hello class and welcome to chapter 24 gynecologic emergencies of the emergency care and transportation of the sick and injured 12th edition after you complete this chapter and the related coursework you will understand the anatomy and physiology including the developmental changes during puberty and menopause of the female reproductive system and identify and describe assessment and treatment for gynecologic emergencies special considerations and precautions that an EMT must observe when arriving at the scene of a suspected case of sexual assault and raped are also discussed okay so women are amazing and we are uniquely designed to conceive and give birth but women are susceptible to problems that men do not occur okay so let's talk about the anatomy and physiology first the female reproductive system includes internal and external structures and the internal female genitalia is the vaginal opening the labia the clitorus and the perum okay so this uh figure on the slide it shows the external female genitalia the internal structures are the ovaries and they lie on each side of the lower abdomen and produce an ovm which is the egg then you have the Fallopian tubes they connect each ovary to the uterus the uterus is the muscular organ that the fetus grows during pregnancy and the narrowest part of the uterus is the cervix and that's that uh opening of um of the uterus and it and it goes down and opens into the vagina okay the vagina is the outermost cavity of the woman's reproductive system and then on this slide there's a figure and it shows the internal female genitalia when a female reaches puberty she begins to ovulate and experience menstration so Monarch that is the onset of menstruation and it usually occurs between ages 11 and 16 any female who reaches Monarch is capable of becoming pregnant women continue the cycle of ovulation and menstruation until they reach menopause and the end of the menstrual activity usually occurs around 50 years old each month one ovom is released into the fian tubes and that's called ovulation the process of fertil begins fertilization begins in the vagina sperm is deposited into the vagina from the M penis and the sperm passes through the cervix into the uterus and eventually up into the floian tubes the floian tubes is where the ovom is fertilized the embryo then travels to the uterus and attaches to the uterine wall and continues to grow if fertilization does not occur within about 14 days of ovulation the lining of the uterus begins to separate and menstration occurs female hormones produced primarily in the ovaries control the process of ovulation and menstration so let's talk a little bit about the pathopysiology ology okay the causes of gynecologic emergencies vary ranging from sexually transmitted diseases to trauma the first one we're going to talk about is pelvic inflammatory disease and that's Pi that's an infection of the upper organs of the reproductive system okay it occurs almost exclusively in sexually active women infection expands to the fallopian tubes it will um and can cause some scarring and that can result in increased risk of eoic pregnancy or sterility if infection expands to the ovaries it can lead to a development of lifethreatening abscesses most common presenting sign of PID is generalized lower abdominal pain other signs include abnormal or foul foul smelling vaginal discharge increased pain with intercourse fever General malaise and nause and vomiting risk factors for PID include multiple sexual partners or a partner who has had multiple sexual partners untreated sexual transmitted diseases a history of PID being sexually active younger than 26 years of age douching or using an IUD for birth control so after pelv inflamate dis disas we're going to talk about STDs and that's sexually transmitted diseases STDs can lead to more serious conditions such as PID chlamidia uh is the first one we're going to talk about and that's the most common STD in the US it's usually milder absent symptoms the infection of the cervix can spread to the rectum and can progress to PID bacterial vaginosis this is most common infection to um afflict women between 15 and 44 untreated it can lead to premature birth or low birth weight in cases of pregnancy make the patient more it can make the patient more susceptible to other serious infections and cause pelvic inflammatory disease and then there's gonorrhea caused by bacteria that grow and multiply in warm moist areas of the reproductive tract the cervix uterus and Fallopian tubes in women and the urethra in men and women severe infections present with cramping abdominal pain nausea vomiting and bleeding between periods untreated it can enter the bloodstream and spread to other body parts including the brain okay so now let's talk about an overall umbrella of the abdominal or vaginal bleeding possible causes include abnormal menstration vaginal trauma a topic pregnancy an a spontaneous abortion or polyps or cancer so next let's get into the patient assessment so we're going to just follow down through the patient assessment form and first thing you want to do is obtain an accurate and detailed assessment it's critical in dealing with gynecological issues so scene safety is the scene safe do you need assistance and how many patients do you have what's the nature of the illness and have you taken standard precautions those are questions you're going to ask on every call you're going to okay gynecologic emergencies can involve large amounts of blood and body fluids potentially contaminated with organisms that can cause communicable diseases so where or in what position did you find the patient if she's at home what is the condition of the residence if it's a crime scene you may be required to testify in court regarding conditions on your arrival so documentation needs to be accurate accurate and thorough involve the police if any type of assault is suspected and in cases of sexual assault it is important to have a female EMT provide patient care mechanism of injury so thei the Moi in some patients with gynecologic problems may be easily understood from the dispatch information such as a sexual res assault in other patients patient history may reveal the nature of the condition next we're into the primary assessment and that's when we form that general impression so is the patient stable or unstable use the avpo scale to determine the patient's level of Consciousness so alert verbal painful or unresponsive always evaluate the airway and breathing immediately to ensure they are adequate okay then palpate the pulse and evaluate skin color temperature and moisture to help identify blood loss in a patient most cases of a gynecologic emergency are not life-threatening if patient has signs