Prima

Management of Medical Emergency

Physical Exam

Pay attention to ABCs:

> Airway maintenance and C-spine control
> Breathing and ventilation
> Circulation (blood pressure, pulse, need for IV fluids?)
!! Focus on BP, pulse, level of consciousness, size and reactivity of pupils

General Appearance

> Hygiene
> Needle marks, nasal septum erosions
> Fatigue
> Mucous membranes
> Weight
> Odours
> Signs of overdose or withdrawal
> Signs of trauma, seizures

> Vital signs: temperature, blood pressure, pulse, respirations
> Neurological: size and dilation of pupils, mental status
> Abdomen: tenderness, rebound, guarding of abdomen,
   symphysis fundal height, fetalheart rate and pattern
> Pelvic: assess for bleeding; perform sterile speculum exam
   (if unknown placental location); examine cervix (if history of
   abdominal pain or contractions); assess for uterine tenderness
> Assess for contractions by palpation or with tocometer

Investigations

> Urine drug screen with consent (consent not needed if emergency situation) (See Toxicology testing section)
> Prenatal bloodwork, hepatitis C antibody, HIV
   (obtain informed consent)
> Ultrasound
   (to rule out placental problems and to assess fetal well-being)

Management

> Treat the intoxication
> Consider management of withdrawal
> Consider child protection concerns (no legal duty to report unborn
   infant; presence of other children in woman’s custody may require
   earlier referral) (See child protection)
> Ensure obstetrical follow-up
   (improved outcomes with prenatal care alone)
> Refer to shelter if social instability or domestic violence

!! Indications for Inpatient Management

> Suicidal ideation
> Opiate withdrawal
> Acute psychosis
> Benzodiazepine withdrawal
> Alcohol withdrawal
> Desire to undergo detoxification