Author: Claudia Passalacqua / Editor: Sarah Edwards / Codes: ObP3, PhC3, PhP1, SLO3, SLO7, XC3, XC4 / Published: 19/07/2024
A 22-year-old woman 11/40 weeks pregnant is brought to the Emergency Department (ED) by her husband with ongoing vomiting and reduced conscious level for three days.
The husband tells you she has been like this for the last three days and they have not sought medical assistance until today. He does not know if she takes any medications or has any allergies but denies she has taken and/or has access to recreational drugs or alcohol.
On initial assessment, the patient is responsive to pain, vomiting, not answering questions or communicating, and not able to mobilize without assistance. You note she has dilated pupils (7mm equal and reactive bilaterally), dry mucous membranes and hot dry skin to touch.
- HR 153; BP 152/87; CRT 5sec
- SO2 100%
- Temp 36.8
Her initial VBG shows a raised lactate and haemoglobin with normal electrolytes and pH. Her blood results show a new severe AKI.
You see in her notes she had her booking appointment a week before and they documented she was worried her husband did not want this baby and had been violent towards her.
Following some initial rehydration, you note some clinical improvement and the patient is now alert and able to communicate. She says she does not know what happened or why she is in hospital. She states she is afraid her husband may have drugged her as he rapes and hits her regularly, and she suspects he has drugged her in the past. She explains she has just moved to the UK to marry him 6 months ago.
6 responses
Multi-theme cases like this are great! Thanks to the author and editor
Good clinical case
Excellent one!
That was great
very informative module, learnt not to label every pregnant patient printing with vomiting with HG ,
Very useful session on toxidromes