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Special Issues in Emergency Care and Resuscitation > GYN emergencies > Flashcards

GYN emergencies Flashcards

1
Q

gynecology

A
  • deals with diseases and routine care of female reproductive system
  • standard care
  • some emergencies
  • entwined with obstetrics
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2
Q

obstetrics

A
  • deals with birth
  • development of the fetus
  • prior the birth, during birth, and post partum
  • entwined with gynecology
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3
Q

vagina

A
  • lower portion of the birth canal

- fetus may pass through

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4
Q

ovaries

A
  • ovaries have two glands
  • there are 2 ovaries
  • each ovary contains thousands of follicles
  • ovaries at birth have all the eggs required for reproduction
  • normally one fallopian tube associated with each ovary -> connecting it to the uterus
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5
Q

uterus

A
  • muscular organ where the embryo grows

- opens into the cervix

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6
Q

the birth canal consists of the:

A
  • cervix- opening between uterus and vagina

- vagina

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7
Q

menstruation

A
  • cyclic and periodic discharge of 25-65 mL of blood, epithelial cells, mucus, and tissue
  • duration and frequency varies
  • cycle every 28-31 days is “normal”
  • cycle is affect by many things (medications, OCP, IUD, hormones)
  • the menstrual cycle is composed of phases
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8
Q

phases of menstruation

A
  • day 1-4- menstrual phase (discharge)- blood and epithelial cells
  • day 5-14- proliferative phase
  • day 14- ovulation- egg has passes from the ovary somewhere in the fallopian tube and tries to find its way to the uterus
  • day 14-28- secretory phase- waiting phase
  • you can get pregnant at any time
  • starts around 11,12,13 years of age
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9
Q

postmenopausal women

A
  • due to decreased hormone production postmenopausal women:
  • are more susceptible to diseases like osteoporosis
  • experience atrophy of genitourinary organs
  • lack of hormones/balance
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10
Q

patients assessment

A
  • obtaining an accurate and detailed patient assessment is very important
  • consider a gynecologic cause in women who complains of abdominal pain
  • protect the patients modesty -> limit the crowd
  • sometimes a witness is necessary
  • form a general impression -> assess consciousness
  • women with abdominal pain -> always think gynecological
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11
Q

asking question: primary assessment

A
  • what is the overall presentation of the patient
  • are there any obvious life threats
  • is she conscious
  • are they sick
  • does she have breathing difficulty or injury
  • in what position did you find the patient
  • how many times has she been pregnant
  • how many live births has she had
  • any complications with pregnancy
  • vaginal or cesarean deliveries
  • how much time between pregnancies
  • any miscarriages or abortions
  • any gynecologic problems
  • any known medical conditions
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12
Q

LORDS TRACHEA

A
  • Location
  • Onset
  • Radiate
  • Duration
  • Severity - wong baker faces scale (1-10)
  • Timing
  • Relieve
  • Aggravates
  • Character- description
  • Historic
  • Eaten
  • Associated details
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13
Q

gynecologic history

A
  • LMP?
  • possibility of pregnancy? -> SA
  • contraception use? (STI, pregnancy)
  • spermicides, condoms, or a diaphragm?
  • implanted devise or an IUD
  • what kind of protection
  • vaginal bleeding? how many saturated pads over a time period
  • if signs of shock are present, a fluid bolus of 100 to 200 mL should improve the status
  • vaginal discharge?
  • STI?
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14
Q

obstetric history

A
  • G (gravida)- number of times pregnant regardless of how they ended
  • P (para)- number of times delivering a newborn (vaginal or c-section)
  • A (abortive history)- number of abortions > miscarriages or elective
  • ex. G 8 P 2 -> A is 6
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15
Q

secondary assessment: abdomen exam

A
  • most common complaint is general abdominal pain in gynecology
  • examine the patients abdomen for:
  • a flat and flaccid abdomen
  • guarding of the abdomen
  • rashes or lesions
  • a symmetrical abdomen
  • an enlarged liver or spleen
  • pushing down on abdomen and there is pain -> tenderness
  • once you let go -> rebound tenderness
  • bowel sounds
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16
Q

secondary assessment: palpate the abdomen

A
  • start at the quadrant farthest from the pain
  • rigid abdomen
  • point tenderness
  • does the palpation elicit more pain
  • rebound tenderness
  • masses
  • palpate all four quadrants
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17
Q

life threatening gynecologic emergencies:

