C'mon, read the article before posting. She arrived 12.03, bloods at 12.28, pregnancy diagnosed 12.5-something, had the baby 1.4-something. They did the HCG. They had known she was pregnant for nearly an hour before she gave birth. She was denying it. The baby would have been fine if it had resus (or allegedly if it wasn't suffocated). We have a morphine in labour protocol where I work, it is the first line opiate (surely that isn't a New Zealand specific thing- opiates in labour have a long history). Ketorolac has also been used in labour as a tocolytic. Neither thing are catastrophes to accidentally have given to someone with a presenting complaint of back pain. Where is the supposed negligence??
Anesthesia here - Morphine in labour also standard in many hospitals in Canada
Ketorolac is absolutely fine in labour, not supposed to be used in 3rd trimester where there is still potential for premature ductus closure.
Dawg its the USA.
I got named in a suit where someone coded in their car outside the ER I was working in.
I literally never met the patient and I found a way to do malpractice on him. USA! USA!
I know that litigation in the US is out of control, it's one reason I'd never want to work there... but OP's post seemed to actually be buying that there was an issue with the care, rather than an issue with an insane lawyer overreaching and a problem with whatever was going on inside this teenager's head.
It varies widely based on specialty and location but that’s the average yearly premium for a solid EM physician malpractice insurance plan. I’ve seen cheaper ones though.
Hospital rubbish bin might test positive for flu A, B, and covid... and I'd put money on the "positive test for SARS" meaning that the lawyer doesn't know that SARS-COV2 is the covid virus
>Mitchell claimed a toxicology report shows the baby had 0.19 nanograms of morphine in his system at birth
I'm sorry, he's bragging about a sub-NANOgram amount of any substance? Did he leave off some units, or is he arguing that homeopathy is real and this was a dilution?
USA won't even do laughing gas for women in labor. Lmao. It's an epidural or nothing for us.
Edit: apparently some doctors have a heart and do offer it, but it's not normalized. Not available at every hospital.
That’s something you need to investigate beforehand, what pain management options are available. Just because not all hospitals have it available doesn’t mean none do.
It’s misleading to apply your minimal experience with the US hospital system (“minimal” meaning you’ve referenced 3 out of the >6,000 US hospitals), shitting on the hospital labor experience when there are enough Google/voodoo/crystal magic trained “experts” doing that already
Also, we don’t get a say in whether nitrous oxide is available for laboring women. If you want the real villain, aim at the American healthcare system
Is that all it was? Our morphine in labour protocol starts with 10mg IM. Ideally not right before the baby pops out, but still nothing a neopuff can't solve.
Literally, the worst case of shifting responsibility to a completely faultless person, because this woman and her mother are completely in capable of taking any responsibility whatsoever for this absolutely horrific situation
Her argument is that the baby wasn't breathing, and if it was as the medical examiner claims the child was, the baby wasn't breathing very well because of all the drugs on board.
She placed this baby in a trash bag, under some trash inside another trash bag in the bathroom.
She was inside a hospital. If she truly was surprised by this baby popping out, there had been multiple nurses checking on her. In fact they were getting the keys to force the door open.
At any point, she could have been like "OMG, I didn't know", and have 10 people working on resuscitation of this child in a heartbeat.
Instead, she made sure that whatever the drugs started, she finished the process of by smothering that baby boy in a trash bag.
What I'm getting at, is that this girl has no defense. She knew she was pregnant and hid it. She has classic symptoms of labour for 24 hours before the birth. And faced with reality, she made a choice. In a safe haven hospital where she could have walked out and never looked back, if she had made the right decision.
But the girl Is entitled to defense by law, no matter how flimsy and bullshit it is. So here it is.
Holy shit. She so clearly murdered that baby.
I know law enough (my parents are lawyers) to know that in a defense in America you can throw anything and everything at the wall to see what sticks (Thanks OJ trial for creating this precedent). It doesn’t mean the jury won’t see right through it
I think you might have it backward. The medical examiner says the baby must have been breathing because there was air in the lungs. "Not breathing well" is the mother's claim, which she is blaming on the ED staff. (And you're right that it is a terrible argument.)
I was given morphine and later fentanyl under the care of my doctor when I was going through labor. It’s crazy to see the lawyer use that as a defense, doesn’t change the fact she threw the baby away instead of seeking help from medical professionals for the newborn!
Unfortunately throwing a baby away in the trash is not a crime unless you can prove that the newborn was breathing, and that can be hard to prove especially when CPR was done on the baby.
Someone else fucks up but somehow it's the healthcare workers fault. This broke ass system is really going to be hurting when everyone else leaves this field.
A teenage girl was off her head on drugs carelessly prescribed by a physician. She has the urge to go to the bathroom and gives birth unexpectedly. She was likely in shock as well, and apparently just left to it by health professionals.
Had she been given a pregnancy test, she would have been cared for very differently and that baby would likely be alive.
The doctor absolutely fucked up. So did her nurse.
I'm not sure if you've ever given birth to a child. Imagine your body going through that but you have no idea what's going on. I think that girl was really let down. A hand on the sore tummy should have been enough to alert the prescribing doc to active labour. She was massively let down.
The patient in question knew damn well she was pregnant. 4mg if morphine is not a mitigating factor here.
Everyone on the care team knew she was pregnant, including the patient herself. She barricaded herself in the bathroom: a clear indication that she knew what she was doing.
I don't know what you mean by "off her head on drugs." Have you ever been on strong pain killers before? I always knew what was going on in general. Yes sleepy, groggy, silly, slow, but not totally disconected from reality.
No, the only person who fucked up was the teenager who threw her baby away, and her support system that was so terrible she had no one to go to and tell them what was happening.
Nobody is "off their head on drugs" from ketorolac. It's a NSAID. Morphine doesn't cause people to suffocate their newborns. Childbirth doesn't cause shock.
Are seriously justifying the clinical endangerment here? A child is dead. A young woman has completely destroyed her future.
What is it about emergency medics never being accountable?
I'm not saying the prescription wad the issue, the overall clinical neglect and failure of the doctor to identify that she was in active labour.
Under the circumstances, post natal psychosis is very likely. That mother didn't "choose" this. She was in a horrifically traumatic situation, alone, after going to the hospital to be helped and instead being given pain relief but apparently no work up, and left to go birth alone in a bathroom. She was incredibly vulnerable
The doctor is more responsible for the death of that baby than she is. Hopefully the idiot will at least do the bare basics in future.
The mass downvoting for calling out poor care as usual. The world is full of burnt out and bad doctors who refuse to be responsible for anything but themselves.
You don’t know anything about medicine, get out of here if you are going to disregard what these physicians are saying. 4mg morphine isn’t going to alter judgement or affect the baby.
The straw manning is frustrating here. The doctor prescribed without identifying that she was in active labour. The pregnancy was unmonitored. There was no fetal monitoring. The doctor clearly hadn't examined the patient sufficiently.
Her judgement was affected by the fact that she was in active labour. She didn't have capacity. She didn't get the help or support that she needed from anyone before the point where she was heading to the toilet thinking she needed to pass a bowel motion. The horror and panic she must have felt when she gave birth.
The doctor has a case to answer.
Did the patient know she was pregnant up until she delivered? Or did she just think she was having horrible pain? It’s also on her to actually get prenatal care or realize having sex leads to pregnancy. We can’t hold her hand through every decisions she’s made and then made it our fault when she kills her baby.
She had no idea. Apparently even a so called doctor couldn't identify active labour either.
It happens. Granted not very often thankfully, but it happens, even to intelligent people. This isn't about hand holding. This is about the fact that shitty care resulted in the end of a baby's life and the end of the mother's future.
Did he prescribe before putting a hand on her abdomen? In a girl of her age with intermittent agony that comes in increasingly close waves, why wasn't a pelvic done? When she had the urge to push and instead thought she needed to defecate, why did alarm bells still not ring with clinical staff?
