INDEX

Note: Page numbers followed by f indicate figure; those followed by t indicate table.

A

Abdominal pain, pregnancy

causes of, 28 t

adnexal masses, 29-30 appendicitis, 27-29 bowel obstruction, 31 cholecystitis, 29

pyelonephritis and nephrolithiasis, 30-31

imaging techniques, 26, 27 t laparoscopic surgery, 32 physical examination, 26 physiologic changes, 25-26 Abortion

complete, 108

complications of, 255-259, 259 t continuing pregnancy, 257 hematometra, 257

hemorrhage, 256

infection, 256-257 retained products of conception, 257 second trimester, 258

contraception, 258

death from, 255

definition, 104

epidemiology and history, 255 etiology of

bleeding, 105 t

spontaneous abortion, 105 t

incomplete, 107-108

induced, 256

inevitable, 107

medical, 255-256

missed, 106-107

postabortion care, 108 self-induced, 255

septic, 256

surgical, 255

threatened, 105-106

Abruptio placenta, 59-60

concealed bleeding, 115f

signs and symptoms, 60

vaginal bleeding, 114f

Abscess

pelvic, 350

tubo-ovarian

pelvic mass, 293 rupture, 263 Acetaminophen, 229 t, 239 Acetylcholinesterase, chemical weapon, 143-144

Acne medications, drug category for pregnancy, 228 t

Acquired immunodeficiency syndrome (AIDS), 266-269.

health care provider precautions, 269 pelvic inflammatory disease, 267 pulmonary issues, 267 visual changes, 269

vulvar ulceration, 269f

Acute abdomen. See Abdominal pain, pregnancy

Acute cystitis (AC), 121

Acute pyelonephritis (AP), 122-123

Acute radiation syndrome (ARS), 145-146, 147 t

Acyclovir, for herpes simplex virus, 127, 274 Adnexal pathology. See Ovarian masses AIDS. See Acquired immunodeficiency syndrome (AIDS); Human immunodeficiency virus (HIV) infection

Air embolism, gynecologic trauma, 345 Amenorrhea, ectopic pregnancy, 37, 41 Aminoglycosides, drug category, 228 t, 238 Amiodarone, 86 t

Ampicillin

endometritis, 207 intra-amniotic infection (IAI), 124 urinary tract infections (UTIs), 122 t Anal intercourse, trauma from, 348 Analgesics, drug category for pregnancy, 229 t, 239

Angiography

fetal exposure, 67 pulmonary, in pulmonary embolism diagnosis, 3

Angiotensin receptor blockers (ARBs), 245 Angiotensin-converting enzyme inhibitors (ACEIs), 233 t, 245

Anthrax, 135-137

cutaneous, 136

gastrointestinal, 136

inhalational, 135-136

prophylaxis, 137

Anthrax vaccine adsorbed (AVA), 137

Antibiotics

endometritis and pelvis abscess, 207 for intra-amniotic infection (IAI), 124,

125 t

mastitis, 208

for postpartum endometritis (PPE), 125,

125 t

pyelonephritis, 208

tularemia, 139-140

Anticholinergic agents, inhaled

for asthma, 6

drug category, 230 t Anticoagulant drugs, 117, 203 t, 204 Antidepressants, 231 t, 242 Antiepileptic drugs (AED), 248

effects on fetus, 18

first generation, 17 t second generation, 19 t

Antihypertensives, 102, 245

Antinausea medication, 246

Antipsychotics, 234 t-235 t

Antiretroviral drugs, for HIV infection, 193,

194 t, 195

Appendicitis, 27-29

vs.

Argyll Robertson pupil, 271

Arterial blood gas, in pulmonary embolism diagnosis, 2

Arthritis, gonococcal dermatitis-arthritis syndrome, 265

Aspirin

drug category, 229 t, 239

for preeclampsia/eclampsia prevention, 102

Assisted reproductive technologies (ARTs) ectopic pregnancy and, 38 heterotopic pregnancy and, 42

Asthma, 4-8

complications of, 5

emergency therapy, 6-8, 7f medications for, 5-6

Asymptomatic bacteriuria (ASB), 120-121

Atropine, 81, 143

Auscultation, of abdomen, 31

Automobile restraint use, blunt trauma from, 62

Aztreonam, 122 t

B

Bacillus anthracis, 135-136

Bacterial vaginosis, 124, 228 t, 238, 278-279

Bacteriuria, asymptomatic, 120-121, 122 t

Bacteroides bivius, 207, 261

Bacteroidesfragilis, 261, 381

Barbiturates, for seizure disorder, 17

Bed rest, for preeclampsia/eclampsia, 98 t,

99-100

Bendectin, 246

Benzodiazepines, for seizure disorder, 20, 248-249

Beta-agonists

for asthma, 240

drug category, 230 t, 240

Beta-blockers, 199

Betamethasone, 186-188

Bicarbonate replacement, in diabetic ketoacidosis, 15

Biliary tract disease, 29

Biological agents, 135-143 anthrax, 135-137 plague, 140-141 Q fever, 141-142 ricin, 142-143 smallpox, 137-138

Biopsy, in pelvic mass diagnosis, 294

Bipolar disorder, medications for, 209 Birth canal, laceration of, 170

Bleeding. See also Menorrhagia, vaginal bleeding anticoagulant use and, 117 fetomaternal hemorrhage, 61 following pregnancy, 104 during pregnancy, 104 rectal, 313, 334-335, 348 vaginal bleeding as abortion complica­tion, 256

