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Endometritis
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Abdominal aortic aneurysm
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Respiratory Presentations
Acute bronchitis
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Neurological Presentations
Bell's palsy
Benign paroxysmal positional vertigo
Brain abscess
Cauda equina syndrome
Cervical radiculopathy
Concussion (mild traumatic brain injury)
Encephalitis
Guillain-Barré syndrome
Hemorrhagic stroke (intracerebral)
Ischemic stroke
Lumbar radiculopathy
Malignant spinal cord compression
Migraine
Peripheral neuropathy (acute)
Retropharyngeal abscess
Schizophrenia (acute exacerbation)
Seizure (breakthrough:known epilepsy)
Seizure (first-time)
Spinal cord injury
Status epilepticus
Subarachnoid hemorrhage
Tension headache
Transient ischemic attack
Traumatic brain injury (moderate-severe)
Vestibular neuritis
Viral meningitis
Gastrointestinal Presentations
Acute appendicitis
Acute cholecystitis
Acute diverticulitis
Acute pancreatitis
Anal fissure
Choledocholithiasis and cholangitis
Clostridioides difficile colitis
Gastritis
Gastroenteritis (viral and bacterial)
Gastroesophageal reflux disease
Incarcerated or strangulated hernia
Inflammatory bowel disease flare
Large bowel obstruction
Lower GI hemorrhage
Peptic ulcer disease
Perforated viscus
Small bowel obstruction
Upper GI hemorrhage
Genitourinary and Reproductive Presentations
Acute prostatitis
Acute urinary retention
Ectopic pregnancy
Epididymitis
Orchitis
Ovarian torsion
Paraphimosis
Pelvic inflammatory disease
Priapism
Pyelonephritis
Renal laceration
Ruptured ovarian cyst
Testicular torsion
Tubo-ovarian abscess
Urinary tract infection (uncomplicated)
Urolithiasis (renal colic)
Vaginal bleeding (non-pregnant)
Infectious Disease Presentations
Acute sinusitis
Acute tonsillitis
Acute upper respiratory infection
Animal bite
Bacterial meningitis
Cellulitis
Conjunctivitis (bacterial)
Dental abscess
Endocarditis
Febrile neutropenia
Fournier gangrene
Hand-foot-mouth disease
Hepatitis (acute)
Herpes zoster
HIV-related illness
Human bite
Impetigo
Infected diabetic foot ulcer
Infectious mononucleosis
Influenza
Necrotizing fasciitis
Osteomyelitis
Otitis externa
Parasitic infection
Periorbital cellulitis
Peritonsillar abscess
Scabies
Sepsis
Septic arthritis
Spontaneous bacterial peritonitis
Tick-borne illness (Lyme disease)
Tinea infection
Tuberculosis
Viral exanthem
Wound infection
Trauma Presentations
Achilles tendon rupture
ACL and mceniscus tear
Ankle fracture
Ankle sprain
Burn
Calcaneus fracture
Cervical spine fracture
Clavicle fracture
Dental avulsion
Distal radius fracture
Drowning
Elbow fracture and dislocation
Electrical injury
Facial bone fracture
Facial laceration
Femur fracture
Fingertip amputation
Forearm fracture (radius and ulna)
Frostbite
Hand:finger laceration
Heat exhaustion
Heat stroke
Hip fracture
Humeral shaft fracture
Knee dislocation
Knee sprain
Lightning injury
Mandible fracture
Metacarpal fracture
Metatarsal fracture
Muscle strain
Nasal fracture
Non-accidental trauma
Orbital fracture
Patella fracture
Phalanx fracture (finger)
Proximal humerus fracture
Pulmonary contusion
Rib fracture
Rotator cuff tear (acute traumatic)
Scalp laceration
Scaphoid fracture
Shoulder dislocation
Skull fracture
Splenic laceration
Sternal fracture
Supracondylar pediatric fracture
Tendon laceration (hand:wrist)
Thoracic and lumbar spine fracture
Tibia:fibula fracture
Tibial plateau fracture
Toe fracture
Traumatic epistaxis
Traumatic hyphema
Toxicologic Presentations
Acetaminophen toxicity
Alcohol intoxication
Alcohol withdrawal
Anticholinergic toxicity
Anticoagulant overdose
Benzodiazepine overdose
Benzodiazepine:sedative overdose
Beta-blocker and calcium channel blocker toxicity
Carbon monoxide poisoning
Caustic ingestion
Digoxin toxicity
Drug eruption
Foreign body ingestion
Opioid intoxication
Opioid overdose
Opioid withdrawal
Organophosphate
Salicylate toxicity
Serotonin syndrome
