Episode 7: Medical and Surgical Emergencies in Pregnancy

Emergency Medicine Cases

Dr. Anton Helman

Science, Courses, Medicine, Health & Fitness, Education

4.7 • 602 Ratings

🗓️ 1 August 2010

⏱️ 87 minutes

🔗️ Recording | iTunes | RSS

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Summary

The whole playing field changes with pregnant patients in the emergency department. When you're faced with one of the Medical and Surgical Emergencies in Pregnancy that we'll cover in this episode, there are added challenges and considerations. Dr. Shirley Lee and Dr. Dominick Shelton discuss a challenging case of a pregnant patient presenting to the emergency department with shortness of breath and chest pain. They review those diagnoses that the pregnant patient is at risk for and discuss the challenges of lab test interpretation and imaging algorithms in the pregnant patient. Next, they walk us through the management of cardiac arrest in the pregnant patient. In another case of a pregnant patient who presents with abdominal pain and fever, they discuss strategies to minimize delays in diagnosis to prevent serious morbidity and mortality. The pros and cons of abdominal ultrasound, CT and MRI are reviewed as well as the management of appendicitis, pyelonephritis and septic abortion in pregnant patients.

Transcript

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0:00.0	Welcome to Emergency Medicine Cases.com.
0:07.7	I'm your host, Dr. Anton Hellman, bringing you Canada's brightest minds in emergency
0:12.1	medicine from EMC Studios in Toronto.
0:20.0	Our expert guests for this episode number seven on medical and surgical emergencies in pregnancy are Dr. Shirley Lee and Dr. Dominic Shelton. Dr. Shirley Lee is an emergency physician and director of education at the Mount Sinai Hospital in Toronto. She's an associate professor at the Faculty
0:38.6	of Medicine at the University of Toronto. She has served in a number of capacities at the
0:43.4	undergraduate, postgraduate, and CME level at the University of Toronto. Dr. Dominic Shelton
0:49.0	is an emergency position at Sunnybrook Health Sciences Center and Women's College Hospital
0:53.4	in Toronto. He is a former director of the Emergency Center and Women's College Hospital in Toronto.
0:59.1	He is a former director of the emergency department at Women's College Hospital as an assistant professor at the University of Toronto.
1:02.6	I don't know about you, but when I see a pregnant patient who presents to the ED looking
1:07.0	really sick or has some non-obstetrical complaint, my worry meter goes through the ceiling.
1:13.5	Why? Because pregnancy changes everything. Their presenting symptoms can be misleading or confused with
1:20.2	normal pregnancy. Their vital signs are normally altered. The physical exam can often be more difficult.
1:27.1	Their lab values are harder to interpret. You need a
1:30.3	fellowship degree in radiology to figure out the best imaging algorithms. Half of the drugs we use in the
1:35.8	ED cannot be used in pregnancy. The outcomes of medical and surgical emergencies are worse in pregnant
1:41.3	patients. Our surgical and medical consultants are also scared of them.
1:45.8	And of course, we're managing two patients, where one of which the fetus can give us no history
1:51.9	and we can't do a physical. To top it off, there is scanty evidence for anything we do in pregnant
1:57.9	patients since we'd be unethical to enroll pregnant patients in
2:01.6	experimental studies. But don't fret. Today on emergency medicine cases, we have with us, Dr. Shirley Lee,
2:09.9	a world-renowned leader in medical education, and Dr. Dominic Shelton, who has given some
	...

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