ED Pathway for Evaluation/Treatment of Post-Pubertal Girls with Lower Abdominal Pain and No Vaginal Bleeding

RN Bedside Procedure

Procedures

  1. Obtain “dirty” urine:
    • No cleaning prior to specimen collection
    • Collect first stream of urine
    • Perform urine dip and Beta-HCG
    • Specimen for GC and Chlamydia LCR
  2. If urine dip is abnormal, obtain “clean-catch” specimen
    • Repeat urine dip
    • If positive, send specimen for urine culture
  3. Prepare patient for possible bimanual pelvic examination.
    Place the following at the bedside:
    • 2 red-topped cotton swabs
    • KY jelly
    • pH paper, glass slide, KOH
    • Hemoccult card & developer
  4. Place an IV in patients with severe pain and/or significant dehydration. If unsure, discuss with the resident, fellow, or attending as soon as possible.

  5. If an IV is placed:
    • Send blood for CBC w/ diff, ESR, CRP; hold gold top tube
    • Start 1 liter of normal saline (wide open)
    • Instruct patient not to urinate
    • Obtain order for analgesia as needed