Stimulant intoxication (cocaine, methamphetamine)
Tricyclic antidepressant overdose
Psychiatric Presentations
Acute anxiety
Acute psychosis
Agitation:behavioral emergency
Bipolar disorder
Conversion disorder
Major depressive episode
Neuroleptic malignant syndrome
Suicidal ideation and attempt
Musculoskeletal and Rheumatologic Presentations
Acute low back pain (mechanical)
Bursitis
Cervical radiculopathy
Costochondritis
Gout (acute)
Lumbar radiculopathy
Pseudogout
Tendinitis
Dermatology Presentations
Acute eczema (Eczema acute flare)
Allergic contact dermatitis
Erythema multiforme
Henoch-Schönlein purpura
Pressure injury
Psoriasis (acute flare)
Stevens-Johnson syndrome
Toxic epidermal necrolysis
Urticaria (acute)
Environmental and Exposure Presentations
Envenomation (snake, spider, insect)
High-altitude illness
Hypothermia
Hematologic and Oncologic Presentations
Acute chest syndrome
Coagulopathy
Hyperviscosity syndrome
Sickle cell crisis (vaso-occlusive)
Symptomatic anemia
Thrombocytopenia (severe)
Tumor lysis syndrome
Pediatric-Specific Presentations
Bronchiolitis
Croup
Emergency delivery
Febrile seizure
Kawasaki disease
Neonatal jaundice
Neonatal sepsis
Nursemaid's elbow
Pediatric fever 0 to 28 days
Pediatric fever 29 to 60 days
Pediatric fever 61 to 90 days
Pyloric stenosis
Slipped capital femoral epiphysis
Intussusception
Endocrine and Metabolic Presentations
Adrenal crisis
Diabetic ketoacidosis
Hypercalcemia
Hyperosmolar hyperglycemic state
Hypertensive emergency
Hypertensive urgency
Hypoglycemia
Myasthenia gravis crisis
Myxedema coma
Severe hyperkalemia
Severe hyponatremia
Thyroid storm
ENT and Maxillofacial Presentations
Acute laryngitis
Acute otitis media
Acute pharyngitis
Cerumen impaction
Epistaxis (anterior)
Nasal foreign body
Otitis externa
Tympanic membrane perforation
Ophthalmologic Presentations
Acute angle-closure glaucoma
Central retinal artery occlusion
Chemical eye injury
Corneal abrasion
Corneal ulcer
Globe rupture
Ocular foreign body
Orbital cellulitis
Retinal detachment
Obstetric Presentations
Hyperemesis gravidarum
Painful vaginal bleeding in pregnancy
Placenta previa
Placental abruption
Preeclampsia:eclampsia
Preterm labor
Threatened:inevitable:incomplete abortion
Systemic and Miscellaneous Presentations
Anaphylaxis
Angioedema
Cannabis-induced hyperemesis
Endometritis
Ultrasound
Procedures
Medications
Calculators
Resuscitation
ECG Guide
Back
Clinical Assessment Checklist
Browse categories and answer follow-up questions to refine your symptom profile.
First 5 minutes
Instability triage
▶
Airway compromise
Respiratory failure
Shock
Altered mental status
Sepsis triggers
▶
Suspected uterine source
Temperature ≥ 38.0 C
Heart rate ≥ 110/min
Respiratory rate ≥ 22/min
Systolic blood pressure < 90 mmHg
Immediate actions
▶
If shock, resuscitation bay
▶
Two large-bore IV
Crystalloid 30 mL/kg for hypotension or lactate ≥ 4 mmol/L
Norepinephrine if MAP < 65 mmHg after fluids
If severe sepsis, time zero bundle
▶
Blood cultures before antibiotics if no delay
Lactate within 1 hour
Broad-spectrum IV antibiotics within 1 hour
Source control pathways
▶
If retained products suspected, urgent obstetrics for evacuation planning
If abscess suspected, gynecology and interventional radiology
If necrotizing soft tissue infection, emergent surgical consult
Hemodynamic and monitoring targets
Monitoring setup
▶
Continuous pulse oximetry
Cardiac monitor
Blood pressure cycling q5 min until stable
Foley catheter if shock or strict urine output targets
Targets
▶
MAP ≥ 65 mmHg
Urine output ≥ 0.5 mL/kg/hour
Lactate downtrend within 2 to 4 hours
Early consultations
Team activation
▶
Obstetrics and gynecology early for postpartum or post-procedure cases
ICU if vasopressors or rising lactate
Infectious diseases if immunocompromised, bacteremia, or antibiotic complexity
Anesthesia if urgent uterine evacuation and instability
Presentation pattern
Classic postpartum presentation
▶
Postpartum day 2 to 3 onset
Fever
Uterine fundal tenderness
Foul-smelling lochia
Non-postpartum presentation
▶
Post-procedure onset
Post-abortion onset
Postpartum day > 7 onset
Timing and risk context
Delivery and procedure details
▶
Cesarean delivery
Prolonged rupture of membranes
Prolonged labor
Multiple vaginal examinations
Intraamniotic infection history
Bleeding and retained tissue clues
▶
Heavy bleeding
Passage of tissue
Subinvolution symptoms
Infectious exposure risks
▶
Group B streptococcus colonization status
Recent antibiotics
STI risks
Postpartum urinary catheter
Symptom review
▶
Pelvic pain
Chills or rigors
Malodorous discharge
Dysuria or flank pain
Breast pain or erythema
Cough or dyspnea
Wound pain or drainage
PITFALLS
Atypical symptoms
▶
Minimal uterine tenderness with severe infection
Afebrile presentation after antipyretics
Missed alternate sources
▶
UTI or pyelonephritis
Surgical site infection
Mastitis
Pneumonia
Persistent fever despite antibiotics
▶
Septic pelvic thrombophlebitis
Retained products
Pelvic abscess
Focused vitals and general exam
Systemic severity
▶
Toxic appearance
Capillary refill delay
Mottling
Mental status changes
Vitals pattern
▶
Fever trend
Tachycardia out of proportion to fever
Hypotension
Tachypnea
Abdominal and pelvic exam
Uterine exam
▶
Fundal tenderness
Uterine size relative to postpartum day
Subinvolution
Lochia and discharge
▶
Foul odor
Purulent discharge
Excess bleeding
Peritoneal signs
▶
Guarding
Rebound tenderness
Pelvic tenderness pattern
▶
Cervical motion tenderness
Adnexal tenderness
Pelvic mass concern
Extra-pelvic sources exam
Breasts
▶
Focal erythema
Fluctuance concern
Surgical site
▶
Incision erythema
Drainage
Crepitus
Lungs
▶
Focal crackles
Hypoxia
Legs
▶
Unilateral swelling
Calf tenderness
Life-threatening and time-sensitive
Critical diagnoses
▶
Postpartum endometritis (ICD-10 O86.12)
Septic shock (ICD-10 R65.21)
Necrotizing soft tissue infection of perineum (ICD-10 M72.6)
Pelvic abscess
Septic pelvic thrombophlebitis
Hemorrhage-related
▶
Retained products of conception (ICD-10 O73.0)
Secondary postpartum hemorrhage (ICD-10 O72.2)
Mimics and alternative sources of postpartum fever
Genitourinary
▶
Cystitis
Pyelonephritis
Surgical and wound
▶
Cesarean wound infection
Endometritis with uterine dehiscence concern
Breast
▶
Mastitis
Breast abscess
Respiratory
▶
Pneumonia
Aspiration pneumonitis
Vascular
▶
DVT
Pulmonary embolism
Abdominal
▶
Appendicitis
Cholecystitis
Sepsis and severity labs
Initial panel
▶
Lactate
▶
Threshold ≥ 2 mmol/L for higher risk
Threshold ≥ 4 mmol/L for aggressive resuscitation pathway
Complete blood count
▶
Leukocytosis supportive but non-specific
Leukopenia as severe sepsis marker
Electrolytes and creatinine
▶
Acute kidney injury support for ICU triage
Liver enzymes
▶
Sepsis-associated organ dysfunction marker
Perfusion and coagulopathy
▶
Venous blood gas
▶
Acidemia support for severity
INR and aPTT
▶
DIC screening if shock or bleeding
Fibrinogen
▶
Low value supportive of DIC
Platelets
▶
Thrombocytopenia supportive of severe sepsis
Microbiology
Cultures
▶
Blood cultures x2
▶
Prior to antibiotics if no delay
Urine culture
▶
Pyelonephritis mimic exclusion
Endocervical or vaginal NAAT if STI concern
▶
Chlamydia
Gonorrhea
When available
▶
Uterine cultures
▶
Typically not required for initial therapy
Consider if ICU course or treatment failure
Other targeted labs
Pregnancy-related
▶
Beta-hCG if postpartum status uncertain
Bleeding concern
▶
Type and screen
Hemoglobin trend
Scoring Systems
Severity tools
▶
qSOFA
▶
Respiratory rate ≥ 22/min
Altered mentation
Systolic blood pressure ≤ 100 mmHg
SOFA
▶
Respiratory component
Coagulation component
Liver component
Cardiovascular component
CNS component
Renal component
Obstetric sepsis screen triggers
▶
Persistent tachycardia
Hypotension
Rising lactate
Oliguria
MRI
Indications
▶
Pelvic deep infection concern with CT contraindication
Complex adnexal pathology characterization
Limitations
▶
Delay to imaging in unstable patient
Limited availability off-hours
CT
Indications
▶
Persistent fever > 48 to 72 hours on appropriate antibiotics
Pelvic abscess concern
Septic pelvic thrombophlebitis concern
Alternative intraabdominal source concern
Technique considerations
▶
Contrast CT abdomen and pelvis if renal function allows
Venous phase adequacy for pelvic thrombosis assessment
Interpretation pearls
▶
Rim-enhancing fluid collection for abscess
Enlarged ovarian vein with thrombus for ovarian vein thrombosis
Evidence level
▶
CT for abscess localization and drainage planning (ACEP Level C)
Ultrasound
Pelvic ultrasound use cases
▶
Retained products of conception concern
▶
Endometrial thickening supportive but non-specific
Intrauterine echogenic material
Increased vascularity on Doppler supportive
Hematometra or intrauterine fluid collection
Adnexal mass or tubo-ovarian abscess concern
POCUS pathways
▶
If shock, focused cardiac ultrasound for pericardial effusion
If shock, IVC assessment for volume responsiveness adjunct
Evidence level
▶
Ultrasound for retained products evaluation (ACEP Level C)
Level of care decisions
Admission indications
▶
Postpartum endometritis suspected
IV antibiotics required
Inability to tolerate oral intake
Significant pain requiring parenteral therapy
ICU indications
▶
Vasopressors requirement
Lactate ≥ 4 mmol/L
Multi-organ dysfunction
Persistent hypotension
Altered mental status
Transfer criteria
▶
Need for obstetric surgical capability not available
Need for interventional radiology drainage not available
Discharge pathways
Copy
Limited outpatient scenarios
▶
Mild non-postpartum endometritis with reliable follow-up
No sepsis physiology
Oral antibiotic plan in place
Safety prerequisites
▶
Reassessment after initial management
Clear return precautions
Follow-up within 24 to 48 hours if outpatient
Empiric antibiotics
First-line postpartum regimen
▶
Clindamycin plus gentamicin
▶
Clindamycin IV 900 mg q8h
▶
Anaerobe coverage
Toxin suppression benefit in streptococcal infection concern
Gentamicin IV 5 mg/kg q24h
▶
Adjusted body weight if obesity
Trough monitoring per local protocol if prolonged course
Continue until afebrile 24 to 48 hours
▶
No routine oral step-down required after clinical response
Enterococcus coverage triggers
▶
If no improvement by 48 hours, add ampicillin
▶
Ampicillin IV 2 g q6h
▶
Enterococcus coverage
If known GBS colonization with clindamycin resistance concern, add ampicillin
Alternative single-agent IV regimens
▶
Ampicillin-sulbactam IV 3 g q6h
▶
Broad aerobic and anaerobic coverage
Useful if aminoglycoside avoidance
Piperacillin-tazobactam IV 4.5 g q8h
▶
If severe sepsis or polymicrobial concern
If persistent fever after first-line regimen
Ertapenem IV 1 g q24h
▶
If beta-lactamase risk and stable hemodynamics
Avoid if Pseudomonas concern
Sepsis resuscitation and supportive care
Fluids and pressors
▶
Crystalloid bolus strategy
▶
500 to 1000 mL reassessment cycles if not meeting 30 mL/kg pathway
Lung ultrasound for fluid tolerance adjunct
Norepinephrine infusion
▶
Initiate if MAP < 65 mmHg after fluids
Titrate q2 to 5 minutes to MAP target
Antipyresis and analgesia
▶
Acetaminophen
▶
Max daily dose per local protocol
NSAIDs if no renal injury or bleeding concern
Thromboprophylaxis
▶
Pharmacologic VTE prophylaxis during admission if no contraindications
Mechanical prophylaxis if bleeding risk
Source control
Retained products pathway
▶
If ultrasound supports retained products with ongoing bleeding, obstetrics evacuation planning
If hemodynamic instability with hemorrhage, emergent uterine evacuation pathway
Abscess pathway
▶
If imaging confirms abscess, drainage planning
▶
Interventional radiology percutaneous drainage
Operative drainage if percutaneous not feasible
Necrotizing infection pathway
▶
If perineal crepitus or rapid progression, emergent debridement
Broad necrotizing coverage regimen per sepsis protocol
Treatment failure and escalation
Persistent fever > 48 to 72 hours on appropriate antibiotics
▶
CT abdomen and pelvis for abscess or thrombophlebitis
Antibiotic broadening pathway