Bleeding in pregnancy abortion, 105 t complete, 108 definition, 104 incomplete, 107-108 inevitable, 107 missed, 106-107 postabortion care, 108 threatened, 105-106 anticoagulants, 117 cervical and vaginal infections/lesions, 111

cervical incompetence, 109 gestational trophoblastic disease (GTD), 110-111

markers, 108-109

nonvaginal sites, 116-117

PPROM, 110

vaginal bleeding

during first half, etiology of, 104, 105 t labor, 116

placenta previa, 112-113

placental abruption, 113-115, 114f, 115f

during second half, etiology of, 112 t uterine rupture, 116 vasa previa, 115-116

Blood pressure

change during pregnancy, 240 presclampsia/eclampsia, 181

Borderline personality disorder, in the emergency room patient, 390

Bowel

colostomy emergencies, 297 complication of radiation therapy, 313 emergencies related to gynecologic cancers, 307-314

evisceration following vaginal surgery, 381

fistula formation, 311-312

injury from laparoscopy, 323-324 obstruction, 31, 310, 323

Bradycardia, embryonic, 362

Breech, 160, 169-170, 173, 185

Brethine, 186

Burn management, 69

C

Calcium chloride, 86 t

Calcium supplementation, preeclampsia/ eclampsia prevention, 102-103

Cancer.

endometrial, 308 metastasis related to gynecologic cancers, 307

vulvar, 308

Candida albicans, 279

Candida tropicalis, 279

Candidiasis, 278

Carbamazepine, 17

Cardiac activity, embryonic, 361

Cardiac arrest, 84-85, 86 t-87 t

Cardiopulmonary resuscitation (CPR), 75-88

ABCDE paradigm, 78, 78 t advanced life support, 80-81 anatomic and physiologic considerations, 75, 76 t, 77-78, 77 t

basic life support, 78-80 cardiac rhythm analysis asystole, 85

atrial fibrillation and flutter, 83 basic analysis, 81 bradyarrhythmias, 81, 82f 83 medications, 86 t-87 t pulseless electrical activity (PEA), 85 supraventricular tachycardia (SVT), 83, 83f

ventricular fibrillation (VF), 84-85 ventricular tachycardia (VT), 84, 84f complications, 88

etiologies of, 76 t technologies, 88

Category A drugs, 225 t

Category B drugs, 224, 225 t

Category C drugs, 224, 225 t

Category D drugs, 224, 225 t

Category X drugs, 225 t, 226, 227 t

Cellulitis, pelvic, 324-325

Cervical bleeding, postoperative, 307-308

Cervical cerclage, 109, 219

Cervical incompetence, 109, 219, 220 f

Cervical infections, vaginal bleeding and, 111

Chancroid, 272, 275

Chemical-biological warfare, 134-150 biological agents anthrax, 135-137 plague, 140-141

Q fever, 141-142

ricin, 142-143

smallpox, 137-138 tularemia, 138-140

general preparation, 134 radiation, 144-146, 145 t, 147 t-150 t toxins/chemicals

acetylcholinesterase inhibitors, 143-144

vesicants and pulmonary agents, 144 Chest injuries, 68

Chicken pox, 128

Chlamydia trochomatis, 37, 111, 206, 261, 330, 335, 338, 339 t, 340, 348

Chloramphenicol, 136-138, 140-141 Cholecystitis, 29

Cholelithiasis, 29

Chorioamnionitis, 123-124

Cidofovir, for smallpox, 138

Cisplatin, 313

Clavulanate, 227

Clostridial infections, 256, 381

Coagulation medications, 117, 202, 230 t Coagulopathy, 308-309

Codeine, drug category, 229 t

Colon conduit complications, 312 Colostomy emergencies, 311 Condyloma latum lesion, 270 Condylomata, 338

Congenital bleeding disorders, 288-289 Contractions, premature, from trauma, 60

Coumarin (Warfarin), 4, 230 t, 241

Coxiella burnetii, 141

Cromolyn, 6, 240

Crowning, 161, 169

Crown-rump length, 108, 216 f, 359

Cuff abscess, 310, 324

Cunnilingus syndrome, 345 Cystadenomas, 295 t

Cystic teratoma, 292

Cystitis, acute, 29, 121, 122 t

Cytomegalovirus (CMV), 126-128

D

Dalfopristin, drug category, 229 t, 239 Deep venous thrombosis, 1-4, 203-204, 240 Defibrillation, cardiopulmonary resuscitation and, 79, 85

Delivery in emergency department delivery kit, 161 t documentation, 173

Delivery in emergency department (Continued)

emergency vaginal delivery, 166-173.

EMS preparedness, 160 spontaneous vaginal delivery, 160-166. See also Vaginal delivery

Desquamative inflammatory vaginitis, 280 Dexamethasone, 186-188

Diabetes, drugs for, 242-243 Diabetic ketoacidosis (DKA), 13-16 diagnosis, 14, 14 t management, 15-16 pathophysiology, 13-14

Diazepam, for seizure, 16-20, 199 Diazoxide, for preeclampsia/ eclampsia, 102 Dihydroergotamine, drug category, 227 t, 234 t, 246