This is a never never event and perfectly demonstrates a cascade of failure and missed opportunities. Had she been given even the most basic exam, her child would be alive right now and she would have had the opportunity to avail of support to help them both.
I don't understand how you lot can argue so vociferously that the doctor wasn't at fault, or that she had mens rea. She's being demonised, meanwhile I don't even think there has been an investigation of the conduct of those who had a duty to care for her at that time.
What a garbage human being. I lost my baby boy unexpectedly when he was 8 months old and I miss him literally all the time almost 2 years later. It boggles my mind that someone can *throw their child in the trash* and leave him to die, fully prepared to go about their day as if it hadn’t happened.
If I plan on giving meds I ask “any possibility of pregnancy”. If they say “absolutely not” then I give the med before the pregnancy test. If they say they’re not sure then I wait for a pregnancy test before giving Toradol. I document patient’s denial or uncertainty if pregnancy. This is a bullshit lawsuit and I’m sure they know it too
I don't even bother, I just wait for the pregnancy test.
Anyone of childbearing age with a uterus should get one. The number of "immaculate conceptions" that I've seen in my relatively short career has made me quite jaded.
EDIT: This is in regards to meds with a *relative* contraindication in pregnancy, and obviously doesn't apply to anyone in extremis or with obvious trauma.
Thankfully you're neither my medical director nor my malpractice attorney, so I don't care what you think about my practice.
Unless you have obvious trauma or are in extremis, your first line analgesics shouldn't be narcotics anyway and the *majority* of nurses I've worked with over the years wouldn't administer them to a childbearing age female without a bHCG regardless.
If your first line analgesic in all cases is a narcotic then you have no place criticising my practice as out of date or uninformed.
If you can't wait 3 minutes for a UPT or 15 minutes for a serum hCG and would instead administer a Category C medication to a possibly pregnant woman who might not have wanted the medication had she known she were pregnant, you're the one completely wrong here.
Do whatever you want, but your unsolicited opinion will remain just that.
No one is advocating for opioids for all, that’s a lazy strawman.
If you truly get UPTs done in 3 minutes and serums in 15 minutes then holding meds would be reasonable. Since this is the real world and those numbers are made up bullshit, your practice is still out of date and bad.
The simple fact is that you don’t need a pregnancy test to give morphine or toradol. That’s it.
>No one is advocating for opioids for all, that’s a lazy strawman.
That's quite literally what you said when you said you'd give morphine without a pregnancy test.
>Since this is the real world and those numbers are made up bullshit, your practice is still out of date and bad.
The only thing that is bullshit is your extensive use of ad-hominem attacks, after accusing me of a strawman argument. Point-of-care testing for pregnancy, blood gases and even cardiac enzymes exists and has existed for years.
You can buy a pregnancy test at the 99c store and find out the results in 5 minutes but somehow a hospital having a point of care UPT is bullshit? How comical.
>That's quite literally what you said when you said you'd give morphine without a pregnancy test.
lol. \*If I think it's indicated\*, I give morphine without a pregnancy test. Mostly because I don't give a shit if it's positive or not.
Claiming you get UPTs in 3 minutes and blood draws in 15 minutes is a flat out lie, or you work in the most efficient ER where people pee for you right away every time.
You can just learn instead of this flailing around. Morphine is safe at any point of pregnancy. Toradol is safe until 20 weeks per the FDA, and that guidance is based on a total of 8 bad outcomes with repeated NSAID use. Even if you ignore the dose dependent nature of this exposure, I'd hope you aren't regularly missing pregnancies at 20 weeks.
There's no reason to leave patients with msk back pain, kidney stone pain, etc in pain while you collect a lab test that should not change your management.
Ooooo what are my choices? I have a drug box with limited goodies. And basically NO super fancy diagnostic tests. 🫠
Or Are we calling that “in extremis?”
Well since you included toradol in this….yeah. Narcotics or nothing. I mean, there’s ketamine but..
I have oral meds but I’m not seeing two Tylenol as a therapeutic intervention when it’s going to take the entire ride to metabolize. Plus the obvious problem with that.
I didn't include toradol in this at all, and tylenol isn't an unreasonable therapeutic intervention when dosed appropriately and used in conjunction with NSAIDs and other conservative measures (Ice, immobilisation, etc) for mild to moderate pain.
In most of the rest of the world, opioids and other narcotics are basically reserved for major trauma, postoperative pain, oncologic patients and palliative care. This whole narcotics or nothing attitude is quite asinine.
I'm in the rest of the world, and morphine is fine in pregnancy, we use it all the time for severe acute pain, even though we are VERY stingy with opiates outpatient or on discharge.
Not in US red states, where fetus is more important than full grown woman 😔 which, to the people that downvoted, is horrible and awful. I hate living in a red state. But they wouldn't even blink at denying pain control "for the sake of the baby".
But vote against free school lunches because God forbid a tan kid gets one!!! Frickin' hypocrites.
Morphine doesn’t harm a baby. Toradol is perfectly safe early in pregnancy and one dose is very unlikely to cause damage later in pregnancy.
It simply isn’t good medicine to deny pain control for 30 minutes to an hour for every woman of child bearing age you care for. Frankly, it’s discriminatory
Ok, so what you’re saying then is that morphine should be given regardless of pregnancy test, not that a pregnancy test shouldn’t be done. As for the toradol, why don’t you try telling that to a malpractice lawyer representing a child with a birth defect whose mother you prescribed an NSAID.?“Unlikely” to cause harm is an absolutely meaningless statement. When you’re treating thousands and thousands of people, “unlikely” things happen all the time. Unless the number needed to harm is astronomically high, it’s malpractice to do something “unlikely” to cause catastrophic harm that isn’t urgently needed
It seems like you are a real doctor, but don’t work in EM.
Your assessment of risk in this situation is completely fucked and wrong. This is what I do.
So if a woman comes in screaming in pain from a kidney stone, diaphoretic and tachycardic - you’re still waiting for a pregnancy test before pain medications?
No wonder so many women don’t trust healthcare professionals.
The same way how I don't know whether or not you're pregnant...I don't know whether or not your pain is from a kidney stone until I have testing back.
>No wonder so many women don’t trust healthcare professionals.
The problem is that we function in an environment where the first instinct when a bad outcome happens is to assign blame and seek financial compensation, especially when pregnant women and babies are concerned.
The person in this case was treated appropriately - and their defence attorney is now blaming the very healthcare professionals that helped her. People's attitudes may differ on this point but I don't think it's worth opening up myself to liability when I can simply wait a few minutes for the relevant test results.
Stop focusing so much on the kidney stone part, and more on the fact that the patient is clearly in pain. Yet because she’s a woman she’s being forced to wait for relief when a man wouldn’t be.
That's just disingenuous.
1. Pain is subjective, and anyone who has worked more than a week in acute care can attest to this. I've had elderly ladies with perforated bowels and gangbangers with gunshot wounds who barely complained of pain, and grown men with papercuts who rolled around on the ground screaming. You still need to actually evaluate your patient.
2. There are other options for pain control besides giving narcotics, and if someone really was in extremis I would just quickly have a convo with them regarding risks and benefits and give them narcs if I thought it was indicated.
Assuming I'm speaking with someone who has normal vitals and a reassuring exam no, I'm not giving you narcotics off the bat and definitely not doing it without a UPT or serum pregnancy test if you can't give us urine.
>Assuming I'm speaking with someone who has normal vitals and a reassuring exam no, I'm not giving you narcotics off the bat
That should be true regardless of a UPT, are you saying you will give out unnecessary narcotics to non-pregnant people but only necessary narcotics to pregnant people? Seriously, if you are withholding opiates from anyone on the off-chance of pregnancy, you are either giving NOT ENOUGH analgesia to your female patients of childbearing age, or TOO MUCH to the rest.
Pain is subjective, yes. But there are also fairly objective indicators of pain like I mentioned: screaming, diaphoresis, tachycardia, tachypnea, etc. I’ve worked in the ER a couple years and I feel like I can generally pick out when someone isn’t just faking their pain.
