Welcome to the Emergency Medicine Cases Podcast. I'm your host, Dr. Anton Hellman, bringing you the brightest minds in emergency medicine from around the world. EMCases is brought to you by Shremi, the Schwartz-Riesman Emergency Medicine Institute. That's a non-profit organization dedicated to improving EM care through high-quality research and education. The opinions expressed on this podcast are intended for information and education purposes only and should not be used to diagnose treat or, or prevent any medical condition, nor should they be used as a substitute for medical advice from qualified practicing physicians.

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metricade.com slash EMC-A-S-E-S. It's 2.15 a.m. on a busy overnight shift. The waiting room is full. Paramedics roll in a 24-year-old woman on a stretcher, curled on her side, pale, diaphoretic, clutching her lower abdomen. She tells you that this pain feels just like the two last times she was in your emergency department, once three months ago

and once six months ago, but this time it's much worse. She's vomiting, non-bilius, non-bloody

emissus, she's having difficulty standing upright. She says her menstrual period started this

morning, and the pain ramped up very quickly over a few hours.

Her vitals are the following.

Heart rate, 118, blood pressure, 108 over 64.

She's afebrile, respiratory rate is 22, and her oxygen saturation is 99% on room air.

She tells you she's had bad periods since high school. She missed school, she missed

work, and she's been told she has ovarian cysts. Last ED visit showed a small hemorrhagic

ovarian cyst on ultrasound. She was discharged with inseds and told to follow up with

gynecology.

She unfortunately never got that appointment.

She doesn't have a family doctor.

You're thinking about what to order.

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