Hi, this is Steve Carroll and you're listening to EM Basic.

Today we're going to talk about first trimester vaginal bleeding.

Yeah, I know this isn't the most exciting emergency medicine topic out there,

but it's something that we deal with a lot.

The medicine here can seem very cookbook at times,

but there are many different pitfalls that we need to be aware of.

Also, we need to know how to talk to the patient and her family about what's going on, which

can be far more difficult than the actual workup itself. As always, this podcast doesn't represent

the views or opinions of the Department of Defense, the U.S. Army, or the Soshchak Emergency Medicine

Residency Program. In addition, I just want to make it clear that I don't take money from drug

companies or device manufacturers.

I know that this may seem a little overkill since I'm still a resident, but I think it's important for everyone to be honest about any possible conflicts of interest.

If this ever changes, I'll be the first to let you know, but I really don't ever see it happening ever.

So, let's get started.

So the shark comes to you and it usually say say pregnant vaginal bleeding at X number of weeks.

Always be sure to scan the vitals and look for any unstable vital signs and take note of any reported G's and P's that the triage nurses may have noted and make sure to actually read the triage note.

When you go see the patient, ask her what brings them in.

See if they can quantify how much bleeding they are having.

You want to ask about any cramping, abdominal pain, nausea, or vomiting.

Also ask about any discharge, itching, or any other vaginal complaints.

Also ask about any chest pain, shortness of breath, presyncope, or syncope that may signal excessive blood loss.

Oftentimes, patients are concerned because they saw blood when they wiped after using the bathroom, so try to quantify this as well.

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