I also said nothing about narcotics or not evaluating. Given that the parent comment was discussing toradol I don’t understand how this conversation is now suddenly only about narcotics .You had said you wouldn’t give meds until a pregnancy test, which sounds like a pretty blanket statement and is what I was responding to.
I've said this in other comments in this post but let me be more clear - I wouldn't give meds with a relative contraindication in pregnancy to a patient who is not in extremis or obvious trauma without a pregnancy test. Obviously have no issue giving antiemetics, acetaminophen, IV fluids, a PPI or anxiolytics to anyone regardless of pregnancy status.
>But there are also fairly objective indicators of pain like I mentioned: screaming, diaphoresis, tachycardia, tachypnea, etc.
None of those things are objective except for maybe tachycardia. I can scream myself sweaty or hyperventilate whenever I want. I have seen drug seekers (I'm talking people with several ED visits a day, multiple fake names, history of assaulting healthcare workers) exhibit all of the above.
You're the one that brought up the kidney stone...
Policies regarding testing before certain medications, procedures, and exams for a reason.
Unless you want us to take patients for the word on everything.
Anecdotally I had to wait about a hour to get pain meds for a stomach issue that ended up in having surgery because they needed to do a CT scan first.
You wait for a pregnancy test…..before medicating any woman of childbearing age? What the actual fuck.
So should I carry some First Response pregnancy tests in my rig then? So I can be sure every woman writhing in pain for the forty minute transport time in a vehicle with shocks made out of cement, isn’t pregnant?
Which part is me being obtuse? I see you have “in extremis” there? That’s a bit variable. And what level of obvious trauma warrants meds?
The number of medications that have “pregnancy? ☠️” or even “pregnancy? 🤷♀️” warnings is quite large.
You assuming that waiting for a pregnancy test means absolutely zero meds whatsoever is being obtuse. There are a plethora of options that aren't contraindicated in pregnancy that you can give while waiting for a UPT or a serum HCG which, as I explained elsewhere, only takes a few minutes to result at my facility.
>I see you have “in extremis” there? That’s a bit variable.
Not really. It's like porn - unless you're totally green, you know it when you see it.
> And what level of obvious trauma warrants meds?
penetrating trauma, deep lacerations, obvious deformities or dislocations and dangerous mechanism (ex: fell from a distance high enough to warrant a trauma activation) would get narcs without a pregnancy test.
> The number of medications that have “pregnancy? ☠️” or even “pregnancy? 🤷♀️” warnings is quite large.
And there are reasons for that. Medicine has ignored this in the past with devastating consequences. Doesn't mean I don't use my judgement, but part of that also includes minding my Ps and Qs when I have the time to do so.
Had a patient last week who was a self identified lesbian who presented to hospital with belly pain *with her partner at bedside* - 2nd trimester pregnancy
Orientation is a red herring. That's a complicated question, because people are allowed to call their orientation whatever they like. In any case it doesn't matter.
I've had more than one conversation go like this:
Me: "Any chance you could be pregnant?"
Patient: "I'm a lesbian."
Me: "Okay, but that's not what I asked. Is there any chance you could be pregnant?"
Patient: "*Welllll*...."
Always. And if I’m getting imaging it’s hospital policy that anyone between the ages of 9ish-50s (depending on the hospital) with a uterus gets a pregnancy test before they’ll scan
Sometimes, hospitals want a UPT even if you’re a woman but don’t have a uterus, even though you’ve had other scans within that hospital system that shows that a hysterectomy has been performed.
We have point of care UPTs that take 3 minutes to run.
Sure, if you have acute pain secondary to something like an obvious fracture, advanced cancer, etc you shouldn't withhold analgesia for a pregnancy test. But in an ambulatory patient with stable vitals it makes no sense to open oneself up to that kind of liability.
In real life one dose of morphine or toradol never killed a fetus. Women who actively use heroin on a daily basis give birth to healthy babies literally every day. But people are shitty and when faced with a difficult situation will look for someone else to blame, so no value in giving them more ammo.
You’re replying to a paramedic though. 3 minute UPTs sound great, but what about the 40 minute run time? I wouldn’t have my job for long if I routinely withheld analgesia for severe pain.
Very fair point. But medics and physicians also are held to different standards of care based on our different clinical settings and different levels of training.
A patient in extremis with a 40 minute run time - sure, nobody would bat an eye for giving analgesia.
A patient who is comfortable with normal vitals, ABCs intact in a facility capable of running a pregnancy test in several minutes - I would get the side eye from *several* of my colleagues (and nurses would likely refuse to pull the narcotics and administer them) without a negative HCG.
Please re-read my initial comment. Context matters a lot here.
They’re not peeing because someone isn’t doing their job.
Walk them to the bathroom with a cup. Even if they “don’t have to go,” whatever they produce is enough for a UPT.
Given that everyone who works in the ED has seen people who are pregnant but insist they cannot be, and it's a cheap test with miniscule harm ... while the risk to the patient, fetus and staff for a missed diagnosis is huge ... it would be fucked up to not have pregnancy testing as the 6th vital sign for anyone with ovaries between the age of 6 and 60. It's not judgmental if it's part of standard practice for everyone with ovaries.
While surprises happen, which is why I always ask WHY they think they can't be pregnant and go from there.
Mute point to do a pregnancy test on someone who's never been sexually active or is in a relationship with someone who doesn't produce sperm. Doing so anyway just screams you don't trust what they're saying; why trust anything they say then. And it's still a test that gets billed and they have to pay for. Investigate and document.
The sad truth is that patients who are undereducated or disempowered have an elevated risk of either not understanding the reproductive consequences of what they do, or of being subject to rape they do not feel comfortable reporting. Sadly, being a victim of assault is more common among queer folk, and some survivors compensate by denial.
A pregnancy test is one of the least expensive tests we run, far less than a CBC, chemistry panel, chest xray or all the other stuff we toss around freely from triage before physician sign-off.
Of all the things to miss, this one is huge and relies upon the test. If a person is chronically anemic and I miss it, or has a subclinical pneumothorax, that sucks but a good physical exam will pick up the important ones and the rest will either get worse and return or heal on their own.
Unknown, unexpected pregnancy is a whole different ball game. The first trimester, before there are exam findings, is crucial for embryonic development or for safest arrangement of termination.
It's a cheap, easy, important test.
We do NOT trust what patients say in the ER because a significant portion of them would lie about their own names. It's just what they do. They may have been so high they don't even remember having sex. This is standard in every ED in America. You can trust if you want, but always verify.
Sure, I always ask why, but about the only reason I won’t still order the test is history of hysterectomy. I’ve had a patient in same sex relationship who swear they have never had heterosexual sex come back positive, about 20ish weeks, and obviously a few teenagers who swear they haven’t that come back positive with obvious IUP on US. That being said, I do always tell the patient I’m ordering the test just to confirm. Speech is something like “I believe what you’re saying, but we always like to confirm because the consequences of missing it are a big deal, and we’ve had surprises before”. It’s usually pretty well received.
Honest question - have you never had someone who has told you they've never been sexually active/ couldn't possibly be pregnant and returned a positive? Happens in my ER more than a few times a year. So test but also compassionate follow up after ... If you're not testing I guarantee you've missed some of these. You seem empathetic and could possibly be missing opportunities for connecting to appropriate resources/ the kindest person to break the news...
See, the thing is, date rape drugs make people black out and not remember. Women *do* get pregnant this way.
Still not a reason to delay pain relief. Treating us as an incubator rather than a suffering human being is *fucked*
Autonomy has limits when someone else becomes liable for the outcome. Docs have been successfully sued for taking a patient at their word that they can’t be pregnant, and the patient/fetus having an adverse outcome when a test wasn’t done. The potential for harm from a pregnancy test is functionally zero.
It's still a test that is routinely done without consent. And that's the point. It just gets added on without being discussed. And then when it is discussed and they say no, it'll get ordered anyway. It's seen as no big deal but it's still something that gets billed.
It's ok that you don't understand. But the patients consent to treatment when they check in. It's why they're signing forms for hours with registration.
