Welcome to The Pearl Log — where post-shift wisdom surfaces, one shiny clinical take at a time. Some pearls are fresh, some are rough, all are found under pressure.
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Pregnancy Ultrasound Potpourri
First trimester bleeding is one of the highest value POCUS moments in the ED. A quick transabdominal scan that shows a clear intrauterine pregnancy lets you safely discharge most patients in minutes. If the IUP is not obvious, move to transvaginal imaging to nail down the diagnosis and guide next steps.
Potpourri: Euglycemic DKA, Slit Lamp, Abd Pain in Pregnancy
A few quick takeaways from shift. Euglycemic DKA is real—new ADA criteria now allow for normoglycemia if ketones and acidosis are present. Think alcohol, SGLT2s, or pregnancy. Brush up on some slit lamp basics. And for early pregnancy with pain or bleeding, grab the probe first. If you find an IUP, congrats, then your basically done.
The Beta-HCG and Ectopic Pregnancy. Myth-Busting.
You can’t rule out an ectopic pregnancy with a low or “reassuring” β-hCG. The discriminatory zone only applies to normal intrauterine pregnancies, not ectopics—and many ruptures occur with levels well below 1,500 mIU/mL. Every symptomatic pregnant patient needs an ultrasound, regardless of hCG value. No hCG cutoff, and no pattern of symptoms, safely excludes an ectopic.