Chapter 24: Gynecologic Emergencies

Introduction

• Women are uniquely formed to conceive and give birth, causing susceptibility to conditions not found in men.
• Topics include:
  • Female anatomy
  • Conditions encountered in pre-hospital settings
  • Causes of vaginal bleeding
  • Health concerns in the young and elderly
  • Treatment of sexual assault victims
  • Recognition of date rape drugs

Anatomy and Physiology

External Female Genitalia

• Vaginal opening located posterior to urethral opening
• Labia majora and minora surround openings
• Clitoris and anus located at anterior and posterior ends of labia, respectively
• Perineum is the area between vagina and anus
• Labia are vascular but seldom damaged unless in sexual abuse cases

Internal Structures

• Ovaries: Primary reproductive organ, produce ovum
• Fallopian Tubes: Connect ovary to uterus
• Uterus: Muscular organ for fetal growth
• Cervix: Opens into the vagina
• Vagina: Outermost cavity, part of birth canal

Menstrual Cycle

• Menarche: Onset of menstruation, occurs around age 11-16
• Menopause: End of menstrual activity, around age 50
• Ovulation and menstruation cycle driven by hormones from ovaries
• Fertilization begins in the vagina, sperm fertilizes ovum in fallopian tube
• If not fertilized, ovum and uterine lining are expelled as menstruation

Pathophysiology

Gynecologic Emergencies

• Causes range from STDs to trauma
• Recognize and manage abdominal/pelvic pain
• Potential life-threatening conditions to consider

Pelvic Inflammatory Disease (PID)

• Infection of upper reproductive organs in sexually active women
• Can lead to ectopic pregnancy or sterility
• Signs: Lower abdominal pain, abnormal discharge, fever, nausea
• Risk Factors: Multiple partners, untreated STDs, douching

Sexually Transmitted Diseases (STDs)

• Chlamydia: Most common STD, can lead to PID, mild symptoms like pain and discharge
• Bacterial Vaginosis: Overgrowth of bacteria, fishy discharge, risk of premature birth
• Gonorrhea: Infects warm, moist areas, symptoms more severe in men

Vaginal Bleeding

• Causes: Abnormal menstruation, trauma, ectopic pregnancy, miscarriage
• Internal bleeding from polyps/cancer may be painless but serious
• Must evaluate all vaginal bleeding seriously

Patient Assessment

Scene Size-Up

• Safety, patient count, mechanism of injury
• Evaluate scene for signs of struggle or substance use
• Involve law enforcement if assault is suspected

Primary Assessment

• Determine if condition is stable or unstable
• Assess airway, breathing, circulation
• Recognize signs of shock, such as weak pulse or pale skin

History Taking

• Ask about onset, duration, quality of symptoms
• Inquire about menstrual history, possibility of pregnancy or STDs
• Maintain privacy and sensitivity

Secondary Assessment

• Limited examination, focus on vital signs and patient's complaints
• Respect patient's privacy, keep personnel minimal

Emergency Medical Care

Sexual Assault Considerations

• Preserve evidence, document accurately
• Provide emotional support and reassurance
• Involve female EMT if possible
• Avoid interrogation, focus on medical and psychological care

General Treatment

• Manage shock symptoms with oxygen, warmth, and supine positioning
• Document interventions and patient conditions carefully

Special Populations

• Women >65 years may have gynecologic issues even past childbearing age
• Consider hormone therapy, cancer risk, aging-related changes
• Thorough assessment and treatment of immediate needs essential

Summary

• Gynecologic emergencies require sensitivity, thorough assessment, and proper treatment
• Understanding anatomy, pathophysiology, and appropriate medical response is crucial
• Handling sexual assault cases with care and professionalism is critical for victim support and evidence preservation