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Gynecologic Emergencies Overview and Care

Sep 4, 2024

Chapter 24: Gynecologic Emergencies

Overview

  • Focus: Anatomy, physiology, assessment, and treatment of gynecologic emergencies.
  • Special Considerations: EMT precautions in cases of sexual assault and rape.

Anatomy and Physiology

  • Female Reproductive System Components:
    • Internal: Ovaries, fallopian tubes, uterus, cervix, vagina.
    • External: Vaginal opening, labia, clitoris, perineum.
  • Developmental Changes:
    • Puberty: Onset marked by menstruation (menarche, ages 11-16).
    • Menopause: End of menstrual activity (~50 years old).
  • Reproductive Process:
    • Ovulation: Release of ovum into fallopian tubes.
    • Fertilization: Occurs in fallopian tubes, embryo implants in uterus.
    • Menstruation: Uterine lining sheds if no fertilization occurs.

Pathophysiology

  • Gynecologic Emergencies Causes:
    • Sexually transmitted diseases (STDs)
    • Trauma

Pelvic Inflammatory Disease (PID)

  • Description: Infection of upper organs of the reproductive system.
  • Risks: Scarring leading to ectopic pregnancy or sterility.
  • Symptoms: Lower abdominal pain, abnormal discharge, pain during intercourse, fever, malaise, nausea, vomiting.
  • Risk Factors: Multiple partners, untreated STDs, douching, IUD use.

Sexually Transmitted Diseases (STDs)

  • Chlamydia: Most common in the U.S., often mild or asymptomatic.
  • Bacterial Vaginosis: Common in ages 15-44, can lead to PID and complications in pregnancy.
  • Gonorrhea: Affects reproductive tract, severe infections spread to the bloodstream.

Abdominal or Vaginal Bleeding

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

Patient Assessment

  • Initial Steps:
    • Scene safety, standard precautions, assess the number and condition of patients.
  • Primary Assessment:
    • Evaluate airway, breathing, circulation.
    • Check for signs of shock.
  • History Taking:
    • Chief complaint, OPQRST for symptoms, SAMPLE history.
    • Inquire about last menstrual period, contraceptive use.
  • Secondary Assessment:
    • Vital signs, abdominal examination, visible bleeding.
    • Limit physical exams to necessary areas.

Emergency Care

  • General Care:
    • Maintain privacy, involve female EMT if possible.
  • For Excessive Bleeding:
    • Use sanitary pads, document blood loss, do not pack dressings internally.

Specific Conditions

  • Pelvic Inflammatory Disease:
    • Symptoms: Pain worsened by walking, distinctive gait.
    • Treatment: Non-emergency transport often recommended.

Sexual Assault

  • Statistics: 1 in 5 women raped, 1 in 3 sexually molested.
  • EMT Role: Medical treatment, preserve evidence, psychological support.
  • Legal Concerns: Document findings, provide a victim-centered approach.

Quiz Review

  • Key points include cervix as narrowest part of the uterus, vagina as outermost cavity, and menarche marking menstruation onset.
  • Drugs Used in Assault: Rohypnol (date rape drug).
  • Preservation of Evidence: Discourage cleaning or changing clothes to preserve forensic evidence.

Conclusion

  • Emphasized privacy, sensitivity, and thorough documentation in gynecologic emergencies.
  • Encouraged continued learning through entire course material.

Full transcript