29 year old woman comes in the other day – complaining of left lower back pain radiating down the buttocks to the lower leg. Easy one. She has no medical problems, is on no meds, and has never been here before. No abdominal pain or tenderness and no CVA tenderness (the flank where the kidneys sit). Positive straight leg raise. OK, lets give her some Toradol and if that does not work, a Percocet or two. Hmmmm. One hour later, no better- in fact she is worse. Better reassess. Well, it looks like the pain also goes into the groin. Maybe she has some urinary condition – like a UTI or a stone. Check a urine. Large blood. Ah ha! Renal colic. Guess we should do a CT to see how big it is. Lets send that urine for pregnancy before he subject her to radiation. CRAAAAP!! She is pregnant. She says “I can’t be”. Why? Are you a virgin or do you have no uterus? No, she says, she is just “always careful”. Well, read-um and weep. Your serum BetaHG is 3000 so you definitely are. What!!!!! So what is my pain from?
Pelvic exam is basically normal – mild uterine tenderness. No CMT (cervical motion tenderness) Better get an ultrasound to see what the heck is going on.
Doooh!!!! (Homer Simpson voice). She has a friggin’ ectopic in the left tube with a heart beat. What the friggin’ heck!?!?!? Sorry, despite your being careful, you are going to the OR and will probably lose that tube.
Gotta remember to get a Beta on every woman with a functional uterus!!!!
“I’m not pregnant, I can’t be pregnant!”
LOL, then let’s put a candle on the window sill, ’cause three fellas from the East are a-comin’!
My question: How is she “always careful”?
Been following your blog for awhile. Always makes me laugh. =)
Quirky question for you – can the ectopic be “saved” and put into the uterus?
When I was in med school the rule was:
Pregnancy test before they leave the ER.
Every woman who is not a nun and every man named Robin or Francis jus tot be sure.
I still hear it in my head every time I admit a woman of any age.
Can’t a nun physiologically be pregnant???
I’m always careful?
Isn’t that what bankers say about their lending practices.
Similar success rates?
You should write this case up.
Seriously.
Very sad, but good catch!
Something to consider–pregnancies have been known to happen even without a uterus, if an ovary is still present. Very rare, but still posible. Or so I’ve been told by my gyn.
Not good situations, of course.
Meh, I’d be surprised if I were pregnant (diligently take my b/c every day) and would probably say “but no! I can’t be!” if that were the case.
one of my favorite sites for great ER stories.
Ectopics!!!
Here’s a california story, this is a ED near by that gets HCG’s on all, that is male and female pts with abdominal pain. Not sure who owns up to having a uterus/ovaries these days.
recently we were visited by a 24 yr/old female 8 wks pregnant with abd pain seen in another ER. Given a US and sent home with Tylenol #3 for pain. showed up at our door white as paste. HGB 2. Reminded we always have to start from the beginning with each patient regardless of past treatment.
[...] Ben Parr posted a noteworthy aricle today onHere’s a small snippetsciatica.jpg. 29 year old woman comes in the other day – complaining of left lower back pain radiating down the buttocks to the lower leg. Easy one. She has no medical problems, is on no meds, and has never been here before. … [...]
[...] Sciatica Home Treatment sciatica 29 year old woman comes in the other day – complaining of left lower back pain radiating down the buttocks to the lower leg. Easy one. She has no medical problems, is on no meds. [...]
This comes as a surprise…as sciatica during pregnancy is quite common. She may very well develop sciaticaduringpregnancy down the road.