Archive for category Triage

When Pregnancy Tests Turn Negative

Working a few Peds shifts lately I’ve run into the same question: when should your urine pregnancy test (or quantitative serum hCG) be negative after a regular pregnancy, a termination, or a miscarriage (meaning, could she really already be pregnant again)? I hear different answers depending on the obstetrical consultant I ask, so I decided to do a little literature search myself. It’s really only been looked at in very small studies; I’ve got the specific numbers if you want them, but based on the studies I found, it looks something like this:

After a Full-Term Pregnancy:

  • Should be 3 weeks or less. In some women, ovulation may occur as early as 3 weeks after delivery.

After a Termination with Misoprostol/Mifepristone:

  • In one study, following up at 6-18 days, if the hCG level was 80% lower than the initial hCG level, there was a positive predictive value for successful expulsion of 0.995. There was no information on when the level dropped to 0 or <5.

After a D&C Termination:

  • Depends on the initial hCG, but mean time was 35 days, but could be up to 60 days.

After Miscarriage in Women Who Then Had a D&E for Continued Bleeding:

  • Median ~20 days, range 9-22 days.

After Ectopic with Laparotomy:

  • Ectopics had the lowest hCG to begin with, reached 0 by 1-31 days, median 8.5 days.

References:

  1. Routine terminations of pregnancy—should we screen forgestational trophoblastic neoplasia? The Lancet, 2004.
  2. Human chorionic gonadotropin in maternal plasma after induced abortion, spontaneous abortion, and removed ectopic pregnancy. Obstetrics and Gynecology, 1984.
  3. Verifying the effectiveness of medical abortion; ultrasound versus hCG testing. European Journal of Obstetrics and Gynecology, 2003.

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Emergency Room Communication

One of the key ingredient to running an efficient Emergency Room is good communication. Depending where you work finding charts, immediately finding a nurse  or calling radiology can take longer than expected. Huntington Hospital is currently using an Iphone/Ipod device that allows the health care staff better communicate with each other. It does this via VOIP (Voice over Internet Protocol), basically the set up the system in the hospital to call each other using these devices instead of the hospital PBX or screaming across the ER. The Voalte One system provides voice, alarm and text services all on one device. Overall helps reduce the noise level and makes it easier for the staff to text each other or call each other.

Over all points:

  • Receive Voice calls, alarms, and text messages all on a single device
  • Easily manage multiple text message conversations
  • Intuitive user interface and ringtones
  • Allows simple alarm acceptance or rejection
  • Custom, user-generated “quick messages” facilitate instant messaging of common items to other users or a web-based client

Overall I see both pros and cons, on one side I think it would be useful to have one device to do it all.

On the other side, I worry that it might make it to easy to interrupt us from patient care. In the end it is all about the balance act.

Huntington Hospital is a 636-bed  trauma hospital. For more information, visit www.huntingtonhospital.com

Company website: www.voalte.com

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