Dimenhydrinate (Dramamine), 234 t, 246 Diphtheria vaccine, 68

Dirty bombs, 144-145, 145 t Dobutamine, 86 t

Domestic violence, physican/ patient communication about, 292

Dopamine, 85, 86 t Double bleb sign, 358

Double decidual sac sign, 257f 258, 356, 360, 364, 365f

Doxylamine, 234 t, 246-247

Drug therapy in pregnancy, 224-249. See also specific drug; specific drug group

FDA drug categories for, 224, 225 t pregnancy registries analgesia, 229 t, 239-240 anti-infectives, 226-227, 228 t-229 t, 238-239

asthma, 230 t, 240 coagulation, 230 t, 240-241 contraindicated medications, 227 t depression, 230 t-231 t, 241-242 diabetes, 231 t-232 t, 242-243 disease-specific medications, categories for, 228 t-237 t gastrointestinal reflux, 232 t-233 t, 244 herbal products, 237 t hypertension, 233 t, 245 migraine/headache, 234 t, 245-246 nausea and vomiting, 234 t, 246-247 psychosis and bipolar disorder, 234 t-235 t, 247-248

seizure, 235 t-236 t, 248-249 teratogenesis, 224, 226

E

Ebstein's anomaly, 235 t, 247

Ectopic pregnancy (EP) ambulatory evaluation algorithm for, 40f culdocentesis, 43-44 history, 41

physical examination, 41

pregnancy tests, 41-42

serial hCG evaluation, 44

serum markers, 45

suction curettage and endometrial biopsy, 44-45

ultrasonography, 42-43, 43 t clinical presentation, 37-38 differential diagnosis, 38-40, 39 t etiology

natural and ART conceptions, locations, 37f

risk factors, 38 t

imaging for, 363-365

management

expectant, 49

medical, 46-49, 47 t

surgical, 46

Edema, with preeclampsia/eclampsia,

97-99, 99f

Electrical injury, 69-70, 76 t

Electrocardiogram (ECG), changes during pregnancy, 57

Embryopathy syndrome, due to varicella zoster, 129

Emergency contraception, 341

Emergency department (ED) communication issues, 394

content issues, 388-389

domestic violence, 392

fetal death, 391

life-threatening disease, 393 national agency support services, 388 t

personality issues, 389-391

process issues, 386-388

rape, 392-393

sexually transmitted disease, 391 delivery in, 160-173

Emergency medical system (EMS), 160 Endocrine bleeding, vaginal, 287-288 Endometrial ablation, in vaginal bleeding management, 285, 289

Endometrial cancer, vaginal bleeding and, 307-308

Endometriosis, ectopic pregnancy and,

38 t, 39 t

Endoscopy, gastrointestinal, for peptic ulcer disease, 47

Enterobacter, 120, 207-208

Enterocutaneous fistula, 311 Enzyme-linked immunosorbent assay (ELISA), 2

Epinephrine, use during cardiopulmonary resuscitation, 85, 87 t

Ergonovine, following delivers, 165

Ergotamine, drug category, 240 t, 251—252, 227 t, 234 t, 246

Erythromycin, 227, 228 t, 275

Estrogen, for vaginal bleeding, 284-285 Estrogen-secreting tumors, 304

Eversion, vaginal, 380

Evidence, in sexual assault, 331 Evisceration

bowel, 381

vaginal, 319-320, 351, 381

F

Famciclovir, for herpes simplex virus, 127,

274

Fasciitis, necrotizing, 200 t, 207-208, 309, 314, 318, 381-382

Fecal impaction, 294, 383-384

Fetal death, maternal death and, 60, 391 Fetal heart rate, fetal viability and, 65, 182 Fetomaternal hemorrhage, 58, 61 Fluoroquinolones, drug category, 239 Fluoxetine, 242

Food and Drug Administration (FDA)

drug categories for pregnancy, 230, 231 t, 224, 225 t-226 t

HIV antibody screening tests, 192 t Fournier’s gangrene, 381-382 Fundal height, gestational age and, 65, 92

G

Gallstones, 25, 29

Gastrointestinal fistulas, 311

Gastrointestinal system

changes during pregnancy, 58 dysfunction, from thyroid storm, 147 postoperative emergencies, 322-324 Genitourinary injuries, resulting in postoperative emergencies, 322-323 Gentamicin

for endometritis, 125-126

for intra-amniotic infection, 123-124

for pelvic inflammatory disease, 365-373 for plague, 140-141

Gestational age

abdominal circumference, 214, 217 crown-rump length, 216/, 359 fundal height and, 65, 92

perimortem cesarean section and, 70 ultrasound for determination of, 221, 376 Gestational trophoblastic disease (GTD), 108, 110-111

Gestational trophoblastic neoplasia, 308 Glomerular filtration rate, during pregnancy, 25

Glucocorticoids, for thyroid storm, 11 Glucosuria, during pregnancy, 25 Glyburide, 231 t, 243

Gonococcal dermatitis-arthritis syndrome, 265

Gonorrhea

dissemination to heart, 266

dissemination to meninges, 266 gonococcal dermatitis-arthritis syndrome, 265

sexual assault and, 335, 338, 340 Gunshot wounds, 56/, 63

Gynecologic traumas, 345-352

nonsexually related, 350-352, 352f sexually related

chancre, 346, 346f evisceration, vaginal laceration,

347f

intrarectal foreign body removal, Foley catheter, 349f

lateral and posterior vaginal fornices, laceration, 348f

oral-genital sex, 345-346

H

Haemophilus influenzae, in pelvic inflammatory disease, 261

Head

breech delivery of, 169

vaginal delivery of, 166

Head injuries, 69

Heart rate

changes during pregnancy, 55

fetal, 112, 114, 116

HELLP syndrome.

