Obestetrical Scenario

Alan L Serve said:

Every female of child bearing age is considered pregnant until proven otherwise by a confirmed laboratory test. I repeat: Every female of child bearing age is considered pregnant until proven otherwise by a confirmed laboratory test. I repeat again: Every female of child bearing age is considered pregnant until proven otherwise by a confirmed laboratory test.

"I can't be preggers! It's IMPOSSIBLE! I'm on b-control, he uses condoms, and I'm a lesbian who has never had sex with a man, and I live in seclusion on the top of a mountain with not a single human being around doing yoga 24/7/365!" Turned out she was preggers and they did an abdominal CT scan for her abd pain while believing her story that she couldn't possibly be preggers. The baby waved and gave the middle finger to the CT tech for the unnecessary high dose of radiation and for believing the mom.

Say it again with me, ok?: Every female of child bearing age is considered pregnant until proven otherwise by a confirmed laboratory test.

Once get those confirmed laboratory results back which show negatives for pregnancy then you can consider others items on your differential such as food poisoning, viral GI, etc.

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Alan L Serve said:

Every female of child bearing age is considered pregnant until proven otherwise by a confirmed laboratory test. I repeat: Every female of child bearing age is considered pregnant until proven otherwise by a confirmed laboratory test. I repeat again: Every female of child bearing age is considered pregnant until proven otherwise by a confirmed laboratory test.

"I can't be preggers! It's IMPOSSIBLE! I'm on b-control, he uses condoms, and I'm a lesbian who has never had sex with a man, and I live in seclusion on the top of a mountain with not a single human being around doing yoga 24/7/365!" Turned out she was preggers and they did an abdominal CT scan for her abd pain while believing her story that she couldn't possibly be preggers. The baby waved and gave the middle finger to the CT tech for the unnecessary high dose of radiation and for believing the mom.

Say it again with me, ok?: Every female of child bearing age is considered pregnant until proven otherwise by a confirmed laboratory test.

Once get those confirmed laboratory results back which show negatives for pregnancy then you can consider others items on your differential such as food poisoning, viral GI, etc.

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Remi said:

I think a better way to put this is that every pre-menopausal female has the potential to be pregnant.

This possibility may or may not be clinically relevant. But the fact is, when a female says "I know I'm not pregnant", the vast majority of the time they are right.

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coffeegal said:

Here is a scenario I came up with for my capstone project, tell me what you think:
TOPIC: Obstetrics
DISPATCH: MED 123 respond emergency traffic to a sick person at 123 Hawthorne Ln. Cad Notes: 20 YOF, nauseated and vomiting. Caller hung up.
BSI/PPE: Gloves
SCENE SIZE UP
Scene is safe
MOI/NOI: N/V
# of patients: 1
Additional Resources: Fire Department is on scene
C-Spine: not indicated
PRIMARY
GI: You arrive to the pt’s residence and go inside the house. Your patient, 20 YOF, is in the hallway bathroom leaning over the toilet vomiting.
LOC: Alert and oriented
CC/Life Threats: N/V
A: Patent
B: 22RR, normal, 98% on room air, L/S clear and equal.
C: Strong radial pulse, no major bleeding, skin pale, diaphoretic, cool.
HISTORY
Onset: Started about a week ago with N, just started throwing up yesterday morning, but it went away about 11, and came back this morning.
Provocation: “Nothing helps”
Quality: N/A, no pain
Radiation: N/A
Severity: N/A, no pain. Threw up three times yesterday, hasn’t stopped today
Time: Started again when I woke up this morning.
S: N/V, approx 100mL fluid loss noted in the toliet
A: Codeine, Ibuprofen
M: Multivitamin, Allergy meds, Birth Control
P: No history
L: Dinner last night
E: Just woke up
SECONDARY
-Cardiovascular: Sinus Tachycardia 124HR
-GI/GU: Last ate a chicken and rice for dinner, staying hydrated with water, urinating normally, LBM yesterday.
-Reproductive: LMP last month, supposed to start 5 days ago for this month. Just got married last month, sexually active, but takes birth control.
VITALS
110/62; 122HR; 20RR; 98% on room air; BGl 74; Sinus Tachycardia
116/64; 110HR; 18RR; 98%; Sinus Tachycardia
DIAGNOSIS: Hyperemesis Gravidarum (Morning Sickness)
INTERVENTIONS: IV, Fluids, Zofran, Oxygen
TRANSPORT: Routine to closest facility.

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savemachine said:

That was an amazing report that you reported about. It was well in depth and very thorough in the reporting status. I can remember doing those very in depth nursing reporting and I also remember doing nursing care plans as well; especially with my patients when I was in clinical rotations as a student nurse. I was in obstetrics and geriatric and I had to do the complex reporting and case work too. We did lots and lots of scenarios like this and it was extremely helpful in nursing critical thinking and it also helped me in my critical thinking skills. I really am thankful for this scenario because it helps so many nursing students.

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savemachine said:

That was an amazing report that you reported about. It was well in depth and very thorough in the reporting status. I can remember doing those very in depth nursing reporting and I also remember doing nursing care plans as well; especially with my patients when I was in clinical rotations as a student nurse. I was in obstetrics and geriatric and I had to do the complex reporting and case work too. We did lots and lots of scenarios like this and it was extremely helpful in nursing critical thinking and it also helped me in my critical thinking skills. I really am thankful for this scenario because it helps so many nursing students.

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ERDoc said:

This. I had a woman in her late 30s who had a tubal ligation and was on OCPs for cycle regulation come in with abd pain. Admitted to OB for her ectopic.

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savemachine said:

I hope that they are going to be OK. I can remember when I was called into work one morning very early and it was because my co-worker called in with abdominal pain and was in the emergency room. When they checked her, they found out that she was pregnant, but the embryo was in her fallopian tubes and that was causing the pain. I believe that they had to take the baby and do a D@C. She was about 3 weeks pregnant I believe. It is hard when that happens. I truly hope that the patient will be OK and will be back on their feet soon.

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savemachine said:

I hope that woman in her late 30's is OK and feeling well. It is always good that EMS personnel understand the symptoms of certain conditions and start treatment early even before nurses get to see the patients. I praise the EMS personnel very much.

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FLMedic311 said:

Any one have concerns with the use of Zofran during pregnancy with the recently release of some data suggesting an association of heart defects or cleft pallet??

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ERDoc said:

This. I had a woman in her late 30s who had a tubal ligation and was on OCPs for cycle regulation come in with abd pain. Admitted to OB for her ectopic.

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