DUB ccs CASE - apollo

[ArchivalUser]

A 16 YEO LADY WITH EXCESSIVE MENSTRUAL BLEEDING @ OFFICE

Step-1
Orthostatic Vitals
IV Access
Normal Saline

Step-2 Complete Physical
Step-3 Differential (Think)
Step-4 Evaluation and Management
4a initial Tests
Urine Pregnancy test
Urinalysis
BMP
CBC---shows severe anemia

*Change Location- WARD
4b
Bed Rest
Vitalsx4hrs
Pulse ox x4 hrs
Regular diet
PT/PTT
TSH
prolactin
pap smear
gono/chlamydea DNA probes
Pelvic Ultrasound
H/H every 8 hrs
Blood type & cross match- transfuse x 3 units
Premarin IV continuous ( to control active bleeding)
Consult: Gynecology

*check labs ,do interval history
*if bleeding stopped and H/H stable stop IV Premarin
Start OCPs
Multivitamins + Iron pills
D/C f/u in 2 weeks

4c Education and Counselling

5 Final Diagnosis
DUB

[ArchivalUser]

A Doubt: How long we can keep the pt at office. Can we do some tests at office or do we need to change the location to ER or Office. In this case we did CBC at office and decided to admitt. what is the right way to do? please post your comments
Thanks