MedBugs: SAQ #88

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Case: RIF pain

A 34-year-old female has been brought in by ambulance to your tertiary hospital with right iliac fossa pain. She appears in distress and the ambulance has cannulated her and given 2.5mg morphine IV. She is otherwise well with no regular medications or allergies. Her vitals on arrival to ED are as follows :

HR 95
BP 100/75
RR 16
Sats 97% RA
Temp 36.7

1. Apart from ectopic pregnancy, give (5) differentials and for each differential state (1) discriminatory factor in history or examination 5 marks

On further questioning, she states she has been having PV bleeding overnight and her last menstrual period was 6 weeks ago. You are suspecting ectopic pregnancy.

2. List (5) risk factors that would increase the risk of ectopic pregnancy 5 marks

You organise an urgent USS for the patient to confirm ectopic pregnancy.

3. Identify the arrowed features on the USS 3 marks

4. Based on the findings above what is your suspected diagnosis? 1 mark

The RN has come to find you to let you know that your patient has now suddenly become hypotensive, distressed with abdominal pain and increased PV bleeding. Her vitals now are HR 128bpm, BP 70/50, GCS 15, sats 93% RA

5. What is your management of this patient? ( 4 marks

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