Hematological changes, during pregnancy, 58, 59 t

Hematometra, 257

Hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome), 99 Hemorrhage

fetomaternal, 61

postpartum, 200-202

Hemorrhagic shock, during pregnancy, 38 Heparin

complications of, 3

for deep venous thrombosis, 207

drug category, 232 t, 241

for pulmonary embolism, 3

use during pregnancy, 119

Hepatitis B

sexual assault and, 340

vaccine for, 244

Hepatitis, syphilis and, 272

Herbal products, drug categories for pregnancy, 237 t

Hernia, incisional, 318-319

Herpes infection, 126-129 cytomegalovirus (CMV), 127-128 herpes simplex virus, 126-127 varicella zoster (VZ) infection, 128-129

Herpes simplex virus, 126-127, 273-275 diagnosis, 126-127

management, 127

Heterotopic pregnancy, 218, 363

History taking

for abdominal pain, 25

for ectopic pregnancy, 41

for menorrhagia, 281

for pelvic mass, 291

for sexual assault case, 331

HIV infection. See Acquired immunodefi­ciency syndrome (AIDS); Human immunodeficiency virus (HIV) infection

Homan's sign, 204 Human immunodeficiency virus (HIV)

infection, 191-197. See also Acquired immunodeficiency syndrome (AIDS) identification of, 191-193, 192 t infants born to infected mothers, 197 intrapartum care, 195-197, 195 t, 196 t pathology, 266 perinatal transmission antiretroviral drugs, 194 t interventions to reduce, 193, 195 postexposure prophylaxis, 340, 341 t postpartum care, 197

Hydralazine, 101-102, 233 t, 245 Hydrosalpinx, 370, 372f

Hymen laceration of, 334f normal in child, 338

Hypertension medications, 233 t, 245 Hypertensive disorders of pregnancy,

97-103. See also Preeclampsia/ eclampsia

Hypotension, septic shock and, 265 Hysterectomy

in vaginal bleeding management, 286 vaginal eversion following, 319-320

I

Ileal conduit complications, 312 Ileus, postoperative, 323

Imaging, gynecologic emergencies abnormal early IUP

blighted ovum, 360, 361f embryonic demise, 360, 362f incomplete abortion, 363f ectopic pregnancy, 364f

hemoperitoneum, 369f-370f incomplete abortion, 366f-367f interstitial, 371 f

nonspecific adnexal mass, 368f pseudogestational sac vs.

amnion and yolk sac, 358, 358f double decidual sac sign, 356, 357f embryo, 359f hemorrhagic corpus luteum cyst, 360f intradecidual sign, 355, 357f subchorionic hemorrhage, 359, 359f yolk sac, 358, 358f ovarian torsion, 373f-374f pelvic inflammatory disease (PID) endometritis, 367 hydrosalpinx, 372f pyosalpinx, 371 f salpingitis and tubo-ovarian abscess, 367, 370-373 tubo-ovarian abscess, 372f ruptured ovarian cyst, 376 transabdominal technique, 355f transvaginal technique, 356f whirlpool sign of, 375f-376f

Imaging modalities, obstetric emergencies, 213 t

computed tomography (CT), 213-214 first trimester bleeding

blighted ovum (anembryonic), 217 ectopic pregnancy, 217-218, 218/, 219f incomplete abortion, 217 molar pregnancy, 218

retroplacental hematoma, 217f spontaneous (complete) abortion, 217 threatened miscarriage/abortion, 216-217, 216f

fluoroscopy, 213

gestational sac, endovaginal image, 214, 215f

magnetic resonance imaging (MRI), 214 nuclear medicine/angiography, 213 principles, 214

radiation exposure, 212-213

second and third trimester bleeding cervical incompetence, 219, 220f placenta previa, 219, 221, 221 f placental abruption, 221 uterine rupture, 221 vasa previa, 221

trauma, pregnancy, 222

ultrasound, 214

x-ray (plain films), 213

In vitro fertilization

ectopic pregnancy and, 36

heterotopic pregnancy and, 257 Incisional hernia, 318-319 Infants

born to HIV-infected mothers, 197

West Nile Virus in, 153, 154 t

Infections

abortion complications, 256-257 postoperative complications, 324-325 during pregnancy

herpes infection, 126-129 intra-amniotic infection (IAI), 123-125

postpartum endometritis (PPE), 125-126

urinary tract infections, 120-123 wound. See Wound infections

Injury. See also Trauma, pregnancy electrical, 69-70

head, 69

spinal, 69

thoracic, 68

to uterus, 58-59

vulvar, 351-352, 352f

Injury severity score (ISS), 68

Interferon α-2b, for West Nile Virus, 158 Interleukin-6, ovarian torsion and, 303

Interstitial line sign, 364

Intestinal obstruction, 31

Intestines. See also Bowel

compartmentalization of, during pregnancy, 56f

Intra-amniotic infection (IAI), 123-125 diagnosis, 123-124 management, 124, 125 t

Intradecidual sign, 355, 357f

Intrauterine pregnancy (IUP)

human chorionic gonadotropin (hCG), 42, 43 t

imaging for abnormal early, 360-363 normal early, 354-360

vs. ectopic pregnancy, 39, 41-44

Iodide treatment, for thyroid storm, 12 Ipratropium

for asthma, 6

drug category, 230 t, 240

Isotope scanning, for deep venous thrombosis, 204

J

Jarisch-Herxheimer reaction, 273

K

Klebsiella, 120, 208

Kleihauer-Betke (K-B) test, 61

L

Labetalol, 233 t, 245

Lactobacillus bacteria, vaginal, 279 Lamivudine, 340, 341 t

Laparoscopic oophoropexy, 304 Laparotomy, in trauma management, 61 Laryngeal mask airway, 80

Legal considerations, with perimortem cesarean section, 95-96

Lewisite, as chemical weapon, 144

Lichen planus, 280

Lichen sclerosus, 280

Lidocaine, 87 t

Life-threatening illness, physician/patient communication about, 390

Linezolid, 228 t, 239

Lithium, 235 t, 247

Liver failure, related to gynecologic cancers, 307

Low molecular weight heparins (LMWHs) drug category, 230 t, 241 in pulmonary embolism treatment,

3-4

use during pregnancy, 117

M

Maculopapular syphilid, 270

Magnesium sulfate (MgSO4)

PPROM, 186

in preeclampsia/eclampsia management,

101

Magnetic resonance imaging (MRI) fetal exposure, 67

in ovarian torsion diagnosis, 304 in pelvic mass diagnosis, 293-294 during pregnancy, 214

