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, fetal heart 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
This site last edited:
June 2008