Emergency Department and Inpatient Clinical Pathway for Evaluation/Treatment of Adolescent with Acute Abnormal Uterine Bleeding

  • Additional Considerations
    • Social Work Consult
    • Peer Educator
Initial MD/CRNP/RN Assessment
  Assess ABC’s, VS
Orthostatic BP changes
Symptoms of hypovolemia, anemia
  Initial Labs
  • HCG (urine or serum)
  • Consider need for
    • Hgb
    • Type and Screen
Stable Hemodynamics
Immediate transfer to HUP ED
Interfacility Transfer Process
Consider Social Work Consult
Concerning Hemodynamics
  • Consider the following based on PE:
  • Transfer to HUP if able
  • If not stable for transfer
    • Consult
    • General or Trauma Surgery, and/or SDU
  • CBC, Type & Screen, PT, PTT
  • NS bolus, 2 PIV
  • CR monitor, VS q 15 minutes
  • Consider need for PRBC's
  • History and physical reassuring
  • Hgb > 12 mg/dL, if checked
  • Consider Gynecology Consult
Hgb 8-12 mg/dL
Hgb < 8 mg/dL
Indications for Admission
  • Significant ongoing blood loss
  • Persistent VS abnormality
  • Consider for:
    • hemoglobin < 9
    • psychosocial concerns
Posted: June 2015
Revised: April 2021
Authors: J. Pletcher, MD; C. Jacobstein, MD; J. Posner, MD; J. Lavelle, MD; L. Karel, Pharm D; K. Smith-Whitley, MD; C. Witmer, MD