Major depressive disorder, 209

Marrow suppression chemotherapy, 287 t complication, 158

Maternal death

changes in causes of, 172

perimortem cesarean section. See

Perimortem cesarean section

McRobert position, 167-168

Meclizine, 234 t, 246

Medical abortion, 255-257, 258 t. See also

Abortion

Meningitis

related to acquired immunodeficiency syndrome, 266-269

related to plague, 140-141

Menorrhagia, vaginal bleeding ancillary testing, 283-284 evaluation and stabilization, 281, 282f idiopathic, 289 management

long-term, 286-288, 287 t with negative pregnancy test, 284-286 with positive pregnancy test, 284 patient examination, 281-283 systemic causes, 288-289

Mental illness, in the emergency room patient, 390

Metastatic disease pelvic mass and, 294 related to gynecologic cancers, 307

Methotrexate (MTX) contraindications for, 47 t for ectopic pregnancy, 44, 46-49

Methyldopa, 233 t, 245

Methylergonovine

following delivery, 172

for postpartum hemorrhage, 200-202 Metronidazole

for bacterial vaginosis, 279 drug category, 230 t, 245 for endometritis, 200 t, 202 for pelvic inflammatory disease, 261-265 for trichomoniasis, 238

Mifepristone, for medical abortion, 255-257 Migraine, medications for, 245-247 Military antishock trousers (MASTs), 45 Miscarriage, 107-109. See also Abortion causes of, 111

completion of, 107 recurrent, 104

Misoprostol

for medical abortion, 255-256

for miscarriage, 107 postabortion care, 108 for postpartum hemorrhage, 200-202

Monoamine oxidase inhibitors, 106, 230 t,

246

Mosquito-borne illnesses, 152-158. See also West Nile virus (WNV)

Motor vehicle accidents

pelvic fractures, 350-351

seat belt trauma, 54, 61f, 62-63

Mustard gas, 144

Myonecrosis, 126

N

Nausea and vomiting

chemotherapy complication, 313 medications, 246-247

related to pregnancy, 341

Necrotizing fasciitis, 207-208, 314, 318, 381-382

Nedocromil, drug category, 240

Neisseria gonorrhea, 265

Nerve agents, 143-144

Neural tuba disorders, antiepileptic drugs and, 248

Neurogenic shock, 69

Neurological issues

related to acquired immunodeficiency syndrome, 272

related to syphilis, 272-273 Neurosyphilis, 268, 272-273

Nevirapine, for HIV infection, 196 t, 197 Nitrofurantoin, 121, 228 t, 238

Nitroimidazoles, for trichomoniasis, 279 Nitroprusside, for preeclampsia/eclampsia, 101-102

Nonconvulsive status epilepticus (NCSE), 18 Non-Hodgkins lymphorna, related to

acquired immunodeficiency syndrome, 268

Nonnucleoside reverse transcriptase inhibitors for HIV infection, 195 t, 197

Nonsteroidal anti-inflammatory drugs (NSAIDs), drug category, 239, 245-246

Nuchal cord, 163, 169

Nucleoside and nucleotide analogue reverse transcriptase inhibitors (NRTIs), for HIV infection, 194 t

O

Obstruction

bowel, 31, 310, 319, 323

intestinal, 31, 323

ureteral, 311-312, 321, 379

Oncologic emergencies, 307-314

bowel emergencies, 309-311 chemotherapy complications, 313-314 bone marrow suppression, 314 hypersensitivity reactions, 313 nausea and vomiting, 313 gastrointestinal complications

bowel obstruction, 310

bowel perforation, 310

bowel prolapse, 311

fistulas, 311

neurologic deficits, 312-313 organ failure, 139 pitfalls, 314

postoperative complications, 316-326 postoperative wound complications dehiscence, 309 evisceration, 309

infections, 309

vaginal cuff cellulitis, 310

vaginal cuff dehiscence, 310 radiation therapy complications enteritis, 313

hemorrhagic cystitis, 313 thromboembolism, 308-309 total parenteral nutrition complications, 269

urologic complications

fistulas, 312

ureteral obstruction, 311

urinary conduit complications, 312 urologic emergencies, 320-322 vaginal bleeding

endometrial cancer, 308

gestational trophoblastic disease, 308 vulvar cancer, 308

Oophoritis, 371

Oral contraceptives, in menorrhagia management, 285

Oral-genital sex, trauma from, 345 OraQuick Rapid MW-i Antibody test, 192 t Ovarian cancer, 292-293, 295, 308, 310-311, 313

Ovarian cyst benign, 320 ruptured, 39, 376 types of, 313

Ovarian hyperstimulation syndrome, ovarian torsion and, 295 t, 299

Ovarian masses

abdominal pain and, 29-31

ectopic pregnancy and, 43 management algorithm, 297 t Ovarian torsion

adnexa, 300f

assistive reproduction and, 304 clinical features, 299-302 considerations for, 304 differential diagnoses, 302-303 etiology, 299 infundibulopelvic ligament, 300f pathology of, 301 t postpartum emergency, 207 during pregnancy, 29-31 symptoms, 302 t treatment, 31, 303-304

