REBEL Core Cast – Basics of EM – Vaginal Bleeding

Take Home Points

• Get a upreg on any childbearing age female with vaginal bleeding – this is an ectopic pregnancy until proven otherwise
• Confirm vaginal vs rectal bleeding – it can be hard for patients to tell, especially the elderly
• Quantify the amount of blood loss – soaking thru >1 pad/hr is a lot
• Ask about Rh status – if pregnant and RH (-), give rhogam
• Perform a POCUS exam to look for IUP or free fluid in the abdomen
• US findings – BOTH a gestational sac and yolk sac are needed to confirm an IUP
• Remember the discriminatory zone of beta quant levels – if >1500 and no IUP – be concerned for ectopic
• If beta quant is <1500, and no pregnancy is seen on u/s, give strict return precautions and repeat u/s in 48 hours

REBEL Core Cast – Basics of EM – Vaginal Bleeding

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Co-Host

Post Peer Reviewed By: Anand Swaminathan, MD (Twitter: @EMSwami)

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