Answer to above scenario ...
Ectopic Pregnancy in early stages of rupture.
Trapper .... good job in catching that.
If anyone would have asked, the Pt. was Gravida: 4, Para: 1 (she miscarried the first 2, had a full term for her 3rd, and then miscarried the 4th ). The last miscarriage was 8 months ago. She does not know if she is pregnant again. She hasn't checked.
All in all, good job in RO the appendicitis, but narrowing it down to the EP.
Quote:
Ectopic Pregnancy
What is an Ectopic Pregnancy? An Ectopic Pregnancy (EP) is a condition in which a fertilized egg has attached itself to anywhere other than the Uterine wall. Most EPs happen in either one of the fallopian tubes. “ This type of ectopic pregnancy is known as a tubal pregnancy.” (1) This type of EP happens in roughly 95% of the cases seen. The other areas prone to EPs would be for the egg to attach itself to the abdomen, the cervix, or within the ovary itself. Because the fallopian tubes were not designed to sustain a growing embryo, if an embryo were to attach itself to one of the tubular walls, as the embryo grows, it will stretch the fallopian tube to where it could eventually burst. The fallopian tubes are not designed to support a growing embryo. They are merely transport vessels, transporting an egg from the ovaries to the uterus. Studies have shown that, “An ectopic pregnancy occurs in about one in 50 pregnancies.” (2) So this is a very common occurrence and as EMS providers, this is something that we must be wary of in female patients complaining of lower abdominal pain. The most common occurrence of EPs happening are with woman “35 to 44 years of age.”(3) But an EP can happen in any sexually active age group.
The only true way to determine if a woman does have an EP is in the clinical or hospital setting. Through the use of either a pelvic or transvaginal ultrasound, can an MD determine if this is an EP. “Treatment options for ectopic pregnancy include observation, laparoscopy, laparotomy, and medication. Selection of these options is individualized. Some ectopic pregnancies will resolve on their own without the need for any intervention, while others will need urgent surgery due to life-threatening bleeding. However, because of the risk of rupture and potential dire consequences, most women with a diagnosed ectopic pregnancy are treated with medications or surgery.” (2)
As EMS providers the best treatment plan for a suspected EP would be to provide comfort care, pain management and treat for shock (if present). If the pain is present on the RightLower Quadrant of any female, don’t be fooled into thinking it is an appendix issue. A detailed physical exam along with a detailed history is important. Even in the above simulation, having to deal with the “language barrier” presented, getting a detailed history can be the difference in alerting the receiving facility to have the appropriate people standing by to deal with either an appendicitis or an ectopic pregnancy.
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