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You spend so much time trimming, shaping, buffing and painting your nails (or having someone else do all of that for you), but you probably don’t spend much time looking at them bare. While nothing replaces a visit to your physician for a proper diagnosis, checking your fingernails for the following abnormalities can help you spot early warning signs, so wipe off that polish and take a glance.
More seriously, pale nails could also be a sign of early diabetes or liver disease, both of which can lead to impaired blood flow. Understand diagnostic and treatment algorithms to make appropriate dispositions for patients suspected of having an ectopic pregnancy. Patients at greatest risk for developing an ectopic pregnancy are those with anatomic abnormalities impairing the ability of a fertilized egg to implant in the uterus. Symptoms of an ectopic pregnancy develop as the fetus grows by distorting surrounding tissue or rupturing causing peritoneal irritation.
In one study, only 10% of physicians were able to identify the presence of less than 400cc of free intraperitoneal fluid, suggesting that a positive FAST typically indicates a large amount of acute blood loss.
All women of childbearing age presenting to the ED with abdominal or pelvic pain should have a urine pregnancy test performed immediately on arrival. Stable patients in the first trimester of pregnancy with abdominal pain and vaginal bleeding can be further evaluated in the ED. The earliest sign of an IUP by transvaginal ultrasound is the double decidual sac sign (click on Figure to the left), occurring at around 4.5-5 weeks after the last menstrual period (LMP). The β-hCG is a glycoprotein hormone produced by trophoblasts that doubles approximately every 48-72 hours in the first trimester.
Although rarely used since the advent of ultrasound, culdocentesis is a simple, bedside procedure that can be performed when ultrasonography is not rapidly available on a potentially unstable patient to detect the presence of intraperitoneal blood. Any patient strongly suspected of having an ectopic pregnancy needs to be medically or surgically managed in conjunction with OB-GYN. Methotrexate is the most successful method to medically manage a patient with ectopic pregnancy and may preserve fertility better than surgical interventions.
All patients suspected of having an ectopic pregnancy are managed in conjunction with OB-GYN. The presentation of ectopic pregnancy can be highly variable, so maintaining a high index of suspicion is paramount to making the diagnosis. Serum β-hCG values should not be used to determine which patients should have transvaginal ultrasound.
An ectopic pregnancy can be 'ruled out' in the presence of an IUP in a patient not undergoing infertility treatment.
Ectopic pregnancy is managed surgically in cases of clinical instability, contraindications to medical therapy, or failure of medical therapy. Any patient discharged from the ED with a potential ectopic pregnancy should understand "ectopic precautions" and have the means to return immediately to the ED.
Please note: If you have a promotional code you'll be prompted to enter it prior to confirming your order. If you subscribe to any of our print newsletters and have never activated your online account, please activate your account below for online access. Various herbs and other supplements have been touted for their ability to improve cholesterol levels. As you've gotten older, have you noticed that you often find yourself marching around the house in a huff, searching for misplaced car keys or eyeglasses, or you just cannot remember the name of that new neighbor you met when walking the dog? The way you live, what you eat and drink, and how you treat your body can affect your memory just as much as your physical health and well-being. If you're having the occasional twinge of joint pain when you go for a walk or climb stairs, or you're worried about arthritis because a parent had it, one step toward prevention is to check your weight.
Sticking with exercise isn't always easy, but setting goals and having a plan for when your motivation lags can help.
If a growth or mole looks like a melanoma, the doctor will take a biopsy to confirm the diagnosis.
It might seem like retirement is a time to take it easy and devote yourself to gardening, golfing, and napping.

What if men approached their health at midlife the same way that financial experts advise them to plan for retirement?
Sleep shortfalls can lead to a range of health problems, from being more likely to catch a cold or gain weight to increased risk of developing heart disease or diabetes. Up to 20% of people in the United States will experience migraine headaches at some point in life. The brain chemical serotonin may play an important role in this process as it does in other conditions, including depression and eating disorders.
And that means you may be missing spots, stripes and odd colors that could indicate that something's up -- in a bad way -- with your body.
If your fingernail beds are looking a little ghostly, you may have anemia, a blood disorder characterized by a low red blood cell count. Ectopic pregnancy is defined as any pregnancy implanted outside the uterus, with approximately 97% occurring in the fallopian tube. Tubal factors including history of salpingitis, tubal surgery, and previous ectopic pregnancy are the most important risk factors for ectopic pregnancy.
The classic triad of abdominal pain, delayed menses, and vaginal bleeding is neither sensitive nor specific for ectopic pregnancy. A pregnancy test should be obtained on all female patients of childbearing age (consider ages 10-60) who present to the ED with complaint of abdominal pain, amenorrhea, or vaginal bleeding.
The combination of positive FAST and positive pregnancy test should prompt an immediate call to OB-GYN to take the patient to the OR for a presumptive diagnosis of ruptured ectopic pregnancy.
If you have a strong suspicion of pregnancy and the patient provides a dilute urine, a serum pregnancy test should be considered. A transvaginal ultrasound should be obtained to evaluate for the presence or absence of an IUP.
A yolk sac (click the Figure just below the one to the left) is typically identified at 5-6 weeks and the presence of a yolk sac has 100% predictive value for an intrauterine pregnancy. The likelihood of finding a live extrauterine embryo with positive heart motion using ultrasound is only 8-26%.
Diagnosis and management of ectopic pregnancy using bedside transvaginal ultrasonography in the ED: a 2-year experience. Clinical Policy: Critical issues in the initial evaluiation and mananagement of patients presenting to the emergency department in early pregnancy. Most people who have migraine experience repeated attacks of headaches that occur over many years.
The pain of migraines is associated with swelling in blood vessels and irritation of nerves that surround the brain. In a typical aura, a person suddenly will develop blurry or distorted vision or will see pulsating lights.
Some people are more likely to experience migraines when they are under stress, while others develop migraines when stress is relieved (for example, the day after exams or an important meeting). For example, a computed tomography (CT) or magnetic resonance imaging (MRI) scan of the brain usually will be normal.
It is a life threatening condition complicating 1 in 80 pregnancies presenting to emergency departments. It is important to recognize that many ectopic pregnancies occur in women without any recognized risk factors, so maintaining a high index of suspicion is paramount to making an accurate diagnosis. Symptoms and physical findings are highly variable among patients, making the diagnosis extremely challenging. If an IUP is visualized, a concurrent ectopic pregnancy (heterotopic pregnancy) is statistically unlikely unless the patient has received fertility treatments.
An ectopic pregnancy cannot be excluded until the patient has a yolk sac demonstrated within the gestational sac. ACEP's clinical policy on patients presenting to the ED in early pregnancy states that a transvaginal ultrasound should be performed on all patients in whom the diagnosis of ectopic pregnancy is considered despite the β-hCG level, as both IUP's and ruptured ectopics have been diagnosed at very low levels. Ultrasound signs of an ectopic include an empty uterus, extraovarian mass, tubal ring sign (click Figure to the left), and pelvic free fluid.
Greater than 2ml of nonclotting blood is suggestive of hemoperitoneum and ruptured ectopic pregnancy. Patients with significant pain without signs of rupture should be admitted for close observation and serial reassessments. The typical migraine headache is throbbing or pulsating, and often is associated with nausea and changes in vision. Two-thirds of people who get migraines are women, probably because of the influence of hormones.