Oxygen therapy, in trauma management, 64 Oxytocin

following delivery, 165-166

for postpartum hemorrhage, 172

P

Packing, in vaginal bleeding management, 285-286, 307

Pain. See Abdominal pain, pregnancy

Palpation, of abdomen, 31

Pancreatitis, 28 t

Peak expiratory flow rate (PEFR), in asthma diagnosis, 6, 8

Pelvic abscess, 348

Pelvic cellulitis, 324

Pelvic fractures, gynecologic trauma and,

350-351

Pelvic inflammatory disease, 261-265

Pelvic mass

asymptomatic, 291-293 differential diagnosis, 295 t evaluation methods, 295-296 management, 296-297, 297f

nongynecologic causes, 295 t symptomatic, 293-294

Penicillin

drug category, 227, 228 t

for syphilis, 269

for urinary tract infection, 125

Peptic ulcer disease, 28 t, 47, 47 t

Perimortem cesarean delivery (PMCD) changes in maternal causes of death, 91

considerations for undertaking, 92-93

equipment for, 95

history, 90-91

medicolegal considerations, 95-96 outcomes, 95

technique for, 93-95

Perimortem cesarean section, 70

Peritoneal lavage, 67

Pessary, neglected, 383

Pfannenstiel incision, 93

Phosphenytoin, 20

Placenta previa, 112-113

Placental abruption, 113-115, 114f 115f

Placental separation, following vaginal delivery, 172

Plague, 140-141

Plan B, for emergency contraception, 341

Pneumoperitoneum, 345, 348

Postexposure prophylaxis, for human immunodeficiency virus (HIV) infection, 340-341, 341 t

Postoperative complications/ emergencies

gastrointestinal emergencies bowel obstruction, 323 ileus, 322-323 laparoscopic bowel injury,

323-324

infections

pelvic cellulitis and abscess, 324-325 septic pelvic thrombophlebitis, 325 retained foreign objects, 326 urologic emergencies

bladder injuries, 320-321

ureteral injuries, 321-322

urinary retention, 320

uterine artery embolization, 325-326 uterine perforation, 325

wound complications

fascial dehiscence and hernia, 318-319 hematoma and seroma, 316-317 surgical site infections, 318 vaginal cuff dehiscence, 319-320 Postoperative emergencies. See Postopera­tive complications/emergencies Postpartum emergencies

infection

abdominal and vaginal wound infections, 207-208

endometritis and pelvis abscess, 207 physical examination, 206 puerperal infection, 205

mastitis, 208

ovarian torsion, 205 postpartum hemorrhage (PPH), 200-202 primary problems of, 200 t psychological issues, 209 pyelonephritis, 208

seizures, 199 thromboembolism

deep venous thrombosis (DVT), 203-205

pulmonary embolism (PE), 205 superficial thrombophlebitis, 203 thrombophilia panel, 203 t

Postpartum endometritis (PPE) diagnosis, 125 management, 125-126

Postpartum hemorrhage, 172-173, 200-202 Postpartum psychosis, 209

Potassium iodide

for children, 146

for radiation poisoning, 146

Potassium loss, in diabetic ketoacidosis, 15 Preeclampsia/eclampsia

criteria for severe, 98 t diagnosis, 98-99, 99f, 100f management

intrapartum, 101-102

postpartum, 102

prepartum, 99-101 pathophysiology, 97-98 prevention, 102-103 seizures and, 16 signs and symptoms, 69, 97

Pregnancy. See also Intrauterine pregnancy (IUP)

abdominal pain during, 25-32 bleeding during, 104-117 cardiopulmonary resuscitation during,

75-88

chemical-biological warfare, 134-150 delivery in emergency department, 160-173

Pregnancy (Continued)

ectopic. See Ectopic pregnancy (EP) emergency contraception for, prevention of, 341

epilepsy effects on, 17-18, 17 t heterotopic, 218, 363 human immunodeficiency virus infection and,191-198

hypertensive disorders of, 97-103 infections during, 120-129 psychological reactions to, 200 t system changes during cardiovascular system, 55-57 gastrointestinal system, 57-58 neurologic system, 58 respiratory system, 57 urinary system, 58 trauma during, 54-71

West Nile Virus and, 153, 153 t

Pregnancy registries, for drug therapy in pregnancy, 226. See also Drug therapy in pregnancy

Pregnancy tests, ectopic pregnancy and, 41-42

Preterm labor (PTL), 185-188

Preterm premature rupture of membranes (PPROM), 110, 185-188

Primidone, 18 Procardia, 186 Procidentia, 351, 382

Prolapse

urethral, 380

uterovaginal, 382-383

Propylthiouracil (PTU), for thyroid storm, 12

Prostaglandin inhibitors, indomethacin, 186

Pseudogestational sac, 363, 365f Psychosis

medications for, 234 t

postpartum, 209

Pulmonary embolism, 1-4 diagnostic tests, 2-3 presentation, 1-2 therapy, 3-4

Pulse oximetry, in asthma diagnosis, 6 Pyosalpinx, 370, 371f

Pyridoxine, 234 t, 246-247

Q

Q fever, 141-142

Quinupristin/dalfopristin, drug category, 229 t, 239, 241

R

Radiation as chemical weapon, 150 t Radiation proctitis, 313

Radiation therapy

for cancer, 307

complications of, 313 hemorrhagic cystitis related to, 313 pelvic mass related to, 307, 312

Radioactive iodine, 146

Radiography

in abdominal pain evaluation, 31

for maternal trauma, 67

Rape. See Sexual assault, emergency

evaluation and treatment

Rape crisis centers, 329

Rape kits, 330

Rectal bleeding, 334-335, 348

Regional enteritis, vulva, 313

Renal calculi, vs. ovarian torsion, 303

Renal failure, related to gynecologic cancers, 382

Renal function, during pregnancy, 20

Reproductive system, changes during pregnancy, 41-42

Respiratory system, changes during pregnancy, 26, 57, 76 t

Restraint use, blunt trauma from, 62-63, 62f

Retinitis, cytomegalovirus, 269

Reveal HIV-1 antibody test, 192 t

Ribavirin, for West Nile Virus, 158

Ricin, 142-143

Ricinus communis, 142

Ritgen maneuver, 161-162, 162f

S

Salpingitis, imaging for, 367-373

Sarcoma, of uterus, 295 t

Schizophrenia, in the emergency room patient, 390

Seat belt use, blunt trauma from,

61-63, 61f

Seizure disorder, 16-20

antiepileptic drugs, 17 t, 19 t

effects of antiepileptic drugs on fetus, 18 management, 18-20 preeclampsia/eclampsia and, 16 pregnancy effects on, 17-18

