A 20s year old female presented with 2 hours right-sided lower abdominal pain. While in triage, she passed out. Initial vitals: BP 70/65, T 37.1C, HR 97, RR 19, SpO2 99% on room air. Triage nursing called the team to the bedside, where the patient was minimally responsive to verbal stimuli. POCUS of the hepatorenal space was positive for free fluid in Morison’s Pouch and at the caudal tip of her liver. Her abdomen was rigid and exquisitely tender to palpation. Three large bore IV catheters were inserted and the patient was resuscitated with 3L of lactated ringer’s solution and 3U of uncrossed blood. Point-of-care urine pregnancy test was positive. She was taken to the operating room where 2.5L of blood was evacuated from her abdomen revealing a ruptured ectopic pregnancy with active arterial hemorrhage from her left fallopian tube. She received an additional 3 units of packed red blood cells and 3 units fresh frozen plasma. Dr. Cap’s take away: Have a low threshold to perform a bedside assessment for abdominal free fluid in syncope. As this case demonstrated, POCUS can significantly decrease a patient’s time from presentation to definitive operative care.
-Dr. Cap Taylor, Bronx, NY USA