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Initial Actions and Primary Survey As with any patient in the ED, first consider airway, breathing and circulation the ABC's in the patient with pelvic pain and vaginal bleeding. Circulation may need to be addressed immediately if the bleeding is heavy or if they have symptoms of poor perfusion such as altered mentation, dizziness, or difficulty breathing. In the hemodynamically unstable patient, placing two large-bore intravenous lines is a priority, followed by resuscitation with crystalloid fluids followed by blood products i. If the source of bleeding is suspected to be a potential ectopic pregnancy, the patient's pregnancy status needs to be established as soon as possible. If positive, it is crucial to determine whether the pregnancy is intrauterine or extrauterine, as a ruptured ectopic is a surgical emergency requiring emergency laparoscopy. Identification of pregnancy location can be accomplished with bedside ultrasonography in the unstable patient. Perform a formal pregnancy test on your pelvic pain and vaginal bleeding patients of childbearing age as soon as possible. Of note, the urine pregnancy test is

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