Seizure medications, 235 t, 247-248

Sepsis

from abortion, 256

during pregnancy, 69

Septic pelvic thrombophlebitis, 325

Septic shock, postoperative, 381

Serotonin reuptake inhibitor drugs, 231 t,

241

Sexual abuse, 329-342

Sexual assault, emergency evaluation and treatment

adult, physical examination, 332f fellatio syndrome, 333, 333f hymenal ring and posterior fourchette, laceration of, 334, 334f

vaginal swabs, 335

child, physical examination, 335-338, 337f forensic medicine, 330-331

history taking, 331 responsibilities of examiner, 329 treatment

CDC 2006 guidelines for, 339 t postexposure prophylaxis (PEP), 340-341, 341 t

pregnancy prevention, 341-342 prevention of, 338, 340 psychological support and counseling, 342

triage, 330

Sexually transmitted diseases, 261-275 acquired immunodeficiency syndrome, 266-269

chancroid, 275

gonorrhea, 265-266 herpes simplex virus, 273-275 pelvic inflammatory disease (PID), 261-265

syphilis, 269-273

Shock

abdominal pain and, 30-31

ectopic pregnancy and, 37-38, 41, 45 neurogenic, 69

pelvic inflammatory disease, 263-265 Shoulder dystocia, vaginal delivery, 166-168

Gaskin maneuver, 168-169

McRoberts position and suprapubic pressure, 167-168, 167f

posterior arm, 168

Woods Corkscrew and Rubin maneuvers, 168

Zavanelli maneuver, 169

Smallpox, 137-138

Sodium bicarbonate, use during cardiopulmonary resuscitation, 87 t

Spinal injuries, 69

Spirochetes, 271-272

Stab wounds, 63, 67

Staphylococcus aureus, 207, 318

Status epilepticus, 18, 20

Steroid therapy, PPROM, 186-188 Streptomycin, for plague, 140 Subchorionic hemorrhage, 359-360, 359f Subgluteal infections, 206

Suction curettage, for ectopic

pregnancy, 44

Sulfonamides, 238

Sulfonylureas, 243

Sumatriptan, 234 t, 246

Supine hypotension syndrome, 55

Surgery

for appendicitis, 27-28

bowel evisceration following vaginal, 381

for ectopic pregnancy, 46

in trauma management, 63

urinary retention following, 320, 380 Syphilis, 271-274

Systemic vascular resistance (SVR), changes during pregnancy, 77 t

T

Tachycardia, thyroid storm and, 11 t, 12

Teratogenesis, 224, 226

Tetanus prophylaxis, in trauma manage­ment, 68

Theophylline, for asthma, 5

Thermal burns, 69

Thoracic injuries, 68

Thrombophlebitis septic pelvic, 325 superficial, 203

Thyroid function tests, 9 t

Thyroid storm, 8-13 diagnostic criteria, 9-10, 9 t differential diagnosis, 10 laboratory evaluation, 10-11 management, 11-13, 11 t precipitating events, 10 t

Ticarcillin, 207, 227

Tococardiography, external, in trauma evaluation, 65

Tocolytics, 185-186

Tonic-clonic convulsion, 69

Torsion of ovary. See Ovarian torsion

Toxins in chemical-biological warfare, 143-144

Toxoplasma gondi, 268

Transabdominal scanning (TAS), 354-356

Transport, pregnant patient assessment, 179 common maternal transports, 184-185 emergency childbirth, 185 fetal assessment and surveillance

abnormal FHR patterns, interventions for, 183

NICHD terminology for, 182-183 standard of care in, 183-184

legal issues, 188 one-way transport, 175 primary and secondary obstetric evaluation, 181-182

PTL and PPROM

preterm patient, stabilization methods, 185-186

steroid therapy, 186-188 team configuration

education competencies, 178 t-179 t performance, 177 t

priority status, 180 t-181 t qualifications, 176 t

two-way transport, 175-176

Transvaginal scanning (TVS), 354-356, 358-360

Trauma, pregnancy. See also Gynecologic traumas

blunt

fetomatemal hemorrhage, 61 fetus and placental injury, 60-61 restraint use, 61 f, 62

death and, 54 domestic violence, 70

Trauma, pregnancy (Continued) electrical injury, 69-70 evaluation and management fetal monitoring, 67 injury severity score (ISS), 68 laboratory studies, 65 mother and fetus, 64-65 peritoneal lavage, 67-68 prehospital management, 64 radiographic procedures, 65-67, 66 t

tetanus prophylaxis, 68 ultrasonography, 67 gunshot wounds, 56, 63 head and spinal cord injuries, 69 imaging for, 222 outcomes, 54-55 patterns of maternal and fetal injury blunt abdominal trauma, 58-61 fetomaternal hemorrhage, 61 penetrating abdominal trauma, 63

restraint use, 62-63, 62f pelvic fractures, 68 penetrating, 58, 63, 68-69 perimortem cesarean section, 70 physiologic and anatomic changes, 59 t

cardiovascular system, 55-57 endocrine system, 58 gastrointestinal system, 57-58 intestines compartmentalization and gunshot wounds, 55, 56f neurologic system, 58 respiratory system, 57 urinary system, 58 stab wounds, 63, 67 thermal burns, 69 thoracic injuries, 68