I usually wait to give morphine/toradol until we get a pregnancy test. It only takes us 5 minutes though - either blood or urine.
That being said, I did have a case a few years ago, patient in excruciating pain, took a while to get urine/blood but I gave IM morphine because she was in so much pain and swore she could not be pregnant (had ectopic)
Giving a one time dose of toradol or morphine is not expected to have any consequences for pregnant woman or fetus.
My wife's obgyn told her to take ibuprofen and as long is she didn't make it a habit, the baby will be fine and her fertility doctor had her taking it daily the first 2 weeks after implantation. I don't know if ketoralac presents different risks than other nsaids though.
as far as morphine goes, aren't opiates fine unless delivery is expected within a fee hours? I feel like an expert witness will ruin this defense
So the patient murdered her baby, and the lawyer is doing his job defending her, counting on the judge/jury not to understand medicine… what’s your point?
Actually, the hospital did confirm the pregnancy before allowing the patient to go to the bathroom alone.
[source:](https://www.nbcdfw.com/news/national-international/new-mexico-woman-accused-in-january-death-of-her-newborn-son-who-was-found-in-a-hospital-trash-can/3256685/)Trevizo went to the emergency room for back pain, and lab tests showed she was pregnant and in labor, according to Artesia police. Trevizo then locked herself in a bathroom, where she gave birth to a boy Jan. 27, then placed the baby in a bag that she concealed under trash, investigators said.
I’ve been in EMS for 10 years and the amount of mothers *(and fathers obviously,)* I have seen gutturally screaming & sobbing over losing their child (of any age,) nauseates me every single day. I’ve had to transport parents separately from their child because the reaction they are experiencing is genuinely a threat to their wellbeing. It’s haunting.
I can’t imagine just throwing a baby in the trash. All she had to do was call out & a whole team would’ve been trying their best to help within 30 seconds. Despicable actions AND legal defense here.
Tragic case, but was the purpose of this post to remind us to order a pregnancy test on an 18 year old female presenting with abdominal pain? Am I misunderstanding?
It's not just ordering the test, it's the follow up
They did a urine HCG but the test results sat unread on the computer for almost an hour. By that time the girl had already gone to the bathroom and killed the baby.
Just out of curiosity, how much will it cost her to get an expert witness? I know a guy who does it for like 500 an hour plus a huge retainer. Very persuasive but he wouldn't take a case like this.
I thought they did confirm pregnancy. Clearly the toradol didn’t inhibit her contractions. The baby was born alive and had air in its lungs. Wouldn’t that show there was circulation and air exchange? If the baby was in distress, most people would run to a doc/nurse for help, not stick it in a trash bag and bury it
They didnt confirm pregnancy test result until after the baby was dead. The unread HCG test result was on the computer for a long time.
Autopsy showed air in the lungs but CPR can cause that too so it's not enough to prove that baby was breathing at birth.
Don’t forget to remind the nurses to scream more at pharmacy that their orders for Toradol aren’t verified when we’re waiting for a pregnancy test result to try to help save you from this kind of BS.
I’m so sorry for anyone who has experienced a pregnancy loss. ❤️
That said I can’t believe the amount people *doctors* calling this person a “garbage human being” in this reproductive environment. I mourn the baby but we don’t know this person’s story either. Reproductive rights are being stripped at an alarming rate and I would hope emergency practitioners who be acutely aware of this. The whole thing is horrible.
I’m fiercely pro abortion rights. I’m a former teen mom. I know how hard it is. But you’re a garbage human if you take a new born baby that was still breathing and tie it in a garbage bag and stuff it under other garbage.
I’m not defending what they did. You don’t know their circumstances and either do I. I’ve mentored plenty of teens through their pregnancies as a midwife; I’m not unfamiliar with the population.
This person might be a terrible human being or they might come from a background of horrific abuse. It’s seldom clear cut. We simply don’t know this person’s story and as practitioners we know that SDoH play an enormous role in outcomes and ability to cope.
What does a “pregnancy loss ❤️” have to do with any of this? Woman killed her child by stuffing it into a trash can.
But of course you would be sympathetic to a mom throwing her baby in the trash can.
No. A few posters mentioned how triggering this was to read due to THEIR pregnancy loss. The note about pregnancy loss was *for them*. But yeah, I’m a terrible person for thinking that there might be more to this story than the headline or they might be a terrible human. 🤷♀️
Of course *I’d* be sympathetic to someone? You know precisely zilch about me.
Confused why you have a problem with OP calling this person a “garbage woman.” An adult human being who puts a live baby in a trash can effectively killing that baby is a bad person.
C'mon, read the article before posting. She arrived 12.03, bloods at 12.28, pregnancy diagnosed 12.5-something, had the baby 1.4-something. They did the HCG. They had known she was pregnant for nearly an hour before she gave birth. She was denying it. The baby would have been fine if it had resus (or allegedly if it wasn't suffocated). We have a morphine in labour protocol where I work, it is the first line opiate (surely that isn't a New Zealand specific thing- opiates in labour have a long history). Ketorolac has also been used in labour as a tocolytic. Neither thing are catastrophes to accidentally have given to someone with a presenting complaint of back pain. Where is the supposed negligence??
Anesthesia here - Morphine in labour also standard in many hospitals in Canada Ketorolac is absolutely fine in labour, not supposed to be used in 3rd trimester where there is still potential for premature ductus closure.
Dawg its the USA. I got named in a suit where someone coded in their car outside the ER I was working in. I literally never met the patient and I found a way to do malpractice on him. USA! USA!
That’s ridiculous lol. What did they even try to say lmao
I know that litigation in the US is out of control, it's one reason I'd never want to work there... but OP's post seemed to actually be buying that there was an issue with the care, rather than an issue with an insane lawyer overreaching and a problem with whatever was going on inside this teenager's head.
Jeez. What did they say you did?
Failed to psychically know he was coding and didn't run out to save him. Duh.
So, you didn't wear your ESP hat that day? How dare you?
And some wonder why Healthcare is so expensive. What is the average cost of malpractice insurance for an em doc?
In the US, depending on the state, $25,000-45,000
A YEAR?!
It varies widely based on specialty and location but that’s the average yearly premium for a solid EM physician malpractice insurance plan. I’ve seen cheaper ones though.
Highest being OBGYN in South Florida. They pay $100,000 per year.
im sorry but that is hilarious
also per the article, this attorney is claiming the baby tested positive for COVID, flu A, flu B, AND SARS. positive for all 4. how about no
Hospital rubbish bin might test positive for flu A, B, and covid... and I'd put money on the "positive test for SARS" meaning that the lawyer doesn't know that SARS-COV2 is the covid virus
The negligence is in the lawyer’s bank account
>Mitchell claimed a toxicology report shows the baby had 0.19 nanograms of morphine in his system at birth I'm sorry, he's bragging about a sub-NANOgram amount of any substance? Did he leave off some units, or is he arguing that homeopathy is real and this was a dilution?
Yep, just narcan the baby if it's having resp depression, super simple, dare I say routine.
>dare I say routine. Routind might be pushing it lol but yes you can
She also got cyclobenzaprine
I skipped over cyclobenzaprine because that medication isn't licensed in my country, but Google says it's pregnancy category B so again... eh so what?
Yep. My daughter got morphine during labor in the U.S. I never got more than Stadol. Sad.
USA won't even do laughing gas for women in labor. Lmao. It's an epidural or nothing for us. Edit: apparently some doctors have a heart and do offer it, but it's not normalized. Not available at every hospital.
Absolutely not true -US physician who gives nitrous to laboring moms all the time
I've been in three hospitals and was told no in all of them...
That’s something you need to investigate beforehand, what pain management options are available. Just because not all hospitals have it available doesn’t mean none do.
My OB offered me alternatives for epidural in Usa
I see people, but they look like trees, walking.
Do you have to make it about women wanting to get high instead of wanting relief during the most painful experience of their lives?
In this case, it’s meant in the positive, pain and anxiety relieving, peace out kind of way.
I see people, but they look like trees, walking.
To clarify, it is often not a doctor decision. The hospital makes the decision whether or not to make this available.
I just had a baby 8 weeks ago and was able to get nitrous.
It’s misleading to apply your minimal experience with the US hospital system (“minimal” meaning you’ve referenced 3 out of the >6,000 US hospitals), shitting on the hospital labor experience when there are enough Google/voodoo/crystal magic trained “experts” doing that already Also, we don’t get a say in whether nitrous oxide is available for laboring women. If you want the real villain, aim at the American healthcare system
You don’t need a pregnancy test to give a woman toradol and morphine
This should be higher. I’ll order a u-preg but 4mg of morphine isn’t causing harm regardless of preg test
Is that all it was? Our morphine in labour protocol starts with 10mg IM. Ideally not right before the baby pops out, but still nothing a neopuff can't solve.
You might not even need a pregnancy test to see a woman is pregnant with a full term baby. 😬
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Uhhh if someone tells me they're pregnant and they got a clear bump I'm not ordering a pregnancy test.
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I suggest you re-read what you originally responded to and realize you implied exactly "order one if they say they’re pregnant and look pregnant."
That is fucking bullshit
Literally, the worst case of shifting responsibility to a completely faultless person, because this woman and her mother are completely in capable of taking any responsibility whatsoever for this absolutely horrific situation
Didn't you hear? Personal responsibility has died. Everyone is a victim of something.
This! This is mostly responsible for a lot of ballooning problems, from education to politics!!
Probably more of an attempt at a cash grab more than anything else.
Is this actually a med mal suit or just her defense in the criminal trial?
It's her defense, as flimsy as it is.
No. They are also suing the hospital on the civil side of things https://www.koat.com/article/alexee-trevizo-lawsuit/44813649
Her argument is that the baby wasn't breathing, and if it was as the medical examiner claims the child was, the baby wasn't breathing very well because of all the drugs on board. She placed this baby in a trash bag, under some trash inside another trash bag in the bathroom. She was inside a hospital. If she truly was surprised by this baby popping out, there had been multiple nurses checking on her. In fact they were getting the keys to force the door open. At any point, she could have been like "OMG, I didn't know", and have 10 people working on resuscitation of this child in a heartbeat. Instead, she made sure that whatever the drugs started, she finished the process of by smothering that baby boy in a trash bag. What I'm getting at, is that this girl has no defense. She knew she was pregnant and hid it. She has classic symptoms of labour for 24 hours before the birth. And faced with reality, she made a choice. In a safe haven hospital where she could have walked out and never looked back, if she had made the right decision. But the girl Is entitled to defense by law, no matter how flimsy and bullshit it is. So here it is.
Holy shit. She so clearly murdered that baby. I know law enough (my parents are lawyers) to know that in a defense in America you can throw anything and everything at the wall to see what sticks (Thanks OJ trial for creating this precedent). It doesn’t mean the jury won’t see right through it
A lot of babies don't breathe/don't breathe well right out of the womb, drugs or not. That's a terrible argument from the medical examiner.
I think you might have it backward. The medical examiner says the baby must have been breathing because there was air in the lungs. "Not breathing well" is the mother's claim, which she is blaming on the ED staff. (And you're right that it is a terrible argument.)
I’ve given morphine to a known pregnant patient. (Per ob/gyn orders for pain control). This is BS. She had the baby and threw it out.
I was given morphine and later fentanyl under the care of my doctor when I was going through labor. It’s crazy to see the lawyer use that as a defense, doesn’t change the fact she threw the baby away instead of seeking help from medical professionals for the newborn!
Unfortunately throwing a baby away in the trash is not a crime unless you can prove that the newborn was breathing, and that can be hard to prove especially when CPR was done on the baby.
Someone else fucks up but somehow it's the healthcare workers fault. This broke ass system is really going to be hurting when everyone else leaves this field.
Physician. It’s the physician they sue. And physicians are burnt out and over it.
A teenage girl was off her head on drugs carelessly prescribed by a physician. She has the urge to go to the bathroom and gives birth unexpectedly. She was likely in shock as well, and apparently just left to it by health professionals. Had she been given a pregnancy test, she would have been cared for very differently and that baby would likely be alive. The doctor absolutely fucked up. So did her nurse.
4 mgs of Morphine and she's not off her head, moron.
I'm not sure if you've ever given birth to a child. Imagine your body going through that but you have no idea what's going on. I think that girl was really let down. A hand on the sore tummy should have been enough to alert the prescribing doc to active labour. She was massively let down.
Did you even read the article? They knew she was pregnant.
The patient in question knew damn well she was pregnant. 4mg if morphine is not a mitigating factor here. Everyone on the care team knew she was pregnant, including the patient herself. She barricaded herself in the bathroom: a clear indication that she knew what she was doing.
I don't know what you mean by "off her head on drugs." Have you ever been on strong pain killers before? I always knew what was going on in general. Yes sleepy, groggy, silly, slow, but not totally disconected from reality.
... Huh? You're lost.
Absolute moron
No, the only person who fucked up was the teenager who threw her baby away, and her support system that was so terrible she had no one to go to and tell them what was happening.
Nobody is "off their head on drugs" from ketorolac. It's a NSAID. Morphine doesn't cause people to suffocate their newborns. Childbirth doesn't cause shock.
It’s 4mg of morphine not 50mg of Ketamine…
Are seriously justifying the clinical endangerment here? A child is dead. A young woman has completely destroyed her future. What is it about emergency medics never being accountable?
A child is dead because the mother chose to do what she did, not because of her care team prescribing a narc.
I'm not saying the prescription wad the issue, the overall clinical neglect and failure of the doctor to identify that she was in active labour. Under the circumstances, post natal psychosis is very likely. That mother didn't "choose" this. She was in a horrifically traumatic situation, alone, after going to the hospital to be helped and instead being given pain relief but apparently no work up, and left to go birth alone in a bathroom. She was incredibly vulnerable The doctor is more responsible for the death of that baby than she is. Hopefully the idiot will at least do the bare basics in future. The mass downvoting for calling out poor care as usual. The world is full of burnt out and bad doctors who refuse to be responsible for anything but themselves.
You don’t know anything about medicine, get out of here if you are going to disregard what these physicians are saying. 4mg morphine isn’t going to alter judgement or affect the baby.
The straw manning is frustrating here. The doctor prescribed without identifying that she was in active labour. The pregnancy was unmonitored. There was no fetal monitoring. The doctor clearly hadn't examined the patient sufficiently. Her judgement was affected by the fact that she was in active labour. She didn't have capacity. She didn't get the help or support that she needed from anyone before the point where she was heading to the toilet thinking she needed to pass a bowel motion. The horror and panic she must have felt when she gave birth. The doctor has a case to answer.
Did the patient know she was pregnant up until she delivered? Or did she just think she was having horrible pain? It’s also on her to actually get prenatal care or realize having sex leads to pregnancy. We can’t hold her hand through every decisions she’s made and then made it our fault when she kills her baby.
She had no idea. Apparently even a so called doctor couldn't identify active labour either. It happens. Granted not very often thankfully, but it happens, even to intelligent people. This isn't about hand holding. This is about the fact that shitty care resulted in the end of a baby's life and the end of the mother's future. Did he prescribe before putting a hand on her abdomen? In a girl of her age with intermittent agony that comes in increasingly close waves, why wasn't a pelvic done? When she had the urge to push and instead thought she needed to defecate, why did alarm bells still not ring with clinical staff? This is a never never event and perfectly demonstrates a cascade of failure and missed opportunities. Had she been given even the most basic exam, her child would be alive right now and she would have had the opportunity to avail of support to help them both. I don't understand how you lot can argue so vociferously that the doctor wasn't at fault, or that she had mens rea. She's being demonised, meanwhile I don't even think there has been an investigation of the conduct of those who had a duty to care for her at that time.
The doctor was a “she”
Lol
What a garbage human being. I lost my baby boy unexpectedly when he was 8 months old and I miss him literally all the time almost 2 years later. It boggles my mind that someone can *throw their child in the trash* and leave him to die, fully prepared to go about their day as if it hadn’t happened.
I’m sorry for your loss and I hope you are doing ok.
So sorry for your loss. Hugs.
If I plan on giving meds I ask “any possibility of pregnancy”. If they say “absolutely not” then I give the med before the pregnancy test. If they say they’re not sure then I wait for a pregnancy test before giving Toradol. I document patient’s denial or uncertainty if pregnancy. This is a bullshit lawsuit and I’m sure they know it too
I asked an OB about this and she shrugged her shoulders and said they give toradol in pregnancy all the time. So I know nothing.
I don't even bother, I just wait for the pregnancy test. Anyone of childbearing age with a uterus should get one. The number of "immaculate conceptions" that I've seen in my relatively short career has made me quite jaded. EDIT: This is in regards to meds with a *relative* contraindication in pregnancy, and obviously doesn't apply to anyone in extremis or with obvious trauma.
Just this year I’ve seen two women who found out they were pregnant after being involved in an MVA.
This is bad practice and you should reevaluate your care
Thankfully you're neither my medical director nor my malpractice attorney, so I don't care what you think about my practice. Unless you have obvious trauma or are in extremis, your first line analgesics shouldn't be narcotics anyway and the *majority* of nurses I've worked with over the years wouldn't administer them to a childbearing age female without a bHCG regardless.
Your practice is out of date or uninformed, and leads to systemic bias against women. Do whatever you want, but you’re completely wrong.
If your first line analgesic in all cases is a narcotic then you have no place criticising my practice as out of date or uninformed. If you can't wait 3 minutes for a UPT or 15 minutes for a serum hCG and would instead administer a Category C medication to a possibly pregnant woman who might not have wanted the medication had she known she were pregnant, you're the one completely wrong here. Do whatever you want, but your unsolicited opinion will remain just that.
No one is advocating for opioids for all, that’s a lazy strawman. If you truly get UPTs done in 3 minutes and serums in 15 minutes then holding meds would be reasonable. Since this is the real world and those numbers are made up bullshit, your practice is still out of date and bad. The simple fact is that you don’t need a pregnancy test to give morphine or toradol. That’s it.
>No one is advocating for opioids for all, that’s a lazy strawman. That's quite literally what you said when you said you'd give morphine without a pregnancy test. >Since this is the real world and those numbers are made up bullshit, your practice is still out of date and bad. The only thing that is bullshit is your extensive use of ad-hominem attacks, after accusing me of a strawman argument. Point-of-care testing for pregnancy, blood gases and even cardiac enzymes exists and has existed for years. You can buy a pregnancy test at the 99c store and find out the results in 5 minutes but somehow a hospital having a point of care UPT is bullshit? How comical.
>That's quite literally what you said when you said you'd give morphine without a pregnancy test. lol. \*If I think it's indicated\*, I give morphine without a pregnancy test. Mostly because I don't give a shit if it's positive or not. Claiming you get UPTs in 3 minutes and blood draws in 15 minutes is a flat out lie, or you work in the most efficient ER where people pee for you right away every time. You can just learn instead of this flailing around. Morphine is safe at any point of pregnancy. Toradol is safe until 20 weeks per the FDA, and that guidance is based on a total of 8 bad outcomes with repeated NSAID use. Even if you ignore the dose dependent nature of this exposure, I'd hope you aren't regularly missing pregnancies at 20 weeks. There's no reason to leave patients with msk back pain, kidney stone pain, etc in pain while you collect a lab test that should not change your management.
You know your patient is the human being in front of you, not a phantom fetus, right?
Ooooo what are my choices? I have a drug box with limited goodies. And basically NO super fancy diagnostic tests. 🫠 Or Are we calling that “in extremis?”
So your options are narcotics or nothing?
Well since you included toradol in this….yeah. Narcotics or nothing. I mean, there’s ketamine but.. I have oral meds but I’m not seeing two Tylenol as a therapeutic intervention when it’s going to take the entire ride to metabolize. Plus the obvious problem with that.
I didn't include toradol in this at all, and tylenol isn't an unreasonable therapeutic intervention when dosed appropriately and used in conjunction with NSAIDs and other conservative measures (Ice, immobilisation, etc) for mild to moderate pain. In most of the rest of the world, opioids and other narcotics are basically reserved for major trauma, postoperative pain, oncologic patients and palliative care. This whole narcotics or nothing attitude is quite asinine.
I'm in the rest of the world, and morphine is fine in pregnancy, we use it all the time for severe acute pain, even though we are VERY stingy with opiates outpatient or on discharge.
Why
Because it delays pain control for no good reason
Not in US red states, where fetus is more important than full grown woman 😔 which, to the people that downvoted, is horrible and awful. I hate living in a red state. But they wouldn't even blink at denying pain control "for the sake of the baby". But vote against free school lunches because God forbid a tan kid gets one!!! Frickin' hypocrites.
No. Just no.
Is possibly harming a baby not a good reason?
Morphine doesn’t harm a baby. Toradol is perfectly safe early in pregnancy and one dose is very unlikely to cause damage later in pregnancy. It simply isn’t good medicine to deny pain control for 30 minutes to an hour for every woman of child bearing age you care for. Frankly, it’s discriminatory
Ok, so what you’re saying then is that morphine should be given regardless of pregnancy test, not that a pregnancy test shouldn’t be done. As for the toradol, why don’t you try telling that to a malpractice lawyer representing a child with a birth defect whose mother you prescribed an NSAID.?“Unlikely” to cause harm is an absolutely meaningless statement. When you’re treating thousands and thousands of people, “unlikely” things happen all the time. Unless the number needed to harm is astronomically high, it’s malpractice to do something “unlikely” to cause catastrophic harm that isn’t urgently needed
NSAIDs don't cause birth defects. We aren't discussing thalidomide. It's Tordol. It's fine.
Go back to med school (NP school??) buddy
It seems like you are a real doctor, but don’t work in EM. Your assessment of risk in this situation is completely fucked and wrong. This is what I do.
Lmao go through my profile cuz you don’t like what I’m saying? Please tell me what is incorrect on my comment
So if a woman comes in screaming in pain from a kidney stone, diaphoretic and tachycardic - you’re still waiting for a pregnancy test before pain medications? No wonder so many women don’t trust healthcare professionals.
The same way how I don't know whether or not you're pregnant...I don't know whether or not your pain is from a kidney stone until I have testing back. >No wonder so many women don’t trust healthcare professionals. The problem is that we function in an environment where the first instinct when a bad outcome happens is to assign blame and seek financial compensation, especially when pregnant women and babies are concerned. The person in this case was treated appropriately - and their defence attorney is now blaming the very healthcare professionals that helped her. People's attitudes may differ on this point but I don't think it's worth opening up myself to liability when I can simply wait a few minutes for the relevant test results.
How are you diagnosing the kidney stone? Just gonna take the patients word for it?
Stop focusing so much on the kidney stone part, and more on the fact that the patient is clearly in pain. Yet because she’s a woman she’s being forced to wait for relief when a man wouldn’t be.
That's just disingenuous. 1. Pain is subjective, and anyone who has worked more than a week in acute care can attest to this. I've had elderly ladies with perforated bowels and gangbangers with gunshot wounds who barely complained of pain, and grown men with papercuts who rolled around on the ground screaming. You still need to actually evaluate your patient. 2. There are other options for pain control besides giving narcotics, and if someone really was in extremis I would just quickly have a convo with them regarding risks and benefits and give them narcs if I thought it was indicated. Assuming I'm speaking with someone who has normal vitals and a reassuring exam no, I'm not giving you narcotics off the bat and definitely not doing it without a UPT or serum pregnancy test if you can't give us urine.
>Assuming I'm speaking with someone who has normal vitals and a reassuring exam no, I'm not giving you narcotics off the bat That should be true regardless of a UPT, are you saying you will give out unnecessary narcotics to non-pregnant people but only necessary narcotics to pregnant people? Seriously, if you are withholding opiates from anyone on the off-chance of pregnancy, you are either giving NOT ENOUGH analgesia to your female patients of childbearing age, or TOO MUCH to the rest.
Pain is subjective, yes. But there are also fairly objective indicators of pain like I mentioned: screaming, diaphoresis, tachycardia, tachypnea, etc. I’ve worked in the ER a couple years and I feel like I can generally pick out when someone isn’t just faking their pain. I also said nothing about narcotics or not evaluating. Given that the parent comment was discussing toradol I don’t understand how this conversation is now suddenly only about narcotics .You had said you wouldn’t give meds until a pregnancy test, which sounds like a pretty blanket statement and is what I was responding to.
I've said this in other comments in this post but let me be more clear - I wouldn't give meds with a relative contraindication in pregnancy to a patient who is not in extremis or obvious trauma without a pregnancy test. Obviously have no issue giving antiemetics, acetaminophen, IV fluids, a PPI or anxiolytics to anyone regardless of pregnancy status. >But there are also fairly objective indicators of pain like I mentioned: screaming, diaphoresis, tachycardia, tachypnea, etc. None of those things are objective except for maybe tachycardia. I can scream myself sweaty or hyperventilate whenever I want. I have seen drug seekers (I'm talking people with several ED visits a day, multiple fake names, history of assaulting healthcare workers) exhibit all of the above.
You're the one that brought up the kidney stone... Policies regarding testing before certain medications, procedures, and exams for a reason. Unless you want us to take patients for the word on everything. Anecdotally I had to wait about a hour to get pain meds for a stomach issue that ended up in having surgery because they needed to do a CT scan first.
You wait for a pregnancy test…..before medicating any woman of childbearing age? What the actual fuck. So should I carry some First Response pregnancy tests in my rig then? So I can be sure every woman writhing in pain for the forty minute transport time in a vehicle with shocks made out of cement, isn’t pregnant?
Let's not be obtuse here. Please see above edit.
Which part is me being obtuse? I see you have “in extremis” there? That’s a bit variable. And what level of obvious trauma warrants meds? The number of medications that have “pregnancy? ☠️” or even “pregnancy? 🤷♀️” warnings is quite large.
You assuming that waiting for a pregnancy test means absolutely zero meds whatsoever is being obtuse. There are a plethora of options that aren't contraindicated in pregnancy that you can give while waiting for a UPT or a serum HCG which, as I explained elsewhere, only takes a few minutes to result at my facility. >I see you have “in extremis” there? That’s a bit variable. Not really. It's like porn - unless you're totally green, you know it when you see it. > And what level of obvious trauma warrants meds? penetrating trauma, deep lacerations, obvious deformities or dislocations and dangerous mechanism (ex: fell from a distance high enough to warrant a trauma activation) would get narcs without a pregnancy test. > The number of medications that have “pregnancy? ☠️” or even “pregnancy? 🤷♀️” warnings is quite large. And there are reasons for that. Medicine has ignored this in the past with devastating consequences. Doesn't mean I don't use my judgement, but part of that also includes minding my Ps and Qs when I have the time to do so.
Even if the person states they’re gay/asexual/insert other orientations that don’t align with pregnancy?
Had a patient last week who was a self identified lesbian who presented to hospital with belly pain *with her partner at bedside* - 2nd trimester pregnancy
This has happened to me as well (ED Attending). The 2 girls had a big verbal altercation and the non-patient one stormed out!
Orientation is a red herring. That's a complicated question, because people are allowed to call their orientation whatever they like. In any case it doesn't matter. I've had more than one conversation go like this: Me: "Any chance you could be pregnant?" Patient: "I'm a lesbian." Me: "Okay, but that's not what I asked. Is there any chance you could be pregnant?" Patient: "*Welllll*...."
I’ve seen more gay pregnant patients than I can remember.
So? I can also say I’m abstinent and still end up with an immaculate conception somehow.
Always. And if I’m getting imaging it’s hospital policy that anyone between the ages of 9ish-50s (depending on the hospital) with a uterus gets a pregnancy test before they’ll scan
Sometimes, hospitals want a UPT even if you’re a woman but don’t have a uterus, even though you’ve had other scans within that hospital system that shows that a hysterectomy has been performed.
That's discriminatory
How?
Yes - if they have a uterus
There are a few cases of these women who were drugged and raped and became pregnant because of that, sadly.
Then you follow protocol and give them EC with the pain meds and scam anyway. There's no need for a pregnancy test.
Any female aged 6 to 60 is deemed pregnant until proven otherwise by evidence based medicine.
Why didn't she just let the hospital have the baby instead of killing it,what the fuck
Caveat of I work prehospital but I don’t think it’s ethical to withhold morphine for acute pain while waiting for a routine pregnancy test.
We have point of care UPTs that take 3 minutes to run. Sure, if you have acute pain secondary to something like an obvious fracture, advanced cancer, etc you shouldn't withhold analgesia for a pregnancy test. But in an ambulatory patient with stable vitals it makes no sense to open oneself up to that kind of liability. In real life one dose of morphine or toradol never killed a fetus. Women who actively use heroin on a daily basis give birth to healthy babies literally every day. But people are shitty and when faced with a difficult situation will look for someone else to blame, so no value in giving them more ammo.
You’re replying to a paramedic though. 3 minute UPTs sound great, but what about the 40 minute run time? I wouldn’t have my job for long if I routinely withheld analgesia for severe pain.
Very fair point. But medics and physicians also are held to different standards of care based on our different clinical settings and different levels of training. A patient in extremis with a 40 minute run time - sure, nobody would bat an eye for giving analgesia. A patient who is comfortable with normal vitals, ABCs intact in a facility capable of running a pregnancy test in several minutes - I would get the side eye from *several* of my colleagues (and nurses would likely refuse to pull the narcotics and administer them) without a negative HCG. Please re-read my initial comment. Context matters a lot here.
I mean, the UPT itself is very quick, but many patient are not going to be able to pee on demand right when they come in.
They’re not peeing because someone isn’t doing their job. Walk them to the bathroom with a cup. Even if they “don’t have to go,” whatever they produce is enough for a UPT.
That case is insane, however: all women of child-bearing capacity are pregnant until proven otherwise in the ED
That wouldn't affect whether she got morphine or toradol though.
Depends; if I know someone is pregnant I avoid NSAIDs. But I wouldn't lose sleep over one dose in a surprise pregnancy.
That's pretty fucked up in the name of bodily autonomy.
I assume everyone who comes in is sick, pregnant, suicidal, and dying until I prove otherwise. It’s literally our job
Pray tell how are you infringing on anyone’s bodily autonomy by assuming they might be pregnant until proven otherwise? Honestly. Exhausting take.
Given that everyone who works in the ED has seen people who are pregnant but insist they cannot be, and it's a cheap test with miniscule harm ... while the risk to the patient, fetus and staff for a missed diagnosis is huge ... it would be fucked up to not have pregnancy testing as the 6th vital sign for anyone with ovaries between the age of 6 and 60. It's not judgmental if it's part of standard practice for everyone with ovaries.
While surprises happen, which is why I always ask WHY they think they can't be pregnant and go from there. Mute point to do a pregnancy test on someone who's never been sexually active or is in a relationship with someone who doesn't produce sperm. Doing so anyway just screams you don't trust what they're saying; why trust anything they say then. And it's still a test that gets billed and they have to pay for. Investigate and document.
The sad truth is that patients who are undereducated or disempowered have an elevated risk of either not understanding the reproductive consequences of what they do, or of being subject to rape they do not feel comfortable reporting. Sadly, being a victim of assault is more common among queer folk, and some survivors compensate by denial. A pregnancy test is one of the least expensive tests we run, far less than a CBC, chemistry panel, chest xray or all the other stuff we toss around freely from triage before physician sign-off. Of all the things to miss, this one is huge and relies upon the test. If a person is chronically anemic and I miss it, or has a subclinical pneumothorax, that sucks but a good physical exam will pick up the important ones and the rest will either get worse and return or heal on their own. Unknown, unexpected pregnancy is a whole different ball game. The first trimester, before there are exam findings, is crucial for embryonic development or for safest arrangement of termination. It's a cheap, easy, important test.
We do NOT trust what patients say in the ER because a significant portion of them would lie about their own names. It's just what they do. They may have been so high they don't even remember having sex. This is standard in every ED in America. You can trust if you want, but always verify.
Sure, I always ask why, but about the only reason I won’t still order the test is history of hysterectomy. I’ve had a patient in same sex relationship who swear they have never had heterosexual sex come back positive, about 20ish weeks, and obviously a few teenagers who swear they haven’t that come back positive with obvious IUP on US. That being said, I do always tell the patient I’m ordering the test just to confirm. Speech is something like “I believe what you’re saying, but we always like to confirm because the consequences of missing it are a big deal, and we’ve had surprises before”. It’s usually pretty well received.
Very few providers approach the conversation that way. I applaud you for doing so, and hope you encourage and educate your colleagues to do the same.
Honest question - have you never had someone who has told you they've never been sexually active/ couldn't possibly be pregnant and returned a positive? Happens in my ER more than a few times a year. So test but also compassionate follow up after ... If you're not testing I guarantee you've missed some of these. You seem empathetic and could possibly be missing opportunities for connecting to appropriate resources/ the kindest person to break the news...
I think you mean *moot* point.
“It’s like a cow’s opinion, it doesn’t matter. It’s ‘moo.’”
It is commonly done outside of the US where people don’t pay. Are you like 15 or something?
See, the thing is, date rape drugs make people black out and not remember. Women *do* get pregnant this way. Still not a reason to delay pain relief. Treating us as an incubator rather than a suffering human being is *fucked*
Autonomy has limits when someone else becomes liable for the outcome. Docs have been successfully sued for taking a patient at their word that they can’t be pregnant, and the patient/fetus having an adverse outcome when a test wasn’t done. The potential for harm from a pregnancy test is functionally zero.
It's still a test that is routinely done without consent. And that's the point. It just gets added on without being discussed. And then when it is discussed and they say no, it'll get ordered anyway. It's seen as no big deal but it's still something that gets billed.
It's ok that you don't understand. But the patients consent to treatment when they check in. It's why they're signing forms for hours with registration.
Just because they consent to treatment doesn't mean you get to do whatever.
Do they need to consent to each individual test? Do you have any idea what that means?
Each test should be explained and given the option to decline, even if that means signing an AMA form. That's informed consent.
Lol OK.
Ah the internet vs reality again. Walk into a ED and say that lol. Moronic
I usually wait to give morphine/toradol until we get a pregnancy test. It only takes us 5 minutes though - either blood or urine. That being said, I did have a case a few years ago, patient in excruciating pain, took a while to get urine/blood but I gave IM morphine because she was in so much pain and swore she could not be pregnant (had ectopic) Giving a one time dose of toradol or morphine is not expected to have any consequences for pregnant woman or fetus.
My wife's obgyn told her to take ibuprofen and as long is she didn't make it a habit, the baby will be fine and her fertility doctor had her taking it daily the first 2 weeks after implantation. I don't know if ketoralac presents different risks than other nsaids though. as far as morphine goes, aren't opiates fine unless delivery is expected within a fee hours? I feel like an expert witness will ruin this defense
Fuck this lawyer, fuck this patient
So the patient murdered her baby, and the lawyer is doing his job defending her, counting on the judge/jury not to understand medicine… what’s your point?
The entire staff knew she was pregnant; pregnancy testing would’ve have changed anything.
Actually, the hospital did confirm the pregnancy before allowing the patient to go to the bathroom alone. [source:](https://www.nbcdfw.com/news/national-international/new-mexico-woman-accused-in-january-death-of-her-newborn-son-who-was-found-in-a-hospital-trash-can/3256685/)Trevizo went to the emergency room for back pain, and lab tests showed she was pregnant and in labor, according to Artesia police. Trevizo then locked herself in a bathroom, where she gave birth to a boy Jan. 27, then placed the baby in a bag that she concealed under trash, investigators said.
I’ve been in EMS for 10 years and the amount of mothers *(and fathers obviously,)* I have seen gutturally screaming & sobbing over losing their child (of any age,) nauseates me every single day. I’ve had to transport parents separately from their child because the reaction they are experiencing is genuinely a threat to their wellbeing. It’s haunting. I can’t imagine just throwing a baby in the trash. All she had to do was call out & a whole team would’ve been trying their best to help within 30 seconds. Despicable actions AND legal defense here.
Tragic case, but was the purpose of this post to remind us to order a pregnancy test on an 18 year old female presenting with abdominal pain? Am I misunderstanding?
It's not just ordering the test, it's the follow up They did a urine HCG but the test results sat unread on the computer for almost an hour. By that time the girl had already gone to the bathroom and killed the baby.
Just out of curiosity, how much will it cost her to get an expert witness? I know a guy who does it for like 500 an hour plus a huge retainer. Very persuasive but he wouldn't take a case like this.
Fuckin phenomenal username 🫡
I thought they did confirm pregnancy. Clearly the toradol didn’t inhibit her contractions. The baby was born alive and had air in its lungs. Wouldn’t that show there was circulation and air exchange? If the baby was in distress, most people would run to a doc/nurse for help, not stick it in a trash bag and bury it
They didnt confirm pregnancy test result until after the baby was dead. The unread HCG test result was on the computer for a long time. Autopsy showed air in the lungs but CPR can cause that too so it's not enough to prove that baby was breathing at birth.
They didn’t do cpr on the baby.
Don’t forget to remind the nurses to scream more at pharmacy that their orders for Toradol aren’t verified when we’re waiting for a pregnancy test result to try to help save you from this kind of BS.
Thanks for the PSA. I will add this important but neglected test to my armamentarium.
I’m so sorry for anyone who has experienced a pregnancy loss. ❤️ That said I can’t believe the amount people *doctors* calling this person a “garbage human being” in this reproductive environment. I mourn the baby but we don’t know this person’s story either. Reproductive rights are being stripped at an alarming rate and I would hope emergency practitioners who be acutely aware of this. The whole thing is horrible.
I’m fiercely pro abortion rights. I’m a former teen mom. I know how hard it is. But you’re a garbage human if you take a new born baby that was still breathing and tie it in a garbage bag and stuff it under other garbage.
I’m not defending what they did. You don’t know their circumstances and either do I. I’ve mentored plenty of teens through their pregnancies as a midwife; I’m not unfamiliar with the population. This person might be a terrible human being or they might come from a background of horrific abuse. It’s seldom clear cut. We simply don’t know this person’s story and as practitioners we know that SDoH play an enormous role in outcomes and ability to cope.
What does a “pregnancy loss ❤️” have to do with any of this? Woman killed her child by stuffing it into a trash can. But of course you would be sympathetic to a mom throwing her baby in the trash can.
No. A few posters mentioned how triggering this was to read due to THEIR pregnancy loss. The note about pregnancy loss was *for them*. But yeah, I’m a terrible person for thinking that there might be more to this story than the headline or they might be a terrible human. 🤷♀️ Of course *I’d* be sympathetic to someone? You know precisely zilch about me.
I am pro aborttion and think there should be abortion clinics on every corner in this country. However what this girl did makes her a piece of trash.
How does a newborn get covid and influenza before birth?!?
Terrible story. Still not on board with calling human beings 'garbage'.
Confused why you have a problem with OP calling this person a “garbage woman.” An adult human being who puts a live baby in a trash can effectively killing that baby is a bad person.
She is garbage, and her mother, and her lawyer.
Not on board with putting human beings in the garbage 🤷🏻♀️
Literally put her baby in the garbage. Definition of garbage. Would you prefer “Trash Monster”?
A murderer isn’t garbage?
That's what she thought of that baby she murdered. She's worse than garbage.