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Immediate priorities
Hemodynamic instability and hemorrhage control
If hypotension or syncope, resuscitation bay
If ongoing shock, activate massive transfusion protocol
If suspected rupture, immediate OB or GYN and anesthesia consultation
Airway and breathing threats
If altered mental status, airway management pathway
Oxygen for hypoxemia
Circulation support
Two large bore IV or intraosseous access
Crystalloid bolus while preparing blood products
Bedside confirmation steps
Urine pregnancy test or serum beta hCG
Point of care ultrasound for free intraperitoneal fluid
Hemorrhage risk stratification
Rupture risk and time critical triggers
Peritoneal signs
Rebound tenderness
Guarding
Hemodynamic compromise
SBP < 90 mmHg
Persistent tachycardia
High risk ultrasound findings
Moderate or large free fluid
Adnexal mass with surrounding fluid
Consultation and escalation
Early specialty involvement
OB or GYN consultation for all suspected ectopic pregnancy
Immediate OR activation if rupture suspected
Transfer to higher level care if no surgical capability
Radiology for urgent transvaginal ultrasound interpretation
If limited availability, bedside transvaginal ultrasound by trained clinician
Key concepts
Time dependent maternal safety problem
Any pregnancy with abdominal pain or bleeding, ectopic until proven otherwise
Pregnancy of unknown location as a high risk category
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.