Latest Medical Decision Making Tools
Vaginal Bleeding in Early Pregnancy
Vaginal bleeding in early pregnancy. Threatened miscarriage and ectopic pregnancy are of concern. Vaginal bleeding with a viable intrauterine pregnancy can occur in 20% of normal pregnancies. Urine infection is estimated to cause 8% of bleeding in pregnancy. Consideration of pain secondary to corpus luteum. Other considerations include causes not associated with pregnancy such as ovarian pathology, fibroids, or appendicitis.
Ultrasound and quantitative HCG to look for to look threatened miscarriage, Ectopic pregnancy, or subchorionic hemorrhage. Complete blood count for anemia or infection[- with blood type and Rh factor to assess for Rh incompatibility-]. Electrolytes to look for imbalance and liver function tests to screen for other intrabdominal sources of pain. Urinalysis to screen for UTI, a possible source of bleeding.
Diarrhea/Vomiting
Adult
History and exam consistent with likely viral gastroenteritis. No frank abdominal pain, recent antibiotic use, contaminated water exposure, or dietary/medication changes. No evidence of obstruction, inflammatory bowel disease, or other surgical pathology.
[-No blood in stool and timing does not warrant stool studies at this time.-] [-CBC and electrolytes ordered to assess for dehydration or infection.-] [-Will provide hydration.-]
Will treat symptomatically with [-Zofran ODT for nausea/vomiting and probiotics for diarrhea-]. Patient stable for outpatient management with return precautions for worsening symptoms, inability to tolerate oral intake, or development of new abdominal pain.
Pediatric
History and exam consistent with likely viral gastroenteritis. No focal abdominal pain, bilious emesis, hematochezia, or signs of obstruction or surgical abdomen. No recent antibiotic use to suggest C. difficile. No concerning exposures or ingestion history. Hydration status [-mildly/moderately/severely-] affected.
[-No blood in stool and timing does not currently warrant stool studies.-]
[-CBC and electrolytes ordered to assess dehydration severity.-]
[-Will provide oral rehydration therapy. Will consider IV hydration if unable to tolerate PO.-]
Symptomatic treatment with [-ondansetron for nausea-]. Family instructed on oral rehydration strategies and signs of worsening dehydration. Patient appropriate for outpatient management with strict return precautions for persistent vomiting, inability to maintain hydration, decreased urine output, worsening abdominal pain, or lethargy.
Burn
History and exam consistent with first and second-degree burns involving less than 3% TBSA. [-Will debride ruptured blisters/Will pad existing blisters/No blisters requiring padding-]. No evidence of inhalation injury, circumferential involvement, or compartment syndrome. Mechanism consistent with [-thermal/chemical/electrical/radiation-] burn. No signs of secondary infection or systemic toxicity.
Will treat with topical antibiotics and provide analgesia as needed [-including short course of narcotic analgesia for breakthrough pain-]. Tetanus prophylaxis is [-up-to-date-]. No involvement of high-risk areas (face, hands, feet, genitalia, major joints). Suitable for outpatient management with wound care instructions and return precautions.
Back Pain
Mechanical/nonspecific low back pain accounts for approximately 90% of cases and typically involves paraspinal muscle strain, ligamentous injury, or facet joint dysfunction. No mechanism to suggest fracture or subluxation, no point tenderness to suggest osteomyelitis, other infection. Timing does not suggest malignant process. No evidence for cauda equina syndrome. No radicular pain or focal neurologic finding to suggest disk injury or nerve impingement. Nothing in history or exam to suggest renal, urinary, or intra-abdominal/pelvic etiology for pain. No indication for emergent imaging.
Symptomatic management and follow up with physical medicine if not significantly improved in 1-2 weeks.
Chest Pain
[-Chest pain-] evaluation contains a wide differential diagnosis. [-D-dimer to screen for pulmonary embolism-].
Ordered electrolytes for baseline assessment and to guide management if CT scan becomes necessary. CBC to assess for infection or anemia that may contribute to presentation. [-BNP to evaluate for congestive heart failure. -] Chest x-ray to evaluate for pneumonia, pulmonary edema, or signs of CHF.
EKG and troponin to evaluate for cardiac injury. [-Will consider serial studies for evolving cardiac injury.-]
[-Prophylactic aspirin and nitroglycerin considered. Nebulizer for possible reactive airway process. Lasix for possible CHF.-]