It’s in the Urine

​"I just put a young woman in her mid-30s back in room 9," the triage nurse said. I made a mental note that that was the GYN room. The nurse continued, "She feels bad, fatigued, and just not right in her stomach." The obvious question flew from my mouth. "Is she pregnant?"​"I have the urine, but the quality controls are being run now, so it will be a few minutes."I glanced at the EMR before heading back to the room: normal vitals, no fever, no medications, a couple of kids, no surgeries, last period three weeks before. Not much there to go on, but I could see her while waiting for the urine.​I found a fully dressed young woman sitting comfortably on the bed. She gave me the same story. I thought I knew where we were going. I asked if she thought she was pregnant. The noncommittal answer made me sure I had the reason she was in my ED in the middle of the night. The answer would be in the urine.Getting back to the computer, the urine results were back. Not pregnant!OK, not the direction I thought we were going. Looking at the urine dip, which always seems to come in tandem with the urine pregnancy, showed she was not dehydrated and didn't have a UTI, but there was trace bilirubin and high urobilinogen. What to do with that?She looked so good clinically. I could send LFTs to the lab. There goes the length of stay with an added hour at least to get the results back. Shared clinical decision-making! That would be the answer.​She ...
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs