Pediatric emergency medicine trisk 2150 2150

abdominal probe and a transvaginal probe For patients who cannot tolerate such an examination or if the ultrasound technologists are not skilled in performing a transvaginal imaging, an MRI should be ordered An MRI may be a better modality to evaluate vaginal and bladder lesions Intraperitoneal lesions, however, are difficult to visualize on imaging studies; surgical approaches may be more useful However, surgical evaluation should not be needed for primary dysmenorrhea and is rarely needed for secondary dysmenorrhea as a surgical emergency Notably, when secondary dysmenorrhea due to endometriosis is suspected, surgical evaluation is best performed by a surgeon with expertise in pediatric endometriosis as the appearance in pediatric patients is very subtle and differs from the appearance in adults Management NSAIDs are first-line medications for most adolescents with dysmenorrhea and have both analgesic and anti-inflammatory effects Nonspecific NSAIDs that inhibit both COX-1 and COX-2 (ibuprofen, naproxen, diclofenac potassium, and meclofenamate) and those that are specific for COX-2 (celecoxib, rofecoxib, and valdecoxib), are effective for treating dysmenorrhea; however use of COX-2 inhibitors has been limited by cardiac side effect The patient should be counseled that NSAIDs are most effective when started to days prior to onset of menstrual bleeding If the patient is unable to predict the onset of her period, she should be advised to start the NSAID at the first sign of cramping or bleeding Naproxen (500 mg PO q12h) and ibuprofen (600 to 800 mg PO q6h) are commonly used Failure to respond to one NSAID does not preclude use of another NSAIDs should be avoided in patients with ulcers, gastrointestinal bleeding, renal disease, or clotting disorders In patients where NSAIDs are contraindicated, tramadol may be used It is a centrally acting analgesic agent that binds to μ-opioid receptors and inhibits the reuptake of norepinephrine and serotonin Tramadol is prescribed as 50 to 100 mg by mouth every hours, not to exceed 400 mg/day Use tramadol with caution in patients with a history of seizures Drug dependence is also possible in patients taking tramadol Patients whose pain is not alleviated by NSAIDs should be offered a hormonal method to treat the dysmenorrhea High-quality randomized clinical trials evaluating the effectiveness of oral contraceptives for dysmenorrhea are lacking, though smaller studies have noted response rates up to 80% Combined oral contraceptive pills (OCPs) containing estrogen and progestin are widely used They work by suppressing ovulation, reducing the amount of endometrial