and signs of shock transport uh is warranted next into the history taking right so we're going to investigate that Chief complaint and some questions may be extremely personal to the patient so be sensitive to the patient's feelings and protect her privacy and dignity for abdominal pain ask about the onset duration quality rate radiation provoking and relieving factors so those opqrst questions are are very big deal um with this type of um of signs and symptoms so in Associated symptoms such as Syncopy have they passed out have they had been laded or nausea vomiting or fever okay for vaginal bleeding ask then after the opqrst questions you know you're going to do your sample history so you want to ask about birth control pills and devices also ask a patient about medical conditions and the last the date of that last menstrual period okay secondary assessment so this is when we're going to focus in on the um the area of the chief complaint so pertinent secondary assessment finding should include we want to make sure we do the vital signs the abdomen is it distended or Tender and then is there visible bleeding or how is the mental status and then physical exams it should be limited and professional only exam in the genitalia if it is necessary to do so to treat the patient patients age 65 and older may have concerns related to hormone replacement therapy cancer pelvic floor collapse or urinary incontinence for vaginal bleeding visualize the bleeding and ask about the quality and quantity observe for vaginal discharge so fever nausea and vomiting are considered uh specific in gynecologic emergencies or significant okay so Syncopy is considered significant as well and treat as if they're in shock until proven otherwise when it comes to assessing the patients's vital signs of course we're going to do the heart rate Rhythm and quality respiratory rate Rhythm and quality skin color temp condition you want to do the cap refill time blood pressure and then consider obtaining orthostatic um vital signs if bleeding is known or suspected okay reassessment of course we're going to repeat the primary and then there are very few interventions of course with that gynecologic emergency so communicate all relevant information to the staff of the Receiving Hospital and including the possibility if the patient could be pregnant okay now emergency care for these cases um the biggest thing with Emergency Care is you want to maintain the patient's privacy as much as you can if in public um we want to get them to the back of the ambulance or some place private okay have the female empt participate in patient care if possible that cannot be stated enough now when it comes to excessive internal vaginal bleeding we want to use sanitary pads on the external genitalia to absorb the blood you need to document the number of pads that were saturated with blood okay in the external genitalia they have a rich nerve Supply so this makes injuries uh very painful treat external lacerations abrasions or tears with steril compresses under no circumstances should you pack or place dressings in the vagina when it comes to assessment and management of specific conditions first we're going to talk about PID pelvic inflam atory disease so a patient with P will complain of abdominal pain pain usually starts during an after normal menstration the pain may be worse by walking and so patients often present with this uh distinctive gate they appear to shuffle so prehospital treatment is limited non-emergency transport is usually recommended and sexual assaults so sexual assaults and rape are common in the United States States one in five women have reported being raped and one in three will be sexually molested often before the ages of 12 EMTs called on to treat a Vic of a victim of sexual assault face many complex issues so issues range from obvious medical ones to Serious psychological and legal issues you may be the first person the victim has come in contact with after the encounter professionalism tacted kindness and sens sensitivity are important when performing your assessment be aware of drugs used during sexual assault and rape to incapacitated a person if possible give the patient the option of being treated by a female EMT your focus should be on medical treatment of the patient psychological care of the patient and your ability to preserve the evidence it may be necessary to persuade the patient not to clean themselves after the call um the local Rape Crisis Center for the patient so offer to call uh if the take the patients's history and limit any physical exam to a brief survey for life-threatening injuries the table on this uh slide shows treatment principles for victims of sexual assault okay so that concludes uh chapter 24 the gynecologic emergencies it's a really short chapter um and next we're just going to go over some of the the key things that we've learned today okay so what is the narrowest portion of the uterus and we know the narrowest portion that opens when giving birth of course is that's the cervix cervix is the narrowest portion what is the outermost cavity of the woman's reproductive system and we we know that that is the vagina okay the vagina is the outermost cavity if fertilization has not occurred within about how many days following ovulation how many days we know that that is 14 right so women menstrate about 14 days following ovulation the onset of menstration is called and we know that's Monarch about 11 to 16 years old which of the following can cause vaginal bleeding all right well looks like it's all of the above what what is the most common presenting sign of a PID and that's lower abdominal pain that's the most common sign when obtaining a sample history which of the following pieces of information is important to obtain this looks like it's another all of the above what is the emt's first priority when dealing with a patient experiencing excessive of vaginal bleeding so the very first thing of course we want to treat uh treat for shock and transport that's always our primary right so treat treat and uh transport which of the following drugs are commonly used to facilitate an assault and so we didn't talk too much about this but it's going to be ruol so that's that's considered the date rap drug ruol is a sedative okay and finally number 10 you should encourage you should discourage a rape or sexual assault victim from doing which um and that's of course all of the above again we um we need to preserve the evidence okay thank you for joining us for this short little chapter on the gynecologic emergencies chapter 24 if you like this video or lecture go ahead and subscribe to the channel because we're going to be completing the whole book very soon okay thanks have a great one