Chapter 24: Gynecologic Emergencies

Overview

This chapter covers the anatomy and physiology of the female reproductive system, assessment and treatment of gynecologic emergencies, special considerations for EMTs, and precautions in cases of sexual assault and rape.

Female Reproductive System

• Internal and External Structures:

  • External Genitalia: Vaginal opening, labia, clitoris, perineum.
  • Internal Structures:
    • Ovaries: Produce ovum.
    • Fallopian Tubes: Connect ovaries to the uterus.
    • Uterus: Where the fetus grows during pregnancy.
    • Cervix: Narrowest part of the uterus, opens into the vagina.
    • Vagina: Outermost cavity of the reproductive system.

• Developmental Changes: Puberty to Menopause

  • Monarch marks the onset of menstruation (ages 11-16).
  • Menopause marks the end of menstrual activity (around age 50).
  • Ovulation: Monthly release of ovum.
  • Fertilization: Sperm meets ovum in the fallopian tubes.

Pathophysiology

• Gynecologic Emergencies:

  • Causes vary from STDs to trauma.

• Pelvic Inflammatory Disease (PID):

  • Infection of upper reproductive organs, common in sexually active women.
  • Signs: Lower abdominal pain, abnormal discharge, fever, nausea.
  • Risk Factors: Multiple sexual partners, STDs, douching, IUD use.

• Sexually Transmitted Diseases (STDs):

  • Chlamydia: Most common STD, can lead to PID.
  • Bacterial Vaginosis: Affects women aged 15-44, can lead to premature birth.
  • Gonorrhea: Affects reproductive tract, severe cases can spread.

• Abdominal or Vaginal Bleeding:

  • Causes include abnormal menstruation, trauma, ectopic pregnancy, miscarriage.

Patient Assessment

• Scene Safety: Evaluate scene, take standard precautions, involve police if needed.
• Mechanism of Injury (MOI): Understand through patient history and dispatch info.
• Primary Assessment:
  • Determine patient stability.
  • Use AVPU scale for consciousness.
  • Check airway, breathing, pulse, skin condition.
• History Taking:
  • Investigate chief complaint with sensitivity.
  • Use OPQRST questions for abdominal pain.
  • Obtain SAMPLE history, including birth control and last menstrual period.
• Secondary Assessment:
  • Focus on chief complaint area.
  • Vital signs, abdomen examination, mental status.

Emergency Care

• Maintain Privacy: Use sanitary pads for bleeding, treat external injuries carefully.
• PID Treatment:
  • Non-emergency transport recommended.
  • Pain often worsens during menstruation.
• Sexual Assault Considerations:
  • Professionalism and sensitivity are crucial.
  • Focus on medical treatment, psychological care, and evidence preservation.
  • Avoid washing to preserve evidence.

Key Points Summary

• Narrowest Uterus Portion: Cervix.
• Outermost Cavity: Vagina.
• Non-fertilization Days: 14 days post-ovulation.
• Onset of Menstruation: Monarch.
• Common PID Sign: Lower abdominal pain.

Quiz Questions

• Cervix is the narrowest portion of the uterus.
• Vagina is the outermost cavity.
• Menstruation occurs 14 days post-ovulation.
• Monarch occurs between 11-16 years old.
• PID presenting sign is lower abdominal pain.
• Date rape drug: Rohypnol.
• Preserve evidence in sexual assault cases.

Conclusion

Chapter 24 covers critical aspects of gynecologic emergencies and provides necessary guidelines for EMTs to handle related situations effectively.