Dr. Shirley Lee and Dr. Dominick Shelton discuss a challenging case of a pregnant patient presenting to the emergency department with shortness of breath and chest pain. They review those diagnoses that the pregnant patient is at risk for and discuss the challenges of lab test interpretation and imaging algorithms in the pregnant patient. Next, they walk us through the management of cardiac arrest in the pregnant patient. In another case of a pregnant patient who presents with abdominal pain and fever, they discuss strategies to minimize delays in diagnosis to prevent serious morbidity and mortality. The pros and cons of abdominal ultrasound, CT and MRI are reviewed as well as the management of appendicitis, pyelonephritis and septic abortion in pregnant patients.

Pregnant patients who present to the emergency department with non-obstetrical complaints are very challenging. Their symptoms can be misleading or confused with normal pregnancy, their vital signs are normally altered, the physical exam can often be more difficult, their lab values are harder to interpret and imaging algorithms for pregnant patients are very complicated. In addition, they generally have worse outcomes than non-pregnant patients. In this episode, Dr. Lee and Dr. Shelton answer questions such as: how is the pregnant patient with suspected pulmonary embolism worked up and treated? How are ACLS protocols different for pregnant patients? How and when should emergency physicians perform emergency C-sections? How is the presentation of appendicitis different in pregnant patients? What are the risks to the fetus of CT pulmonary angiogram vs. VQ scan? What is the role of MRI for diagnosing appendicitis in pregnant patients? Is gadolinium contrast contraindicated in pregnancy? How can we minimize radiation exposure to our pregnant patients? Which pregnant patients with UTI should be admitted to hospital? What are the best antibiotic choices for asymptomatic bacteruria, cystitis and pyelonephritis in pregnant patients? Do we need to do a BhCG on every woman of childbearing age who presents to the ED? How is septic abortion diagnosed and best managed? and many, many more……