Heavy Menstrual Bleeding Guideline

CME CREDIT NOW AVAILABLE-1.0 AMA PRA Category 1 Credit FOR EACH ISSUE (2 ARTICLES)!!!!!!

 

by Mona Kulkarni

mona.kulkarni@pemaweb.com

 

Case: 15-year-old otherwise healthy adolescent presents to your office complaining of a menstrual cycle lasting longer than 10 days. She has been changing her sanitary pads hourly at times and passing heavy clots.  Now she’s feeling a bit dizzy.

What is the work up that we need to do?  The Heavy Menstrual Bleeding guideline was created by our team to help guide us in the evaluation.

Heavy Menstrual Bleeding (HMB) is one of the most common adolescent gynecology complaints we see in the ED.  The differential diagnosis is broad including anovulatory cycles, hypothyroidism and underlying bleeding disorders (up to 20% of cases). The importance of early recognition and determination of the underlying cause can positively impact the teen’s quality of life, school attendance and sports participation.

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Behavioral Health ED Visit: Expectations and Limitations

 

CME CREDIT NOW AVAILABLE-1.0 AMA PRA Category 1 Credit FOR EACH ISSUE (2 ARTICLES)!!!!!!

By: Kristin Weinschenk, MD and Michael Lowley, MD

Kristin.Weinschenk@choa.org

The primary goal of the psychiatric evaluation in an ED setting is to assess the safety of the individual, and to connect them with resources at the appropriate level of care. This begins at triage with a screening tool called the ASQ (Ask Suicide-Screening Questions to Everyone in Medical Setting), a five-item questionnaire which flags patients for risk of recent or current thoughts of self-harm. A positive screen will then trigger referral for amore detailed evaluation by either the psychiatric social worker in the ED, or by a member of the Psychiatry Consult Liaison service. The MH professional will conduct a psychosocial assessment, and complete a more detailed suicide risk assessment tool called the BSSA. Once level of risk is established, the treatment plan will reflect the need for appropriate safety and monitoring, whether at an inpatient psychiatric hospital or in a less restrictive care setting.

 

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