A 17-year-old female presents to your ED with abdominal pain. Her vital signs are as follows: BP 90/60, HR 120, RR 16, and SpO2 99%. LMP is unknown. A urine pregnancy test is pending. She is awake and alert but looks uncomfortable so you decide to perform a bedside ultrasound:

Case courtesy of Dr Alexandra Stanislavsky, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/13489">rID: 13489</a>

A. Obtain CBC, BMP, and give a bolus of cystalloid

B. Obtain a serum quantitative hCG level 

C. Await the urine pregnancy test result

D. Call OBGYN STAT

D. This patient has a ruptured ectopic pregnancy until proven otherwise. She is hemodynamically unstable with a positive FAST exam concerning for hemorrhagic shock. Therefore, OBGYN needs to be consulted stat for emergent operative intervention. Lab testing will be a part of her care but should not delay immediate surgical intervention in any way.

This is what a tubal ectopic pregnancy may look like on a transvaginal ultrasound with the characteristic “ring of fire” sign of hypervascularity. 

Case courtesy of A.Prof Frank Gaillard, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/8161">rID: 8161</a>

Barash, J et al. "Diagnosis and Management of Ectopic Pregnancy." Am Fam Physician. 2014 Jul 1;90(1):34-40. < https://www.aafp.org/afp/2014/0701/p34.html#afp20140701p34-b12Vidhi>. (12/6/19).