT
intravenous fluids at 30 mL/kg intravenous fluids and reassess volume status.
Vasopressors:
Norepinephrine continuous infusion at a rate of 0.01-0.3 μg/kg/minute; titrate by 0.02 μg/kg/minute every 5 minutes
Vasopressin continuous infusion of 0.01-0.04 units/minute
Transfuse pRBC and FFP 2:1
Acetaminophen 1000 mg PO/PR q 6 hr. Caution with weight < 50 kg, Hepatic dysfunction
Toradol 10 mg IM. Avoid in renal disease, PUD, history of gastrointestinal bleed.
Ketamine 0.3 mg / kg slow IV push
Morphine 1-4 mg IV up to 10 mg q 4 hrs
Hydromorphone 0.2-0.5 mg IV up to 1 mg q 4 hrs
Ondansetron 4 mg IV
Metaclopramide 10 mg slow IV Can administer with diphenhydramine 25-50 mg intravenous as prophylaxis against dystonia.
Haloperidol or droperidol 1.25-5 mg IV / IM for intractable nausea/vomiting, acute on chronic abdominal pain, gastroparesis, and cannabis hyperemesis syndrome
INVESTIGATIONS
CBC
lytes
LFTs
BUN/Cr
Lactate
Coags
Type & Cross
β-hCG, +/- vaginal and cervical swabs
U/A
Resuscitation Considerations for Pregnancy Patients
Difficult Airway - airway edema, decreased FRC
Place patient on left side or on a wedge / pillow to alleviate aortocaval compression
Avoid a femoral line because of aortocaval compression
Transfuse Rh- blood if unstable / active bleeding in a pregnan patient
DOCUMENTATION
HISTORY
Mentrual History
Pregnancy History
History of STI
Past Sx History
Current Sexual History
Sexual Abuse
PHYSICAL EXAM
Tachycardia and Hypotension are reliable indicators of instability.
DO NOT be falsely reassured by stable vital signs or hypertension
Intra-abdominal bleeding may be heralded by Paradoxical bradycardia
Do a pevlic exam: external genitalia, speculum, bimanual.
Uterus reaches umbilicus at 20 weeks, grows 1 cm per week after.
DDx: Can’t Miss Diagnosis
OBSTETRICAL:
Ectopic Pregnancy
Placental Abruption / Uterine Rupture
GYNECOLOGICAL:
Ovarian Torsion
Pelvic Inflammatory Disease / Tubo-ovarian abscess
NON GYNE:
Testicular Torsion
Pyelonephritis
Obstructing Renal Stone
Appendicitis
Incarcerated Hernia
Fournier’s Gangrene
