Gynecologic Emergencies - In Depth Notes

Emergency Medical Services Competencies

  • Basic Emergency Care: Apply fundamental knowledge for acutely ill patients based on assessment findings.
  • Gynecology: Recognition and management of conditions like shock and vaginal bleeding.

Gynecologic Emergencies Overview

  • Anatomy Consideration: Women possess unique reproductive systems prone to specific health issues not seen in men.

Anatomy and Physiology

  • External Genitalia Components:

    • Vaginal opening
    • Labia majora and minora
    • Clitoris
    • Perineum

  • Internal Reproductive Organs:

    • Ovaries: Produce ovum, located at lower abdomen sides, connected to uterus via fallopian tubes.
    • Uterus: Muscular organ where the fetus develops, with the cervix being the narrowest part that leads into the vagina.

  • Menstrual Cycle:

    • Begins between ages 11 and 16 (menarche) and continues until menopause (~age 50).
    • Ovulation occurs monthly; menstruation follows if fertilization does not happen within 1414 days of ovulation.

Common Conditions in Gynecology

  • Pelvic Inflammatory Disease (PID):

    • Infection affecting the reproductive organs, primarily in sexually active women.
    • Symptoms: Generalized lower abdominal pain, risk of ectopic pregnancy or sterility.

  • Sexually Transmitted Diseases (STDs):

    • Chlamydia: Most common STD, often asymptomatic, can progress to PID.
    • Bacterial Vaginosis: Overgrowth of bacteria in the vagina, can lead to complications in pregnancy if untreated.
    • Gonorrhea: Infects warm areas of the reproductive tract, untreated cases can become systemic.

Vaginal Bleeding

  • Causes: Abnormal menstruation, trauma, ectopic pregnancy, spontaneous abortion, or cancer.

Patient Assessment

  • Scene Size-Up:

    • Ensure safety and consider emotional implications of situations such as assault.
    • Gather pertinent history to understand condition.

  • Primary Assessment:

    • Check stability using AVPU scale.
    • Evaluate airway, breathing, and circulation. Identify signs of shock if present.

  • History Taking:

    • Obtain how long symptoms have been present, what alleviates or worsens them, and associated symptoms.
    • Utilize SAMPLE history to check for medication, menstrual cycle details, and potential pregnancy.

Secondary Assessment

  • Goals:
    • Gather vital signs and observe for signs of distress or other pertinent findings.
    • Conduct physical examinations carefully, limiting unnecessary exposure.

Management of Conditions

  • For PID: Limited emergency treatments available; undertake nonemergency transport unless the condition exacerbates.

Sexual Assault Response

  • Understanding Victims: Awareness that many women experience assault, necessitating a compassionate and professional approach.

    • Special considerations include preserving evidence and ensuring psychological support.

  • Documentation: Detailed records of patient history, observations, and treatments are vital, especially in legal contexts.

  • Preserving Evidence:

    • Discourage bathing or cleaning before the assessment to maintain integrity of evidence.
    • If feasible, transport to facilities equipped for handling such cases (e.g., SANE).

Review Questions & Answers

  1. Narrowest portion of the uterus: Cervix
  2. Outermost cavity of woman's reproductive system: Vagina
  3. Vaginal bleeding causes: Ectopic pregnancy, spontaneous abortion, trauma—All of the above.
  4. Common presenting sign of PID: Lower abdominal pain.
  5. SAMPLE history inquiries: Medical conditions, menstrual history, contraceptive use—All of the above.