1. Book Review
Drew Paulson, MD
Chap

2. “Whinee Gynee”
Complications of Gynecologic Procedures

3. The most common reasons for ED visits during the postoperative period following gynecologic procedures are (3)…

4. Pain
Fever
Vaginal Bleeding

5. After laparoscopy, patients may have pain radiating to their shoulder for several days because of remaining…

6. CO2 Bubbles

7. The major complications associated with laparoscopy are…

8. Thermal injury of the bowel
Perforation of a viscus
Bleeding/Vascular injury
Bladder/Ureteral injury
Incisional Hernia
Wound dehiscence

9. Complications of Hysteroscopy include…

10. Fluid Overload
Uterine Perforation
Infection
Toxic Shock Syndrome
Postoperative Bleeding
Embolism (CO2)
Anesthesia Reaction

11. The entry of _______ into the circulation can lead to pulmonary edema & DIC

12. Dextran
No more than 500ml should be used during the procedure

13. Early postoperative infections, especially cellulitis, are treated with what class of antibiotics?

14. Penicillins (parenteral)

15. Septic Pelvic Thrombophlebitis consists of the following signs/symptoms…

16. Fever
Tachycardia
GI Distress
Unilateral Abdominal Pain
Palpable Abdominal Cord (50-67%)

17. Treatment of Septic Pelvic Thrombo-phlebitis consists of…

18. Antibiotics (Clindamycin)
Heparin
Antibiotics (Clindamycin)
Coverage against heparinase-producing Bacterioides species
Treatment for 7-10 days

19. What should be avoided in a female patient presenting to the ED with abdominal pain/distention, weight gain, & ovarian enlargement, & a history of assisted reproductive therapy?

20. Abdominal Examination Pelvic Examination
Defer these exams until consulting a GYN
Due to extremely fragile ovaries that are at high risk of rupture &/or hemorrhage, & torsion

21. “Don’t be a PUS…”
Pelvic UltraSonography

22. Transabdominal US is best performed with a _________ Bladder, while a Trans-vaginal US is best performed with a _________ Bladder.

23. Transabdominal = filled bladder
Transvaginal = empty bladder

24. The first sonographic finding in early pregnancy is what?

25. Gestational Sac
4-5 weeks
BhCG 1000

26. Gestational Age can be determined by measuring (3)…

27. Gestational Sac Diameter
Crown-rump Length
Biparietal Diameter

28. Gestational Age (GA) Mean Sac Diameter (MSD) MSD = (L + W + D)/3
GA (days) = MSD (mm) + 30

29. Gestational Age (GA)
GA (wks) = CRL (cm) + 6.5

30. After the 1st trimester, gestational age should be measured by which technique?

31. Biparietal Diameter

32. The best initial test to rule out an ectopic pregnancy is…

33. Transvaginal Ultrasound

34. The inability to visualize a yolk sac or embryo in a large gestational sac is referred to as a…

35. Blighted Ovum

36. Bleeding in the endometrial cavity between the chorionic membranes & the uterine wall during pregnancy is called…

37. Subchorionic Hemorrhage/Hematoma

38. Sensitivity of US for evaluating placenta previa is ______________, while Sensitivity of US for evaluating placenta abruption is _______________...

39. Placenta Previa = highly sensitive
Placenta Abruption = not very sensitive

40. “I Ain’t Queer & Stuff”
The Normal Child

41. How do you approach a child in the ED?

42. In a positive & gentle manner
First impressions count
Be honest & tell them what to expect

43. True or False:
When a parent states, “This is not my child”, it is best to assume he/she is over-reacting.

44. False!

45. How do you estimate the weight of a child between 1 & 12 years of age?

46. Weight (kg) ~ (2 x Age) + 10

47. What vaccination is given at birth?

48. Hepatitis B Vaccine

49. What vaccine is given at 11-12 years of age?

50. Td

51. What are the milestones of early infancy (0-6 months)?
Motor
Verbal
Social

52. Motor = lifts head, reaches
Verbal = cooing
Social = responsive smile

53. A minor (under 18) should be evaluated but not receive treatment in the emergency department without consent obtained from a parent or legal guardian, with the following exceptions:

54. Life or Limb-threatening emergency State-Protected right to treat
Child abuse
Pregnancy-related complaints
STD’s
Substance abuse
Outpatient mental health (some states)

55. State-defined “emancipated minor” status
Married
Member of armed forces
Self-supporting & living independently

56. “I’ve Got a Fever, and the only Cure is More Cow Bell”

57. What is the Rochester Criteria for low-risk bacteremia in infants < 3 months of age?

58. Nontoxic appearance
No soft tissue infections
WBC ,000
Normal Urinalysis
Stools < 5 WBC/hpf with diarrhea

59. Risk of serious bacterial infection in the absence of these variables is 0.2%

60. The body looses heat in 4 ways:

61. Radiation (60%)
Evaporation (25%)
Convection (10%)
Conduction(5%)

62. “I think She’s Sick, & I want some too?!”
Bacteremia, Sepsis, & Meningitis in Children

63. What are the top pathogens in neonates (0-28 days)?

64. Group B Strep
E. Coli
Listeria
Enterococcus sp.

65. What are the top pathogens in older infants (3-36 months)?

66. Neisseria Meningitidis
Strep Pneumonia
Neisseria Meningitidis
H. Flu
Group A Strep
E. Coli (pyelonephritis)
Salmonella (gastroenteritis)
Staph Aureus (osteomyelitis)

67. If the kid looks sick, the kid is probably…

68. Sick.

69. True or False: The finding of a minor focus of infection (URI, UTI, OM) excludes the possibility of bacteremia or serious bacterial infection

70. False

71. What are general comments in the History that suggest a febrile infant is at Low-Risk for a SBI?

72. Full Term (>37 weeks gestation)
No prior infection or medical problems
No current antibiotics

73. What are some indications for obtaining blood cultures in children?

74. Unexplained ill appearance (fever or not)
Febrile neonates
Febrile infants up to 90 days
Febrile children with immune deficiency
Clinical sepsis
Clinical meningitis
Pneumonia requiring admission

75. Pyelonephritis (<6 months or admission)
Bacterial enteritis (<24 months)
Facial cellulitis
Septic arthritis
Osteomyelitis

76. Antibiotics for Neonatal Sepsis & Meningitis

77. Ampicillin 100mg/kg plus:
Cefotaxime 50mg/kg or
Ceftriaxone 50mg/kg

78. Antibiotics for Children with Sepsis & Meningitis

79. Cefotaxime 50mg/kg, or
Ceftriaxone 50mg/kg
Consider Vancomycin 15mg/kg

80. Response to IV fluids given in sepsis should be monitored &/or titrated to what?

81. Urine output of 1-2mL/kg per hour

82. What is a positive Kernig Sign?

83. Neck pain elicited with passive knee extension

84. What is a positive Brudzinski Sign?

85. Involuntary lower extremity flexion elicited with passive neck flexion

86. CSF fluid should be sent for…

87. Culture & Sensitivity
Glucose
Protein
Cell Count
Gram Stain

88. La Hacienda Del Paulson

92. Gardening/Pool/Home Protection…

94. The END…
A Tribute/Toast to Harry Frederick: