Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York.
J Emerg Med. 2020 Feb;58(2):e75-e78. doi: 10.1016/j.jemermed.2019.11.033. Epub 2020 Jan 22.
Severe vaginal hemorrhage caused by disseminated intravascular coagulation (DIC) after dilation and evacuation is a rare but life-threatening situation that can be difficult to manage. Obtaining hemostasis in such a patient with heavy vaginal bleeding secondary to DIC can be difficult. One technique involves the use of a urinary bladder catheter inserted into the uterus that is inflated to apply pressure on the endometrium, allowing for tamponade of the bleeding.
A 36-year-old female gravida 2 para 0 at 21 weeks' gestation presented to the emergency department after being transferred from another facility for a higher level of care available at our facility, after a dilation and evacuation procedure that was indicated because of intrauterine fetal demise. The physical examination was significant for an ill-appearing female with active heavy vaginal bleeding. Resuscitation was initiated with packed red blood cells, cryoprecipitate, and platelets. Because of her thrombocytopenia, the development of DIC was suspected. Point-of-care ultrasound (POCUS) was performed and showed a thickened endometrial stripe with evidence of multiple anechoic foci, which were thought to represent intrauterine clots. To tamponade the bleeding, a 30-cc standard Foley urinary bladder catheter was placed into the uterus, using POCUS for guidance, to attempt to induce hemostasis via tamponade of the bleeding after inflation of the catheter balloon. Placement of an intrauterine urinary catheter to enable tamponade can be useful for the management of uncontrolled hemorrhage, but can be difficult to accomplish without use of POCUS for guidance. POCUS enabled us to accomplish accurate intrauterine placement of the urinary catheter and confirmation of a properly placed catheter balloon within the uterus. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Menorrhagia in the emergency department can be difficult to manage, especially in the setting of DIC. Placement of an intrauterine urinary catheter can be useful in management but may be difficult for the inexperienced provider. POCUS can be used to guide the catheter into place and confirm the location once the balloon is inflated.
弥漫性血管内凝血（DIC）导致的扩张和排空后严重阴道出血是一种罕见但危及生命的情况，可能难以处理。在继发于 DIC 的大量阴道出血的患者中获得止血可能很困难。一种技术涉及将膀胱导尿管插入子宫，然后充气以对子宫内膜施加压力，从而进行填塞止血。
一名 36 岁女性，妊娠 2 次，产 0 次，妊娠 21 周，因宫内胎儿死亡而进行扩张和排空，在另一家机构转来我院接受更高水平的治疗后，被收入急诊部。体格检查显示患者外观不佳，有活动性大量阴道出血。通过输入红细胞悬液、冷沉淀和血小板开始复苏。由于她的血小板减少，怀疑发生了 DIC。床边超声检查（POCUS）显示子宫内膜带增厚，有多个无回声灶的证据，这些灶被认为代表宫内血块。为了填塞止血，使用 POCUS 引导将一个 30 毫升标准 Foley 膀胱导尿管插入子宫，通过充气导管球囊尝试填塞止血以诱导止血。放置宫内导尿管进行填塞对于控制出血的管理很有用，但如果没有 POCUS 引导，放置可能会很困难。POCUS 使我们能够准确地将导尿管放置在子宫内，并确认导尿管球囊在子宫内的正确位置。
为什么急诊医生应该了解这一点？：在急诊室，月经过多很难处理，尤其是在 DIC 的情况下。放置宫内导尿管在管理中可能很有用，但对于经验不足的提供者可能很困难。POCUS 可用于引导导管到位，并在充气后确认位置。
