03-24-2007, 09:57 AM
A 32-year-old woman who is 17 weeks pregnant was a restrained driver involved in a motor vehicle crash. No air bags were deployed. She complained of neck, back, and abdominal pain after the crash. Initial vital signs are: temperature, 99°F; blood pressure, 108/64 mm Hg; heart rate, 94 bpm; and respiratory rate, 18 breaths/min. A radiograph of the cervical spine is normal. A focused abdominal sonography for trauma (FAST) ultrasound demonstrates free fluid in her pelvis. Complete blood count is normal, Kleihauer-Betke test is negative, and her ß-human chorionic gonadotropin level is 23,255 mIU/mL. Which of the following is the most appropriate next intervention?
1. Infraumbilical diagnostic peritoneal lavage (DPL)
2. Discharge home with obstetrician/gynecology follow-up
3. Surgical consult
4. Transfer to the obstetric service for cardiotocographic monitoring
5. Transvaginal ultrasound
1. Infraumbilical diagnostic peritoneal lavage (DPL)
2. Discharge home with obstetrician/gynecology follow-up
3. Surgical consult
4. Transfer to the obstetric service for cardiotocographic monitoring
5. Transvaginal ultrasound