lOMoARcPSD|44532475
I. Patient Profile
Samantha Hasting is a 32-year-old female presenting to the emergency department with
severe lower abdominal pain and vaginal bleeding for 3 hours. The patient was admitted to ER
and given a pregnancy test which was positive. Bedside ultrasound shows a 24–25-week
gestation. Patient denies previous knowledge of pregnancy with no prior prenatal care. Patient
states she has had gas for the past 2 months that she now believes could have been fetal
movement. Past medical history shows uncontrolled type 1 diabetes, chronic hypertension,
preeclampsia in previous pregnancy, substance abuse (heroin), atrial fibrillation, hepatis C,
depression, previous cesarean 3 years ago. Patient has 9 previous pregnancies, 3 children, 2
spontaneous abortions and 3 medical abortions.
Ultrasound shows, single live fetus along with placenta previa and free fluid in the
abdomen. Urine drug screen is positive for methadone and cannabinoids. Vital signs are unstable:
BP- 162/98, HR- 118, RR-24, TEMP- 38.5C/101.3F, SpO2 94% on room air. Patient is anxious,
pale and diaphoretic. Upon examination eyes show conjunctival pallor with dry mucous
membranes. Patient is tachycardic with 2+ pitting edema in lower extremities and tachypneic
with clear auscultation. Abdomen tender upon palpitation with positive rebound tenderness and
positive pregnancy. Cervix appears closed on examination, but active vaginal bleeding is present.
Patient is alert and oriented x4 with no focal deficits. Diagnostic testing was completed as
follows.
Lab Results:
CBC: Hgb 9.2 g/DL, WBC 16.5 x 10 ^9/L, Platelets 90 x 10^9/L
BMP: Na 134 mEq/L, K 3.3 mEq/L, Cr 1.4 mg/dL, Glucose 210 mg/dL
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, lOMoARcPSD|44532475
LFTs: AST 80 U/L, ALT 75 U/L, Total Bilirubin 1.8 mg/dL
Urinalysis: 3+ protein, 2+ leukocytes, 1+ blood
Urine Drug Screen: Positive for methadone and cannabinoids
Bedside ultrasound: single live fetus, placenta previa, free fluid in
abdomen.
Medications:
Insulin
Methadone 80 mg PO qd
Sertraline 100 mg PO qd
Omeprazole 20 mg PO qd
Eliquis 5 mg BID
o Allergies: penicillin (anaphylaxis), latex (severe rash), Haldol
(anaphylaxis).
Patient is currently homeless, staying at multiple shelters and has limited social support.
All living children are currently in foster care. Patient reports to be an active 1 pack per day
smoker, occasional alcohol user, and substance user (methadone and heroin). Patient is to be
admitted to Labor and Delivery for urgent maternal-fetal evaluation and management.
II: Pharmacological Analysis
Methadone: 80 mg PO daily.
o Methadone is used as opioid detoxification, and it works by binding with opioid
receptors in the central nervous system which alters the perception and emotional
response to pain.
Downloaded by madiba South Africa stuvia ()
I. Patient Profile
Samantha Hasting is a 32-year-old female presenting to the emergency department with
severe lower abdominal pain and vaginal bleeding for 3 hours. The patient was admitted to ER
and given a pregnancy test which was positive. Bedside ultrasound shows a 24–25-week
gestation. Patient denies previous knowledge of pregnancy with no prior prenatal care. Patient
states she has had gas for the past 2 months that she now believes could have been fetal
movement. Past medical history shows uncontrolled type 1 diabetes, chronic hypertension,
preeclampsia in previous pregnancy, substance abuse (heroin), atrial fibrillation, hepatis C,
depression, previous cesarean 3 years ago. Patient has 9 previous pregnancies, 3 children, 2
spontaneous abortions and 3 medical abortions.
Ultrasound shows, single live fetus along with placenta previa and free fluid in the
abdomen. Urine drug screen is positive for methadone and cannabinoids. Vital signs are unstable:
BP- 162/98, HR- 118, RR-24, TEMP- 38.5C/101.3F, SpO2 94% on room air. Patient is anxious,
pale and diaphoretic. Upon examination eyes show conjunctival pallor with dry mucous
membranes. Patient is tachycardic with 2+ pitting edema in lower extremities and tachypneic
with clear auscultation. Abdomen tender upon palpitation with positive rebound tenderness and
positive pregnancy. Cervix appears closed on examination, but active vaginal bleeding is present.
Patient is alert and oriented x4 with no focal deficits. Diagnostic testing was completed as
follows.
Lab Results:
CBC: Hgb 9.2 g/DL, WBC 16.5 x 10 ^9/L, Platelets 90 x 10^9/L
BMP: Na 134 mEq/L, K 3.3 mEq/L, Cr 1.4 mg/dL, Glucose 210 mg/dL
Downloaded by madiba South Africa stuvia ()
, lOMoARcPSD|44532475
LFTs: AST 80 U/L, ALT 75 U/L, Total Bilirubin 1.8 mg/dL
Urinalysis: 3+ protein, 2+ leukocytes, 1+ blood
Urine Drug Screen: Positive for methadone and cannabinoids
Bedside ultrasound: single live fetus, placenta previa, free fluid in
abdomen.
Medications:
Insulin
Methadone 80 mg PO qd
Sertraline 100 mg PO qd
Omeprazole 20 mg PO qd
Eliquis 5 mg BID
o Allergies: penicillin (anaphylaxis), latex (severe rash), Haldol
(anaphylaxis).
Patient is currently homeless, staying at multiple shelters and has limited social support.
All living children are currently in foster care. Patient reports to be an active 1 pack per day
smoker, occasional alcohol user, and substance user (methadone and heroin). Patient is to be
admitted to Labor and Delivery for urgent maternal-fetal evaluation and management.
II: Pharmacological Analysis
Methadone: 80 mg PO daily.
o Methadone is used as opioid detoxification, and it works by binding with opioid
receptors in the central nervous system which alters the perception and emotional
response to pain.
Downloaded by madiba South Africa stuvia ()
