EMT Chapter 23 - Gynecologic Emergencies

An old medical axiom states,

*"Anyone who neglects to consider a gynecologic cause in a woman of childbearing age who reports abdominal pain will miss the diagnosis at least 50% of the time."*

*Drugs such as Rohypnol (flunitrazepam), known as "roofies"; GHB (gamma-hydroxybutyric acid), known as "Liquid Ecstasy"; Ketalar (ketamine), known as "Special K"; Klonopin (clonazepam); MDMA, known as "Ecstasy"; Xanax (alprazolam); and alcohol are drugs typically used during sexual assault and rape for the intended purpose of incapacitating a person.*

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*The genitals have a rich nerve supply, making injuries very painful. Treat any external lacerations, abrasions, and tears with sterile compresses, using >>local pressure to control bleeding and a diaper-type bandage to hold the dressings in place.<<*

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gonorrhea

A sexually transmitted disease caused by *Neisseria gonorrhoeae.* - occurs in moist areas of the reproductive tract: the cervix, uterus, and fallopian tubes in women and in the urethra in women and men. - symptoms: painful urination, burning or itching; a yellowish or bloody vaginal discharge, foul odor; and blood associated with vaginal sexual intercourse. - If infection is not treated, the bacterium may enter the bloodstream and spread to other parts of the body, including the brain.

chlamydia

A sexually transmitted disease caused by the bacterium *Chlamydia trachomatis.* - some women may report lower abdominal pain, low back pain, nausea, fever, pain during sexual intercourse, and/or bleeding between menstrual period - In rare cases, chlamydia causes arthritis that may be accompanied by skin lesions and inflammation of the eye and urethra.

sexual assault

An attack against a person that is sexual in nature, the most common of which is rape.

pelvic inflammatory disease (PID)

An infection of the fallopian tubes and the surrounding tissues of the pelvis. - the uterus, ovaries, and fallopian tubes—occurs almost exclusively in sexually active women.

bacterial vaginosis

An overgrowth of bacteria in the vagina; characterized by itching, burning, or pain, and possibly a "fishy" smelling discharge. - most common vaginal infection in women age 15 to 44 - can result in PID

labia minora

Inner fleshy "lips" devoid of pubic hair that protect the vagina.

labia majora

Outer fleshy "lips" covered with pubic hair that protect the vagina.

Safety Tips

Remember that many sexually transmitted diseases can also be transmitted by contact with blood. Some examples of these diseases include syphilis, many types of hepatitis, and human immunodeficiency virus (HIV).

rape

Sexual intercourse forcibly inflicted on another person, against that person's will.

perineum

The area of skin between the vagina and the anus.

cervix

The lower third, or neck, of the uterus.

uterus

The muscular organ where the fetus grows, also called the womb; responsible for contractions during labor.

vagina

The outermost cavity of a woman's reproductive tract; the lower part of the birth canal.

ovaries

The primary female reproductive organs that produce an ovum, or egg, that, if fertilized, will develop into a fetus.

ovulation

The process in which an ovum is released from a follicle.

fallopian tubes

The tubes that connect each ovary with the uterus and are the primary location for fertilization of the ovum.

Whenever possible, a female sexual assault victim should be: a) given the option of being treated by a female EMT. b) encouraged to take a shower and change her clothes. c) thoroughly assessed, even if no signs of injury exist. d) asked to provide a brief description of the perpetrator.

a) given the option of being treated by a female EMT.

If a woman with vaginal bleeding reports syncope, the EMT should assume that she: a) is pregnant. b) is in shock. c) has an infection. d) has an ectopic pregnancy.

b) is in shock.

Which of the following processes occurs during ovulation? a) Certain female hormone levels decrease significantly in quantity. b) The endometrium sheds its lining and is expelled from the vagina. c) The inner lining of the uterus thickens in preparation for implantation. d) Numerous follicles mature and release eggs into the fallopian tubes.

c) The inner lining of the uterus thickens in preparation for implantation.

A 26-year-old female presents with heavy vaginal bleeding. She is conscious, but restless. Her blood pressure is 84/54 mm Hg, her pulse is 120 beats/min and weak, and her respirations are 22 breaths/min with adequate depth. She tells you that she inserted a tampon about 2 hours ago. You should: a) administer high-flow oxygen, ask her to remove the tampon, perform a detailed secondary assessment, and transport promptly. b) administer high-flow oxygen, perform a detailed assessment of her vaginal area for signs of trauma, place her on her side, and transport. c) administer high-flow oxygen, place a sterile pad over her vagina, keep her warm, elevate her lower extremities, and transport without delay. d) assist her ventilations with a bag-valve mask, place one sterile dressing into her vagina, perform a rapid secondary assessment, and transport.

c) administer high-flow oxygen, place a sterile pad over her vagina, keep her warm, elevate her lower extremities, and transport without delay.

When caring for a woman who is experiencing a gynecologic emergency, the EMT's main focus should be to: a) determine the underlying cause of her problem. b) ask questions related to her gynecologic history. c) maintain her ABCs and transport without delay. d) keep assessment and treatment to a minimum.

c) maintain her ABCs and transport without delay.

Pelvic inflammatory disease (PID) typically does NOT affect the: a) uterus. b) ovaries. c) urinary bladder. d) fallopian tubes.

c) urinary bladder.

Which of the following infections, when left untreated, may lead to infection of the blood and brain? a) Pelvic inflammatory disease b) Chlamydia c) Bacterial vaginosis d) Gonorrhea

d) Gonorrhea

The vagina and the neck of the uterus comprise the: a) womb. b) cervix. c) fundus. d) birth canal.

d) birth canal.

The most common presenting sign of pelvic inflammatory disease is: a) vaginal discharge. b) fever. c) nausea and vomiting. d) lower abdominal pain.

d) lower abdominal pain.