Hi bodies!
L’article d’aujourd’hui est une belle histoire, racontée par notre collègue et ami le Dr Carlos Lojo Rial, urgentiste au Kingston and Richmond NHS fondation Trust. Elle nous conforte dans le fait que l’échographie est parfois décisionnelle (mais qui en douterait encore?) et peut sauver des vies. Mais aussi, elle dépasse un peu le cadre strict de l’échographie : elle nous rappelle toujours d’être très vigilant en médecine d’Urgence!
Je le laisse parler juste après, c’est en anglais donc vous bosserez votre médecine et aussi la langue de Shakespeare, all in one folks!
Si tu veux en savoir un peu plus sur lui c’est ici : https://www.kingstonandrichmond.nhs.uk/services/consultants/dr-carlos-lojo-rial
Check this out!
And happy scanning !
Hi all,
I just wanted to highlight a very unusual case today from Resus of a 40ish year old patient 12/40 weeks pregnant who presented with severe abdominal pain.
Near collapse while awaiting in the corridor despite normal original observation.
Moved her to Resus (Resuscitation Unit), she went into shock.
Artery line inserted. Blood products and Noradrenaline started peripherally. Broad spectrum antibiotics given.
Gynae SR performed a transabdominal echo which showed intrauterine pregnancy no foetal heart beat.
- Differential of septic miscarriage ? DIC?
- Differential also including cornual or interstitial ectopic or transmural haemorrhage. Uterine artery going along the uterine wall see below:
FAST scan with us was positive for free fluid :
Major hemorrhage protocol started in view of the free fluid despite the « intrauterine pregnancy ».
The patient was optimized for surgery in the ED and did well despite 4-5L of blood intraperitoneal.
This is first of all to highlight was a brilliant team we have in Resus so THANK YOU for your hard work.
But also, to highlight that although the majority of ectopics will happen around the 8 weeks marks because of the size of the fallopian tube, some very rarely will happen in the interstitial area or cornual area and those may look like intrauterine pregnancy. Some also have anatomical variation as described in the infographics below:
This is the second one in my career and helps to simply think that:
Early pregnancy and severe pain even beyond 8 weeks = THINK ECTOPIC
Call Gynae EARLY if you recognise that the patient is unwell
This is I think the 4th ruptured ectopic since I started here so be vigilant
Thank the Resus team = ED ROCKS
Carlos
