Hello, med students. My name is Zach Olson and thank you for downloading this episode of the EM Clerkship Podcast.

Today, we're going to hit a core topic, vaginal bleeding, specifically first trimester vaginal bleeding.

This is common.

You absolutely will see this on your clerkship, quite possibly on your next shift.

And as always, you will look really, really smart if you know exactly what to do when these patients come into the department.

And specifically, what we're going to focus on today is what tests your attending is going to want you to order.

Now with any vaginal bleeding or abdominal pain, or to be honest, any host of symptoms in young females, the most important thing to remember is that

pregnancy test. The point of care pregnancy test is one of your top three most important stat tests

in all of emergency medicine. We get it all the time right away. The other two being EKG and a finger stick blood glucose.

But the urine or blood HCG, that pregnancy test, is right up there with those other two in females of reproductive age.

Think of it as the EKG of young females.

So this patient, let's say, has vaginal bleeding.

Let's say they've been in triage and they had

a pregnancy test, which is positive. You do your initial evaluation, you ask your questions,

and now let's go through the five tests that you are going to order. Step one, recommend a CBC.

Both the hematicrit and the platelets are important here.

You need these with all bleeding patients really, but this one is kind of self-explanatory.

The only thing to add here is that pregnant females do get a physiologic anemia of pregnancy because of increased

plasma volume. Usually no big deal. But again, get a CBC. You're looking at that hematicrit. You're

looking for those platelets. Step two, type and screen. Why? Well, I suppose partially in case you need to give a blood transfusion, but really, this is usually

secondary to the question of whether you need to give Rogam.

This is a pimp question you are going to get.

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