6/4/19 8:00 PM-6:00 AM, 10 hours; 6/5/19 8:00 PM-6:00 AM, 10 hours; 6/6/19 8:00

PM-6:00 AM, 10 hours

Hours worked this week – 30
Total hours – 140/456

Every woman of childbearing age gets a pregnancy test when they come to the ER. The

only exception is if the woman states that she has had a total hysterectomy. There have

been a multitude of women in various stages of pregnancy – some knew they were

pregnant, some did not. For the newly diagnosed pregnancy – we do the blood test for

confirmation, but then we have to recommend an obstetrician. We have also gotten

several women who come in spotting or cramping. They get vaginal ultrasounds to tell if

they might be having a miscarriage. Even then, there is nothing that necessarily has to be

done in the ER, but time and follow up with their regular doctor. It does not seem to be

the right place to have to deal with all those emotions and issues.

Tuesday

All pregnant women who come in from a trauma must be cleared from the ER

physician before they are transported upstairs to the labor and delivery portion of the

hospital. A 32-year-old woman came in, 34 weeks pregnant with her third child and she

was involved in a fender bender. She thought she might be progressing into labor, and

she was right. Because she had blunt force trauma to her abdomen, we did a CT scan and

found that she was bleeding behind her uterus into her abdomen. Before we could rush

her upstairs, blood came out of everywhere. I have never seen so many people move so

quickly. My job was to stay out of the way. Nurse practitioners, physicians,

anesthesiologists, ER nurses, L&D nurses, radiology techs, ER techs all seemed to be

doing something. She was emergently intubated and placed on the ventilator and the ER
physician performed an emergency C-section. It was cool. They began to give her a lot of

blood and blood products and the bleeding gradually slowed down to the point they could

proceed to the operating room. I later learned that the baby girl was doing well, but the

mother had to have a hysterectomy to ultimately control the bleeding.

Wednesday

In addition to the women who come in with complications of pregnancy – the

majority come in and do not realize that they are pregnant. Obviously, this means that

they are not practicing protected sex. My preceptor gives them a speech regarding the

magnitude of this issue – there are many other concerns besides an unwanted pregnancy,

including hepatitis B, C, HIV, STDs, etc. The ER is not the place to prescribe birth

control devices or to start and elective removal of the pregnancy since there is no way to

follow up on any issues that may arise. Many women do not seem to be knowledgeable

or educated in basic sex education and prevention. One young woman said that her

method of birth control was that she only had sex standing up. Several others stated they

had their partners pull out or promise not to ejaculate.

Thursday

More concerning is the number of families that present to the ER with a variety of

issues with 3- 6 children, all young, and usually on Medicaid or “Self –pay.” The parent

or parents seem overwhelmed, and the issues are usually those of primary care. I am

trying not to judge, but limiting the number of children would be more financially

responsible and improve the overall welfare of the entire family. There are many types of

birth control that could be discussed and evaluated by the family in the appropriate

setting.