Treponema pallidum, 269-271 Trichomonas vaginalis, 338 Trichomoniasis, 238, 278-279, 339 t Tricyclic antidepressants, 231 t, 241 Trimethoprim, 229 t, 238 Tubal rupture, 36-37, 41, 46, 49 Tuberculosis

acquired immunodeficiency syndrome and, 267

pelvic inflammatory disease and, 261

Tubo-ovarian abscess

imaging for, 367-373, 372f pelvic mass and, 293, 295 rupture, 263, 265

U

Ulcerative vulvar disease, 269f, 274 Ulcers, 28 t

Umbilical cord

clamping, 163 nuchal cord, 163

Uni-Gold Recombigen HIV test, 192 t Ureteral obstruction, 311-312, 321, 379, 382 Urethral prolapse, 380

Urinary conduit complications, 312 Urinary tract disorders, 31

Urinary tract infections (UTIs), 120 -123

acute cystitis (AC), 121

acute pyelonephritis (AP) diagnosis, 122-123 management, 123

asymptomatic bacteriuria (ASB) diagnosis, 120-121 management, 121

therapeutic options, 122 t Urine artery embolization, in vaginal bleeding management, 286 Urogynecologic emergencies, 379-384

bowel evisceration, 381

fecal impaction, 383-384

Fournier’s gangrene, 381-382 incarcerated uterovaginal prolapse, 382-383

neglected pessary, 383

urethral caruncles and prolapse, 380 urinary retention, 380

urinary tract injury, 379-380 Urolithiasis, 213-214

Urologic emergencies, related to gynecologic cancers, 320-322

Uterine cancer, 286, 294, 313

Uterine contractions, premature, from trauma, 60

Uterine massage, for postpartum hemorrhage, 202

Uterovaginal prolapse, 382-383

V

Vaccines

for anthrax, 135

for smallpox, 135

for tetanus and diphtheria, 68

for West Nile Virus, 158

Vaginal bleeding

abortion and, 256

evaluation and stabilizntion, 281 laboratory tests, 283-284 management long term, 286

with negative pregnancy test, 284-286 with positive pregnancy test, 284 menorrhagia. See Menorrhagia, vaginal bleeding

patient examination, 281-283

placenta previa, 112-113, 219, 221, 221f placental abruption, 113-115, 114f, 115f during pregnancy

first half, etiology of, 104, 105 t labor, 116

placenta previa, 112-113 placental abruption, 113-115, 114f, 115f during second half, etiology of, 112 t uterine rupture, 116 vasa previa, 115-116

related to oncologic emergency, 307-308

related to pelvic mass, 297f

vasa previa, 115-116

Vaginal cuff cellulitis, 310

Vaginal delivery

breast-feeding, 166

breech presentation, 169-170, 171f cord clamping, 163

genital tract lacerations, 172-173

head delivery, 161-162, 162f

infant care, 166

nasopharynx, 163, 164f

neonatal resuscitation, 171-172

nuchal cord, 163

oxytocin agents, 165-166, 166 t placenta, 163, 165

postpartum hemorrhage, 172

shoulder dystocia, 166-169

shoulders, 162

umbilical cord prolapse (UCP), 170

Vaginal diseases, 278-280

Vaginal evisceration, 319-320, 351, 381 Vaginal foreign bodies, 381

Vaginal infections, vaginal bleeding and, 111

Vaginal lacerations

etiology, 350

management, 346

nonsexually related, 350-352

pelvic fractures and, 350-351

sexually related, 345

vaginal bleeding and, 111

Vaginal prolapse, 382

Vaginitis, 278-280

Vaginosis

bacterial, 278-279

streptococcal, 208 Valacyclovir, for herpes simplex virus, 274 Valproic acid, 17 t, 18, 19 t, 236 t, 248 Vancomycin, 229 t, 239 Varicella pneumonia, 129

Varicella zoster (VZ) infection, 128-129 Vasa previa, 115-116, 216, 221 Vasospasm, 97, 99, 246

Vector, in West Nile Virus, 153 Venography, for deep venous thrombosis, 204

Venous thrombosis, 308-309 Ventilation-perfusion (V/Q) lung scan, 2 Ventilatory support, for cardiopulmonary resuscitation, 80

Vesicants, as chemical weapon, 143-144 Vesicovaginal fistula, 322, 348, 379-380, 383

Visual disturbances

related to acquired immunodeficiency syndrome, 269

related to syphilis, 271

Vitamin K antagonists, 248-249

Vulvar cancer, vaginal bleeding, 308 Vulvar disease, 278-280

Vulvar hematoma, 346, 351-352, 352f

Vulvar injuries, 351-352, 352f

Vulvar ulceration

related to acquired immunodeficiency syndrome, 269, 269f

related to herpes simplex virus, 274 Vulvovaginitis, 278-279

W

West Nile fever, 152

West Nile meningoencephalitis, 152, 157

West Nile virus (WNV), 152-158 activity in U.S., 156f diagnosis

clinical, 155-157, 157 t

laboratory, 157

epidemiology, 152-153, 153 t exposure, 152, 153 t in infants, 153, 154 t prophylaxis, 155 treatment, 157-158

vectors

modes of, 155 mosquitoes, 153, 155f Woods screw maneuver, 168 Wound complications dehiscence, 316, 319 postoperative, 309-310 Wound dehiscence, 316, 319 Wound infections

necrotizing fasciitis, 309, 318 pelvic cellulitis and abscess, 324-325

postoperative, 309

X

X-rays. See Radiography

Y

Yersimia pestis, 140-141

Yolk sac, imaging of, 358, 358f 359f

Yuzpe method, for emergency contraception, 341

Z

Zavanelli maneuver, 167, 169

Zidovudine (ZDV)

for HIV infection, 193-195

for infants, 193