It's the pain processing networks, or centers, in the brain that are overly reactive or dysfunctional in migraine. Activity, bright light or loud noises can make the headache worse, so someone having a migraine often seeks out a cool, dark, quiet place. These changes in vision will come and go over 15 to 30 minutes and alert someone that a headache is about to begin. Women who have migraines often find that their headaches occur or worsen around the time of their menstrual periods. However, your doctor may recommend additional testing if your headaches have features that are not typical for migraines, or you develop other worrisome symptoms.
However, some people have only one attack in a lifetime, while others have more than three attacks per week. Be sure you’re consuming good sources of iron, including green leafy vegetables, beans and red meat, to boost your levels.
Avoid processed foods with refined sugars and carbs, and eat more fiber, vegetables and whole grains. Abdominal pain is the most common symptom and is reported in as many as 98.6% of patients, but its severity and quality is highly variable.
This occurs spontaneously at a rate of only 1 in 10,000 pregnancies, but the incidence is much higher for women using infertility drugs or assisted reproductive technologies . An ectopic pregnancy is highly likely in patients with a β-hCG level greater than 1500 with the absence of intrauterine pregnancy on transvaginal ultrasound. It works by interfering with syntheses of DNA and cell replication of fetal cells, resulting in involution of the pregnancy.
Clinically stable patients with an ectopic pregnancy may be managed medically with methotrexate if they have an excellent follow up plan.
While many migraine headaches are severe, not all severe headaches are migraines, and some episodes can be quite mild.
If there is any doubt about your diagnosis, your doctor also may recommend a consultation with a neurologist, a doctor specializing in illnesses of the nerves and brain. Despite the improved diagnostic modalities, ectopic pregnancy is still frequently misdiagnosed on initial presentation with up to 40-50% of patients correctly diagnosed on repeat visits. Amenorrhea is present in almost 75% of women with ectopic pregnancies, and irregular vaginal bleeding occurs in 56.4%, but may be minimal even in the critically ill patient. Treatment failure with single dose methotrexate occurs in up to 36% of patients necessitating administration of a second dose of methotrexate if β-hCG values are not decreasing as expected. For those hemodynamically stable patients with inconclusive ultrasound findings where the diagnosis is in doubt, they may be managed as an outpatient with serial ultrasound examinations and β-hCG levels.
Overall, it accounts for about 9% of all pregnancy-related maternal deaths, and is one of the leading causes of maternal death in the first trimester. Tenderness on pelvic exam is the most common physical exam finding, but few patients will have a palpable pelvic mass. Contraindications for receiving methotrexate include hemodynamic instability, inability to return for follow-up, breastfeeding, immunodeficiency, renal, liver or pulmonary disease, peptic ulcer disease, and blood dyscrasias. Early diagnosis and treatment is essential in reducing maternal mortality and preserving future fertility. The diagnosis of ectopic pregnancy should be considered in female patients presenting to the ED with syncope or unexplained hypotension.
All patients discharged from the ED who have the potential to have an ectopic pregnancy must receive and understand the "ectopic precautions" and be instructed to return to the ED immediately if they develop worsening pain, vaginal bleeding, dizziness, syncope, or weakness. Rarely, migraines can cause unusual neurological symptoms such as dizziness, loss of vision, passing out, numbness, weakness or tingling. The majority of patients with an ectopic pregnancy have normal vital signs until they have experienced significant blood loss.
Migraines also have typical aftereffects, such as a feeling of exhaustion that lasts a day or two after a severe migraine headache has faded. Paradoxic bradycardia can occur in ectopic pregnancy, thus vital signs should not be reassuring and all patients with ectopic pregnancy should be considered potentially unstable.

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