A
  • (ruptured) ectopic pregnancy (more of an OB emergency)
  • ruptured ovarian cyst
  • tubo-ovarian abscess- can lead to sepsis or peritonitis
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18
Q

pathophysiology of vaginal bleeding

A
  • dysmenorrhea- painful menses
  • primary dysmenorrhea occurs with the start of the menstrual flow, lasting 1-2 days**
  • secondary dysmenorrhea is present before, during, and after the menstrual flow** (all around that period)
  • vaginal bleeding is one of the most frequent reasons that women consult a gynecologist
  • hypermenorrhea- flow lasts longer than normal or is excessive
  • polymenorrhagia
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19
Q

polymenorrhea

A
  • flow occurs more often than a 24-28 day interval

- bleeding all throughout the cycle

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20
Q

hypermenorrhea

A

flow lasts longer than normal or is excessive

  • can be a true emergency
  • especially is anemia is there -> may need iron or blood transfusion
  • can be ectopic, ruptured cyst, placenta previa etc.
21
Q

endometritis pathophysiology

A
  • inflammation or irritation of the endometrium*
  • more likely after a baby or miscarriage
  • most likely caused by an infection
22
Q

endometritis assessment

A
  • symptoms may include:
  • malaise
  • vaginal bleeding (rarely) or discharge
  • lower abdominal or pelvic pain
  • decreased bowel sounds
  • ultrasound
23
Q

endometritis management

A
  • treat with antibiotics
  • vaginal culture
  • outpatient care
  • provide reassurance
  • transport in a comfortable position
24
Q

endometriosis pathophysiology

A
  • endometrial tissue grows outside the uterus
  • organs of the pelvic cavity are the most common locations for growths
  • can grow anywhere -> most common is pelvic cavity
  • one of the leading causes of infertility
  • seek care early
  • no real prevention
25
Q

endometriosis assessment

A
  • symptoms include:
  • pain
  • dysuria*
  • very heavy menstrual periods
  • bleeding between periods
26
Q

endometriosis management

A
  • care is based on signs/symptoms
  • can have flare ups
  • if the patient reports severe pain:
  • provide pain relief
  • use dressing or towels as needed
27
Q

pelvic inflammatory disease (PID) pathophysiology

A
  • infection of the female upper* GU organs
  • affects sexually active women most often
  • organisms enter the vagina and migrate into the uterine cavity and find a place to grow
  • risk factors:
  • IUD use- depends on the IUD, how long ago it was placed, how it was placed
  • frequent sexual activity with multiple partners
  • history of PID
28
Q

pelvic inflammatory disease (PID) assessment

A
  • abdominal pain will be present
  • during or after normal menstruation
  • typically diffuse- hard to pinpoint or describe
  • throughout entire abdominal cavity
  • be alert for signs or peritoneal cavity irritation-> peritonitis
  • PID can lead to sepsis
  • peritonitis can lead to sepsis
29
Q

vaginitis pathophysiology

A
  • inflammation of the vagina caused by infection
  • most commonly vaginal yeast infections
  • yeast population may increase if the vagina becomes less acidic
30
Q

vaginitis assessment

A
  • symptoms of yeast infections:
  • itching/burning
  • soreness
  • dysuria
  • vulvar swelling
  • thick, white vaginal discharge- odor
  • pain during intercourse
31
Q

symptoms of vulvovaginitis

A
  • redness
  • pain
  • swelling
  • discharge
  • burning
  • itching
32
Q

vaginitis management

A
  • outpatient
  • if not treated, vaginitis can lead to:
  • infertility or preterm birth
  • endometritis- infections can travel
  • PID
  • antibiotics are required for definitive treatment
33
Q

ruptured ovarian cyst pathophysiology

A
  • can be life threatening
  • fluid filled sac on or within an ovary
  • SHARP, STRONG, INTENSE abdominal pain*
  • functional cyst is the most common**
  • corpus luteum cyst develops if the sac seals itself after release of the oocyte
  • cysts arnt bad or life threatening until they rupture
  • if the cycle of forming sacs is repeated excessively, polycystic ovaries may develop
  • lack of progesterone and high levels of androgens -> imbalance of hormones
  • ruptured cyst-possibility of bleeding, horrible pain
34
Q

ovarian torsion

A
  • can be life threatening
  • ovarian torsion occurs when a cyst does not self-resolve and grows to a significant size
  • ovary itself gets cut off from the fallopian tubes from the size of a cyst
  • can lead to disconnect of blood flow to ovary and loss of fertility
  • sudden onset of severe lower abdominal pain
  • nausea and vomiting
  • hospitalization
35
Q

tubo-ovarian abscess

A
  • life threatening
  • tubo-ovarian abscess is encountered secondary to a primary infectious agent
  • fallopian tubes or ovaries become blocked by an infectious mass
  • removed surgically (sometimes self resolved but not often)
  • becomes life threatening when it ruptures and becomes PID, peritonitis
36
Q

ovarian cyst assessment (not ruptured)

