Chapter 25
Gynecological
Emergencies
Copyright (c) The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
25-1
Objectives
25-2
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
– Sweating
– Increased heart rate
– Nausea, vomiting
– Pain during
intercourse
– Pain that worsens
with coughing or
urination
– Fainting
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.
25-10
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.
25-15
Ectopic Pregnancy
[Insert figure 25-6]
25-16
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.
25-21
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