Copyright (c) The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 25 Gynecological Emergencies

25-2 Objectives

Review of the Female Reproductive System 25-3

Female Anatomy and Physiology 25-4

Female Anatomy and Physiology Vagina –Birth canal Perineum –Area between vaginal opening and anus 25-5

Assessment of the Gynecological Patient 25-6

Gynecological Emergencies SAMPLE history 25-7

Gynecological Emergencies Common assessment findings and symptoms –Abdominal pain –Abdominal tenderness –Vaginal discharge –Abnormal vaginal bleeding –Fever, chills –Fainting –Sweating –Increased heart rate –Nausea, vomiting –Pain during intercourse –Pain that worsens with coughing or urination 25-8

Physical Examination Be certain to explain what you are about to do and why it must be done. Remember to properly drape or shield an unclothed patient from the stares of others. Conduct the examination professionally and efficiently. Talk with your patient throughout the procedure. 25-9

Physical Examination Do not visually inspect the vaginal area unless major bleeding is present or you anticipate that childbirth is about to occur. Have another healthcare professional or law enforcement officer present. If possible, include a female attendant or rescuer in your examination

Emergency Care Standard precautions Give oxygen Treat for shock, if indicated Keep patient warm Apply external sanitary napkins as necessary –Take blood-soaked garments and pads with patient to hospital 25-11

Nontraumatic Gynecological Emergencies 25-12

Pelvic Inflammatory Disease (PID) Infection of the uterus, fallopian tubes, and other female reproductive organs Usually caused by sexually transmitted bacteria If untreated, can lead to septic shock and infertility 25-13

Pelvic Inflammatory Disease Assessment findings and symptoms –Lower abdominal pain –Fever –Vaginal discharge –Painful intercourse –Painful urination –Increased heart rate –Normal or slightly elevated blood pressure 25-14

Pelvic Inflammatory Disease Allow the patient to assume a position of comfort. Document any vaginal discharge including the color, odor, and amount. Transport for physician evaluation. Reassess as often as indicated. Record all patient care information on a prehospital care report

Ectopic Pregnancy [Insert figure 25-6]

Ectopic Pregnancy If rupture occurs: –Patient may experience sudden, severe pain on one side of the lower abdomen –Vaginal bleeding may or may not be present –Patient may feel faint or actually faint –Patient may complain of severe pain in the back of the shoulder (referred pain) –Patient may have severe internal bleeding –Patient may exhibit signs of shock 25-17

Emergency Care Medical emergency! Prepare for immediate transport Keep on scene time to a minimum Give oxygen by nonrebreather mask Assess and treat for shock Keep the patient warm Provide emotional support for the patient and family 25-18

Ovarian Cyst A fluid-filled sac that develops on or within an ovary The most common type of ovarian cyst forms during the menstrual cycle 25-19

Ovarian Cyst Assessment findings and symptoms –Lower abdominal or pelvic pain –Irregular menstrual periods –Dull ache in the lower back and thighs –Faintness, dizziness, or weakness –Lower abdominal or pelvic pressure or fullness –Pelvic pain after strenuous exercise or sexual intercourse –Weight gain –Pain or pressure with urination or bowel movements –Difficulty passing urine completely –Nausea and vomiting 25-20

Ovarian Cyst Provide supportive care Allow the patient to assume a position of comfort. Transport for physician evaluation. Reassess as often as indicated. Record all patient care information on a prehospital care report

Traumatic Gynecological Emergencies 25-22

Traumatic Gynecological Emergencies Possible causes –Bicycle injuries –Blows –Foreign body insertion –Childbirth lacerations –Sexual assault 25-23

Traumatic Gynecological Emergencies Standard precautions Give oxygen Control bleeding with local pressure to area Treat for shock, if indicated Provide reassurance and privacy 25-24

Apparent Sexual Assault Standard precautions When possible, ask EMT of same gender to assess patient Maintain nonjudgmental attitude Protect crime scene Careful documentation Discourage patient from bathing, etc. Bag patient’s clothing separately in paper (not plastic) bags 25-25

Questions? 25-26