▶
Switch to piperacillin-tazobactam
Consider carbapenem if resistant organism concern
Septic pelvic thrombophlebitis suspicion
▶
Persistent fevers with negative imaging for abscess
Anticoagulation consideration with obstetrics and hematology
Continue antibiotics during anticoagulation course
Evidence levels and outcomes
Clindamycin plus gentamicin as effective first-line regimen for postpartum endometritis (ACEP Level C)
Once-daily gentamicin dosing similar clinical success to q8h dosing in postpartum endometritis (ACEP Level C)
Pregnancy
Postpartum physiology considerations
▶
Normal postpartum leukocytosis as diagnostic confounder
Hypercoagulability postpartum with thrombosis risk
Lactation considerations
▶
Clindamycin compatible with breastfeeding
Gentamicin minimal oral absorption in infant
Monitor infant for diarrhea or thrush if maternal antibiotics
Obstetric complications overlap
▶
Retained products association with secondary hemorrhage
Endometritis risk higher after cesarean delivery
Geriatric
Post-procedure endometritis considerations
▶
Higher comorbidity burden
Higher risk of rapid decompensation
Medication considerations
▶
Renal dosing for aminoglycosides
Drug interactions with anticoagulants
Pediatrics
Adolescent endometritis context
▶
STI-associated endometritis within PID spectrum
Mandatory pregnancy testing in reproductive-age adolescents
Antibiotic selection
▶
PID regimens per local and national STI guidance
Weight-based dosing for all agents
Safeguarding considerations
▶
Sexual assault and consent context pathways as indicated
Epidemiology
Incidence patterns
▶
Higher rates after cesarean delivery than after vaginal delivery
Polymicrobial infection as typical postpartum pattern
Risk factors prevalence contributors
▶
Prolonged rupture of membranes
Prolonged labor
Multiple vaginal examinations
Intraamniotic infection
Pathophysiology
Mechanism
▶
Ascending polymicrobial infection of decidua and endometrium
Anaerobes and aerobes synergy
Common organisms
▶
Anaerobes
▶
Bacteroides species
Peptostreptococcus
Aerobes
▶
Streptococcus species
Enterococcus species
Enterobacterales
Complications
▶
Bacteremia
Pelvic abscess
Septic pelvic thrombophlebitis
Septic shock
Therapeutic Considerations
Antibiotic rationale
▶
Broad anaerobic plus gram-negative coverage requirement postpartum
Enterococcus coverage as escalation consideration
Duration rationale
▶
Clinical response based discontinuation after afebrile 24 to 48 hours
Prevention concepts
▶
Cesarean prophylactic antibiotics reduce endometritis risk
Avoid unnecessary vaginal examinations after membrane rupture
copy discharge instructions
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Home care
▶
Rest
Hydration
Continue prescribed antibiotics exactly as directed if outpatient regimen
Return now
▶
Fever
Worsening pelvic or abdominal pain
Heavy bleeding
Fainting
New shortness of breath
Chest pain
Confusion
Persistent vomiting
Follow-up
▶
Obstetrics or gynecology follow-up within 24 to 72 hours
Earlier follow-up if symptoms not improving within 24 hours
Breastfeeding
▶
Continue breastfeeding unless clinician advises otherwise
Infant diarrhea or oral thrush monitoring
Clinical guidelines and evidence
Merck Manual Professional Edition
▶
Postpartum endometritis treatment section
Clindamycin 900 mg IV q8h plus gentamicin as first-line regimen
Cochrane review
▶
Antibiotic regimens for postpartum endometritis
Clindamycin plus gentamicin more effective than many alternatives
NIH NCBI Bookshelf StatPearls
▶
Postpartum infection and endometritis treatment summaries
Continue IV therapy until afebrile for 24 to 48 hours
American Journal of Obstetrics and Gynecology
▶
Once-daily gentamicin dosing efficacy compared with q8h dosing in postpartum endometritis
CDC STI Treatment Guidelines
▶
PID spectrum includes endometritis
STI-associated upper genital tract infection considerations
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.
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