Transcript Document

Chapter 13
Gynecology
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 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., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Anatomy and
Physiology
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Anatomy and Physiology of the
Female Reproductive Organs
External Genitalia
Internal Genitalia
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
External Genitalia (1 of 2)
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 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., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Internal Genitalia (1 of 2)
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 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., Paramedic Care Principles & Practice Volume 3: Medical
© 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., Paramedic Care Principles & Practice Volume 3: Medical
© 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., Paramedic Care Principles & Practice Volume 3: Medical
© 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., Paramedic Care Principles & Practice Volume 3: Medical
© 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., Paramedic Care Principles & Practice Volume 3: Medical
© 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., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
The Menstrual Phase
The Menstrual Cycle
Premenstrual Syndrome
Menopause
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Assessment of the
Gynecological Patient
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 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., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 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., Paramedic Care Principles & Practice Volume 3: Medical
© 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., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Specific Gynecological
Emergencies
Medical and Trauma
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Medical Gynecological
Emergencies
Gynecological Abdominal Pain
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–
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–
–
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Pelvic Inflammatory Disease
Ruptured Ovarian Cyst
Cystitis
Mittelschmerz
Endometriosis
Ectopic Pregnancy
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Management of Gynecological
Abdominal Pain
Make the patient comfortable and
transport.
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Vaginal Bleeding
Nontraumatic
– Menorrhagia
– Spontaneous Abortion
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 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., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Traumatic Gynecological
Emergencies
Causes of Gynecological Trauma
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–
–
–
–
Blunt Trauma
Sexual Assault
Blunt force to Lower Abdomen
Foreign Bodies Inserted in Vagina
Abortion Attempts
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 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., Paramedic Care Principles & Practice Volume 3: Medical
© 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., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 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 exam 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., Paramedic Care Principles & Practice Volume 3: Medical
© 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., Paramedic Care Principles & Practice Volume 3: Medical
© 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
Bledsoe et al., Paramedic Care Principles & Practice Volume 3: Medical
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