team what's up zak here from med geeks so as I pick up more per diem shifts in the

er I've been seeing more and more chief complaints of my dreaded vaginal bleeding

at first I avoided these patients as much as I could because this is not your everyday complaint in the medical

ACU, AKA, really I had no idea how to approach this patient.

I mean the last time I did a speculum exam was when I was a

student. So I challenged myself to see more of these patients with this

complaint so that I could really develop a good diagnostic algorithm and management plan for these patients.

So now I wouldn't say that I'm a pro, but at least I know the right history questions to ask exams

to perform and diagnostics to order so that I don't miss any life-threatening

problems and most importantly know where to get help.

So today I want to discuss the approach to the vaginal bleeding patient,

aka what's normal bleeding?

What are the red flag emergencies that you just don't want to miss?

What are the common causes?

What diagnostics are we ordering to help us rule out and figure out what's going on?

So without further ado, how do we approach vaginal bleeding?

So quick introduction. Before we dive into abnormal

vaginal bleeding, let's quickly review what normal is. So if you remember from your

OB Gyan lecture from school, the menstrual cycle is broken down into the first half known as the follicular phase, and then there's a second half known as the ludio phase.

So first half follicular, second half ludial. During that first

half the follicular phase, the hypotheramus decrees gonatotropin releasing hormone which stimulates the pituitary to release two important hormones,

the lutinizing hormone and the follicle stimulating hormone.

...