The Advanced Practice Registered Nurse (APRN) who practices in the emergency department
must understand how to rapidly diagnose and rule out life-threatening conditions.
In women presenting to the emergency department within the first trimester of pregnancy,
an ectopic pregnancy is a potentially life-threatening condition that must be explored.
An ectopic pregnancy is the presence of a fertilized embryo that implants outside
of the uterus, with almost 70% occurring in the fallopian tube.
1
,
2
Implantation of the fertilized embryo outside the uterus, especially in the fallopian
tube, can have devastating consequences. Fallopian tube rupture secondary to an ectopic
pregnancy is the most lethal consequence of an ectopic pregnancy and is one of the
leading causes of hemorrhage-related mortality in the pregnant population.
2
While a thorough history and physical examination are key for identifying high-risk
patients, point of care ultrasound (POCUS) is a vital tool that can be used by the
APRN in the emergency department as part of the management of these patients. POCUS
has gained utilization in emergency departments during the past few years and can
aid the trained APRN in answering clinical questions to help guide their patient management.
3
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References
- Diagnosing ectopic pregnancy in the emergency setting.Ultrasonography. 2018; 37: 78-87
- Tubal ectopic pregnancy. The American College of Obstetricians and Gynecologists Web site.(Published March 2018. Accessed August 9, 2019)
- Emergency ultrasound: point-of-care ultrasound in emergency medicine.R I Med J. 2015; 98: 18-22
- Clinical policy: critical issues in the initial evaluation and management of patients presenting to the emergency department in early pregnancy.Ann Emerg Med. 2017; 69: 241-250https://doi.org/10.1016/j.annemergmed.2012.04.021
- First-trimester pregnancy.in: Soni N.J. Arntfield R. Kory P. Point-of-care ultrasound. Elsevier, Philadelphia, PA2015: 184-198
- Ectopic pregnancy. Clerkship Directors in Emergency Medicine Web site.
- Ultrasound in pregnancy. EB Medicine Web site.(Published March 2, 2011. Updated April 5, 2019. Accessed August 9, 2019)
- Ultrasound: focused 1st trimester pregnancy transabdominal ultrasound. Academic life in Emergency Medicine Web site.(Published February 25, 2015. Accessed August 9, 2019)
- Ultrasound evaluation of the first trimester.Radial Clin N Am. 2014; 52: 1190-1199
- Ultrasound in pregnancy..Emerg Med Clin N Am. 2012; 30: 849-867
- Caudal edge of the liver in the right upper quadrant (ruq) view is the most sensitive area for free fluid on FAST exam.West J Emerg Med. 2017; 18: 270-280https://doi.org/10.5811/westjem.2016.11.30435Date accessed: August 9, 2019
- AIUM practice parameter for the performance of the focused assessment with sonography for trauma (FAST) examination.J Ultrasound Med. 2014; 33: 2047-2056
- Point-of-care ultrasound versus radiology department pelvic ultrasound on emergency department length of stay.World J Emerg Med. 2016; 7: 178-182https://doi.org/10.5847/wjem.j.1920-8642.2016.03.003
Biography
David G. Morrison III is an emergency nurse practitioner at Independent Emergency Physician Group in Detroit, MI.
Article info
Footnotes
Earn Up to 8.0 Hours. See page 727.
Section Editors: Cindy D. Kumar, MSN, RN, AG-ACNP-BC, FNP-BC, ENP-C, and Darleen A. Williams, DNP, CNS, CEN, CCNS, CNS-BC, EMT-P
Submissions to this column are encouraged and may be sent to Cindy D. Kumar, MSN, RN, AG-ACNP-BC, FNP-BC, ENP-C [email protected] or Darleen A. Williams, DNP, CNS, CEN, CCNS, CNS-BC, EMT-P [email protected]
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© 2019 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.
