ch 24 Gynecologic Emergencies Study Notes

Chapter Overview

  • Title: Gynecologic Emergencies

  • Source: Emergency Care and Transportation of the Sick and Injured, AAOS, Twelfth Edition

  • Copyright © 2021 by Jones & Bartlett Learning, LLC

National EMS Education Standard Competencies

  • Medicine: Applies fundamental knowledge to provide basic emergency care and transportation based on assessment findings for an acutely ill patient.

  • Gynecology: Key areas include:

    • Recognition and management of shock associated with vaginal bleeding.

    • Understanding anatomy, physiology, assessment findings, and management related to:

    • Vaginal bleeding

    • Sexual assault (including appropriate emotional support)

    • Infections

Introduction to Gynecologic Emergencies

  • Unique medical considerations for women due to reproductive anatomy:

    • Women experience health issues not typically found in men.

Anatomy and Physiology of Female Reproductive System

  • External Female Genitalia: Components include:

    • Vaginal opening

    • Labia majora and labia minora

    • Clitoris

    • Perineum

  • Primary Internal Reproductive Organs:

    • Ovaries:

    • Located on each side of lower abdomen.

    • Produce ova (eggs).

    • Connect to the uterus via fallopian tubes.

    • Uterus: Muscular organ where fetus grows.

    • Narrowest part = cervix, which opens into the vagina.

    • Vagina is the outermost cavity, forming the lower part of the birth canal.

  • Menstrual Cycle:

    • Ovulation and menstruation begin in puberty:

    • Menarche: Onset of menstruation, occurring between ages 11 and 16.

    • Menstruation continues until menopause around age 50.

    • Each ovary alternates in producing an ovum monthly.

    • Fertilization Process:

    • Begins in the vagina when sperm is deposited.

    • Sperm travels through cervix to uterus and then to fallopian tubes.

    • Embryo attaches to uterine wall for growth.

    • If fertilization does not occur within about 14 days post-ovulation, the uterine lining begins to separate, leading to menstruation controlled by female hormones.

Pathophysiology

  • Causes of Gynecologic Emergencies: Can stem from a variety of reasons, including:

    • Sexually transmitted diseases (STDs)

    • Trauma

    • Possible complications such as ectopic pregnancy or sterility.

Specific Conditions

  • Pelvic Inflammatory Disease (PID):

    • Infection affecting upper reproductive organs, primarily in sexually active women.

    • Common sign: generalized lower abdominal pain.

  • Sexually Transmitted Diseases (STDs):

    • May lead to severe conditions like PID. Common STDs include:

    • Chlamydia: Most prevalent; often asymptomatic; can progress to PID.

    • Bacterial Vaginosis: Affects women aged 15-44; can lead to complications in pregnancy.

    • Gonorrhea: Affects the reproductive tract; can enter the bloodstream if untreated.

Assessment of Vaginal Bleeding

  • Possible causes include:

    • Abnormal menstruation

    • Vaginal trauma

    • Ectopic pregnancy

    • Spontaneous abortion

    • Cervical polyps or cancer.

Patient Assessment Techniques

  • Emphasis on accurate and detailed assessment to determine patient condition and need for interventions.

    • Scene Size-up: Ensure safety; be cautious with bodily fluids; involve police in suspected assaults.

    • Primary Assessment:

    • Determine patient stability using the AVPU scale.

    • Prioritize Airway, Breathing, and Circulation (check for blood loss).

    • Recognize shock signs; some emergencies may not be life-threatening.

  • History Taking:

    • Conduct with sensitivity; protect patient privacy.

    • For abdominal pain:

    • Questions around onset, duration, and associated symptoms.

    • For vaginal bleeding:

    • Ask about onset, duration, quantity, and associated symptoms like syncope.

    • Use SAMPLE History for more insights into patient background (birth control methods, menstrual cycle).

Secondary Assessment

  • Key components include vital signs and targeted examinations:

    • Vital Signs: Blood pressure, pulse, respiratory assessment.

    • Abdominal Examination: Check for tenderness or distention.

    • Genitourinary Assessment: Check for visible bleeding and any abnormalities in discharge.

Reassessment Protocol

  • Important to repeat primary assessment; communication with hospital staff is essential.

  • Accurate documentation of all relevant information, especially in sensitive cases like sexual assault.

Emergency Medical Care Steps

  • Maintain patient privacy; have a female EMT involved when possible.

  • Use sanitary pads to control external bleeding; note number of pads saturated.

  • Treat external lacerations cautiously; avoid internal packing of the vagina.

Management of Sexual Assault Cases

  • Recognize the prevalence: 1 in 5 women have reported rape.

  • Techniques for handling situations with care:

    • Remain professional and empathetic; preserve evidence meticulously.

    • Discourage the victim from washing, changing clothes, or harming evidence potential.

Special Treatment Principles for Sexual Assault Victims

  1. Thoroughly document history and treatment details as this may be required later.

  2. Complete the SAMPLE history objectively.

  3. Protect the crime scene to preserve potential evidence.

  4. Do not examine genitalia unless significant bleeding is present; avoid removing foreign objects.

  5. Reduce anxiety by having a same-gender EMT involved when possible.

  6. Prevent the patient from disturbing potential evidence until hospital staff can conduct a thorough evaluation.

  7. Transport to hospitals with specialized personnel (e.g., Sexual Assault Nurse Examiners).

Review Questions

  1. A series of questions to reinforce learning regarding anatomical structures, menstrual cycle, causes, and management of gynecological emergencies.

  • Key Review Points:

    • Identify the cervix as the narrowest part of the uterus.

    • Recognize the vagina as the outermost cavity

    • Understand menstruation and related timings post-ovulation as approximately 14 days.

    • Identify abnormal causes of bleeding and the presentation of PID, highlighting abdominal pain.

    • Assess correct history taking in emergencies, focusing on symptoms and last menstrual date.