Ch 23: Gynecologic Emergencies

Discuss the assessment and management of a pt who is experiencing a gynecologic emergency; include a discussion of specific assessment findings pg 832-835

-Determine if condition is un/stable. -AVPU -ABCs -Take pt's CC -Take personal/private history info discretely, professionally. -Obtain SAMPLE -Detailed exam including: vitals, abdomen, genitourinary, neurologic. -Little prehospital care can be done, transport and take care of ABCs

Discuss the assessment and management of a pt who has been sexually assaulted or raped; include the additional steps EMTs must take on behalf of the pt pg 837-839

-Maintain pt's privacy as much as possible. If in a public place, consider moving to ambulance. -Determining cause of bleeding is less important than treating shock and transport. -Women may use sanitary pads to control bleeding before EMS arrives; continue that approach, bring pads with you to determine blood loss. -External genitals have rich nerve supply; makes injuries very painful. -Treat external lacerations with moist, sterile compressions; use local pressure to control bleeding. Use diaper-type bandage to hold dressings in place. Do not pack or place dressings IN vagina.

Discuss the special considerations and precautions EMTs must observe when arriving at the scene of a suspected case of sexual assault or rape pg 837-838

1 in 3 women will be raped in her lifetime. 1 in 4 women will be sexually molested. EMTs treating victims face a lot of complex issues. May be the first person victim contacts after encounter. How EMT handles situation has lasting effects for pt and you. Perform pt assessment, other injuries are possible. Expect police involvement. Attempts to gather details from victim may cause her to shut down. If pt prefers, consider care by female EMT. Focus of EMT: provide medical treatment of pt. offer psychological care of pt, preserve evidence, ask pt not to clean herself, take history, transport to hospital designated as capable of performing forensic sexual assault exams, produce PCR.

Explain the general management of a pt who is experiencing a gynecologic emergency in relation to privacy and communication pg 833-835

Be discrete, professional and nonjudgemental. Be supportive and treat for what you can.

Give examples of the PPE EMTs should use when treating pts with gynecologic emergencies pg 836

Gynecological emergencies may involve significant blood and body fluids. PPE including gloves, mask, goggles, and gown should be considered.

Discuss the special, age-related pt management considerations EMTs should provide for both younger and older female pts who are experiencing gynecologic emergencies pg 830-831

Onset of puberty can be emotionally and physically disturbing. Cramps can be misinterpreted by young woman who has not experienced them before. Approach this pt in a professional manner. Empathize concerns, provide transport to ease concerns and also rule out other possible conditions. Menopause is complicated. Older women going through menopause may still become pregnant at this point. Treat with compassion, transport for examination to see if something else is going on.

Describe the anatomy and physiology of the female reproductive system; include the developmental changes that occur during puberty pg 829-830

Ovaries: Primary reproductive organ. Contains thousands of follicles that contain one ovum (egg) each. Ovum is released from alternating ovary each month (ovulation). Ovulation occurs approx 2 weeks prior to menstruation. Fallopian tubes: Connect ovary with uterus. Primary site of fertilization. Fertilized egg continues to uterus where it continues to develop into embryo. Uterus: Womb. Muscular organ where fetus grows. Narrowest part is cervix ("neck"). Responsible for contractions during labor. Helps to push infant through birth canal. If egg is not fertilized within about 14 days of ovulation, uterus sheds lining and menstruation occurs. Cervix: "Neck" of uterus, connecting to vagina. Vagina: Outermost cavity of reproductive system. Lower birth canal. sperm deposited from penis; passes through cervix to uterus, and up fallopian tubes. Genitalia: Vaginal opening, urethra, labia majora, labia minora, clitoris, perineum (skin between anus and bottom of vagina). Breasts: Produce milk, carried through ducts to nipple to nourish infant once born. Signs of pregnancy can be found in breasts; increased size, tenderness. Puberty: Onset of ovulation and menstruation. Called menarche. Occurs between ages 11-16. Women continue ovulation and menstruation until menopause around age 50.

List three common examples of gynecologic emergencies; include the causes, risk factors, assessment findings, and pt management considerations pg 831-832

PID: Pelvic inflammatory disease. Infection of upper reproductive organs. Occurs almost exclusively in sexually active women. Can result in ectopic pregnancy or sterility. Most common sign is generalized lower abdominal pain. PID shuffle (walking in a way that doesn't hurt). Nonemergency transport is usually recommended. STI: Can lead to more serious conditions (PID). Chlamydia is common STI, effecting around 2.8 million annually. Usually mild or absent symptoms. Can spread to rectum and progress as PID. Bacterial vaginosis: most common conditions to afflict women. Normal bacteria in vagina are replaced by overgrowth of other bacteria. Left untreated, it can progress to premature/low birth weight in pregnancy; PID. Gonorrhea: Grows and multiplies rapidly in warm, moist areas of reproductive tract; cervix, uterus, fallopian tubes in women; urethra in men and women. If untreated, can enter bloodstream and spread to other parts of the body. Vaginal Bleeding: Bleeding may be considered menstrual bleeding even though it is not. Possible causes include: abnormal menstruation, vaginal trauma, ectopic pregnancy, spontaneous abortion, cervical polyps, cancer. Transport to hospital for thorough exam.