First Trimester Vaginal Bleeding

In this EM Basic podcast episode, Steve Carroll discusses first-trimester vaginal bleeding, emphasizing the importance of a thorough patient history, physical exam, and appropriate lab workup, including UA, quantitative HCG, CBC, type and screen, and pelvic exam with GC, chlamydia, and wet prep. He stresses the need to rule out other potential medical emergencies and warns against tunnel vision, focusing solely on pregnancy-related issues. Carroll details the use of transvaginal ultrasounds to identify intrauterine pregnancies and ectopic pregnancies, providing guidelines based on HCG levels. The episode also covers management strategies for ectopic pregnancies and miscarriages, including expectant management, Cytotec, and D&C, along with advice on how to compassionately communicate with patients about possible miscarriages and follow-up care.