Bledsoe et al., Essentials of Paramedic Care: Division 1V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Division 4 Medical Emergencies

Bledsoe et al., Essentials of Paramedic Care: Division 1V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Chapter 39 Gynecology

Bledsoe et al., Essentials of Paramedic Care: Division 1V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Topics Anatomy and Physiology of the Female Reproductive Organs The Menstrual Cycle Assessment of the Gynecological Patient Management of Gynecological Emergencies Specific Gynecological Emergencies

Bledsoe et al., Essentials of Paramedic Care: Division 1V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Anatomy and Physiology of the Female Reproductive Organs External Genitalia Internal Genitalia

Bledsoe et al., Essentials of Paramedic Care: Division 1V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ External Genitalia (1 of 2)

Bledsoe et al., Essentials of Paramedic Care: Division 1V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ External Genitalia (2 of 2) Perineum –Muscular tissue that separates the vagina and the anus Mons Pubis –Fatty layer of tissue over the pubic symphysis Labia –Structures that protect the vagina and the urethra Clitoris –Vascular erectile tissue that lies anterior to the labia minora Urethra –Drains the urinary bladder

Bledsoe et al., Essentials of Paramedic Care: Division 1V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Internal Genitalia (1 of 2)

Bledsoe et al., Essentials of Paramedic Care: Division 1V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Internal Genitalia (2 of 2) Vagina –Female organ of copulation –Birth canal –Outlet for menstruation Uterus –Site of fetal development Fallopian Tubes –Transports the egg from the ovary to the uterus –Fertilization usually occurs here Ovaries –Primary female gonads

Bledsoe et al., Essentials of Paramedic Care: Division 1V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ The Menstrual Cycle Monthly hormonal cycle, usually 28 days. Prepares the uterus to receive a fertilized egg. The onset of menses, known as menarche, usually occurs between the ages of 10 and 14.

Bledsoe et al., Essentials of Paramedic Care: Division 1V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Phases of the Menstrual Cycle The Proliferative Phase The Secretory Phase The Ischemic Phase The Menstrual Phase

Bledsoe et al., Essentials of Paramedic Care: Division 1V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Proliferative Phase This is the first two weeks of the menstrual cycle. Estrogen causes the uterine lining to thicken and become engorged with blood. Secretion of LH day 14: ovulation takes place. If the egg is not fertilized, menstruation takes place. If the egg is fertilized, the corpus luteum produces progesterone until the placenta takes over. Cilia sweep the egg toward the uterus. A fertilized egg normally implants in the lining of the uterus. If the egg is not fertilized, it is expelled from the uterine cavity.

Bledsoe et al., Essentials of Paramedic Care: Division 1V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Secretory Phase The secretory phase is referred to as ovulation. Progesterone increases and estrogen drops if the egg is not fertilized. The uterus becomes more vascular in preparation for implantation of a fertilized egg.

Bledsoe et al., Essentials of Paramedic Care: Division 1V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ The Ischemic Phase Estrogen and progesterone levels fall without fertilization. The endometrium breaks down.

Bledsoe et al., Essentials of Paramedic Care: Division 1V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ The Menstrual Phase The Menstrual Cycle Premenstrual Syndrome Menopause

Bledsoe et al., Essentials of Paramedic Care: Division 1V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Assessment of the Gynecological Patient

Bledsoe et al., Essentials of Paramedic Care: Division 1V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ History Initial Assessment—SAMPLE. Does the patient complain of pain? Use OPQRST. –Dysmenorrhea/dyspareunia Associated signs or symptoms. Has she ever been pregnant? –Gravida/parity/abortion Document last menstrual cycle. Medications—contraceptives.

Bledsoe et al., Essentials of Paramedic Care: Division 1V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Bledsoe et al., Essentials of Paramedic Care: Division 1V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Physical Exam Respect patient’s privacy. Be professional. Explain procedures. Observe patient. Check vital signs. Assess bleeding or discharge: Do not perform an internal vaginal exam in the field. Abdominal examination.

Bledsoe et al., Essentials of Paramedic Care: Division 1V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Management of Gynecological Emergencies General management of gynecological emergencies is focused on supportive care. Do not pack dressings in the vagina.

Bledsoe et al., Essentials of Paramedic Care: Division 1V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Specific Gynecological Emergencies Medical and Trauma

Bledsoe et al., Essentials of Paramedic Care: Division 1V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Medical Gynecological Emergencies Gynecological abdominal pain –Pelvic inflammatory disease –Ruptured ovarian cyst –Cystitis –Mittelschmerz –Endometriosis –Ectopic pregnancy

Bledsoe et al., Essentials of Paramedic Care: Division 1V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Management of Gynecological Abdominal Pain Make the patient comfortable and transport.

Bledsoe et al., Essentials of Paramedic Care: Division 1V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Vaginal Bleeding Nontraumatic –Menorrhagia –Spontaneous abortion

Bledsoe et al., Essentials of Paramedic Care: Division 1V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Treatment for Vaginal Bleeding Do not pack vagina. Transport. Initiate oxygen and IV access based on patient condition.

Bledsoe et al., Essentials of Paramedic Care: Division 1V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Traumatic Gynecological Emergencies Causes of gynecological trauma –Blunt trauma –Sexual assault –Blunt force to lower abdomen –Foreign bodies inserted in vagina –Abortion attempts

Bledsoe et al., Essentials of Paramedic Care: Division 1V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Management of Gynecological Trauma Apply direct pressure over laceration. Apply cold pack to hematoma. Establish IV if patient is severe. Transport.

Bledsoe et al., Essentials of Paramedic Care: Division 1V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Sexual Assault Do not ask specific details of a sexual assault. Do not examine the external genitalia of a sexual assault victim unless there is a life-threatening hemorrhage.

Bledsoe et al., Essentials of Paramedic Care: Division 1V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

Bledsoe et al., Essentials of Paramedic Care: Division 1V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Management Protect the scene. Handle clothing as little as possible. If removing clothing, bag each item separately. Do not cut through any tears or holes in clothing. Place bloody articles in brown paper bags. Do not examine the perineal area. Do not allow patient to change clothes, bathe, or douche. Do not allow patient to comb hair, brush teeth, or clean fingernails. Do not clean wounds, if possible.

Bledsoe et al., Essentials of Paramedic Care: Division 1V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Documentation State patient remarks accurately. Objectively state your observations of patient’s physical condition, environment, or torn clothing. Document evidence turned over to hospital staff. Do NOT include your opinions as to whether rape occurred.

Bledsoe et al., Essentials of Paramedic Care: Division 1V © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Summary Anatomy and Physiology of the Female Reproductive Organs The Menstrual Cycle Assessment of the Gynecological Patient Management of Gynecological Emergencies Specific Gynecological Emergencies