A 28-year-old female presented to the WakeMed Emergency Department (ED) after developing vomiting, diarrhea, and syncope while at dinner with friends. Due to the COVID surge, our ED wait time was several hours and I was asked to see her in the children’s ED since I care for both children and adults. The patient revealed that she was 7 ½ weeks pregnant with an upcoming first OB appointment. On exam she had very mild abdominal tenderness, normal vital signs (BP 101/62, HR 80), and a negative bedside FAST exam. I ordered labs and a formal ultrasound, which was delayed for over an hour due to high patient volume. After another delay waiting for a radiologist to read the study, I looked at the images and saw that her liver and spleen surrounded by free fluid. This confirmed my suspicion of ruptured ectopic pregnancy. Her vitals remained stable, but the diagnosis triggered a call to the on-call obstetrician for surgical intervention.
When I called the obstetrician, he was in the middle of another procedure, so I notified the OR team of the critical nature of this patient and told the ED team that “If she drops her pressure at all, I want you to ‘LifeFlow’ two units of un-cross-matched blood in her”. She then suddenly became lethargic and less responsive, with a BP of 84/46. I immediately ordered blood as her BP continued to fall, hitting a low at 68/36. She had received 2 liters of fluid by this time. Using the LifeFlow device we delivered 2 units of cross-matched blood during her transport to the OR. That’s such a great thing about LifeFlow – that you can get the blood in fast, in the volume you desire, in a critical situation. Her blood pressure had stabilized to 130/100 by the time we arrived to pre-op. In the OR she was found to have a ruptured ectopic pregnancy with 1800mL free blood in the abdomen. She received 1 additional of unit PRBC’s, did well post-op, and was discharged the next day.
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