A
  • a patient with an ovarian cyst may report:
  • dull achy pain in the lower back and thighs
  • sharp, specific location, intense pain
  • abdominal pain or pressure
  • nausea and vomiting
  • breast tenderness
  • abnormal bleeding and painful menstruation
37
Q

a ruptured ovarian cyst usually presents:

A
  • lower abdominal pain (sharp)
  • intense
  • abdominal distention and tenderness
  • dizziness
  • weakness
  • syncopal episode
  • surgical emergency
38
Q

a tubo-ovarian abscess may present with:

A
  • severe abdominal pain
  • guarding and rebound tenderness
  • nausea and vomiting
  • abdominal distention
  • fever* infection 100-101 F**** test
39
Q

ruptured ovarian cyst, ovarian torsion, and tubo-ovarian abscess management

A
  • treat a ruptured ovarian cyst or tubo-ovarian abscess the same as an ectopic pregnancy
  • surgical emergency until proven otherwise
  • for patients with ovarian torsion:
  • start an IV for pain medications and dehydration
  • administer antiemetics
40
Q

toxic shock syndrome (TSS) pathophysiology

A
  • can be life threatening
  • a form of septic shock caused by streptococcus pyogenes or staphylococcus aureus
  • can include several body systems
  • most likely going to start in vagina or uterus
  • usually starts from forgotten/retained tampon
  • can progress from minor infections
  • particularly affects menstruating women
41
Q

toxic shock syndrome assessment

A
  • initial symptoms may include:
  • syncope
  • myalgia
  • diarrhea and/or vomiting
  • sore throat
  • fever
  • chills
  • signs of shock
  • signs of sepsis
42
Q

toxic shock syndrome management

A
  • treat like sepsis
  • provide:
  • high flow supplemental oxygen
  • IV therapy
  • vasopressors - bc this is a distributive shock state
  • cardiac monitoring
  • can lead to infertility, death
43
Q

chlamydia

A
  • caused by the chlamydia trachomatis
  • symptoms:
  • lower abdominal or back pina
  • pain during intercourse
  • bleeding between menstrual periods
  • treated with antibiotics
  • commonly administered intramuscularly (shot)
  • very common
44
Q

genital herpes

A
  • infection of the genitals, buttocks, or anal area caused by herpes simplex virus
  • type 1: infects the mouth and lips (cold sores)
  • type 2- primary cause of genital herpes -> herpes simplex VIRUS for genital herpes*
  • if an outbreak, symptoms can last several weeks and may include:
  • can be triggered by stress
  • tingling or sores where the virus entered the body
  • small red bumps that develop into small blisters and painful sores
45
Q

gonorrhea

A
  • caused by Neisseria gonorrhoeae
  • can grow and multiply in warm, moist areas
  • symptoms may include:
  • dysuria
  • burning or itching
  • a yellowish or bloody vaginal discharge
  • foul smelling
  • treatment should be done early
  • antibiotics
  • severe infections may progress to PID
  • gonococcal pharyngitis- infection of the throat
  • if not treated, may enter the bloodstream and other parts of the body -> disseminated gonococcemia (in the bloodstream) -> sepsis
  • can cause meningitis
46
Q

genital warts

A
  • caused by HPV- causative agent in cervical, vulvar, and anal cancers
  • vaccine
  • in pregnant women, warts may impede urination or obstruct the birth canal
  • some infected people have no symptoms
47
Q

syphilis

A
  • caused by treponema pallidum
  • mandating reporting*- notify the public health authority bc it is rare
  • signs and symptoms mimic other diseases
  • manifests in 3 stages
  • transmission occurs through direct contacts
  • primary stage- appearance of a single sore
  • secondary stage- development of mucous membrane lesions and a skin rash
  • late stage- internal damage -> memory loss, neurological damage, dementia, CNS damage
48
Q

pregnant women with syphilis may have:,

A
  • stillborn babies
  • babies who are born blind
  • developmentally delayed babies
  • babies who die shortly after birth

Special Issues in Emergency Care and Resuscitation (15 decks)

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