Gynecological Emergencies and Assessment

• Gynecological emergencies can involve large amounts of blood and body fluids contaminated with communicable diseases, requiring standard precautions. • Primary survey is crucial to identify life threats and determine ABCs (airway, breathing, and circulation). • Recognize that gynecological emergencies can be embarrassing for patients, ensuring privacy and dignity during assessment. • OBGYN emergencies often have similar signs and symptoms as emergencies involving other abdominal organs, requiring thorough assessment. • When physically assessing patients, external genitalia examination should only be done when absolutely necessary and should be a visual inspection only. • If vaginal bleeding is present, visualize the bleeding and ask about quantity and quality, including how many pads or tampons used and how often they need to change. • Never insert anything into the vagina to control bleeding, including tampons, and observe any vaginal discharge. • Assess vital signs, recognizing that hypotension, tachycardia, and respiratory changes may signal shock. • Reassess patients considering few interventions can be done with these patients, mainly keeping them supine, treating for shock, and providing supplemental oxygen. • Always recheck primary interventions and communicate relevant information to the receiving hospital staff. • Document everything, especially in cases of sexual assault, including patient condition, chief complaint, scene, vital signs, and interventions. • Maintain patient privacy and modesty, gain confidence by communicating appropriately, and use sanitary pads to absorb blood. • Discourage tampon use, and if patient demonstrates signs of shock or excessive bleeding, place them in a supine position and keep them warm. • Consider the possibility of pregnancy and be prepared for possible miscarriage. • Treat external lacerations, abrasions, and tears with sterile compresses, but avoid packing or placing dressings inside the vagina. • If external injuries are caused by sexual assault, avoid cleaning or allowing the patient to shower before transport to preserve DNA evidence. • With ovarian cysts, offer supportive care and be aware of possible vaginal bleeding. • Ectopic pregnancies, especially ruptured ones, are true medical emergencies requiring rapid transport. • Assume any bleeding in the first or second trimester is a sign of spontaneous abortion or miscarriage. • Third-trimester bleeding is a very serious emergency. • With sexual assault, prioritize medical treatment and psychological care, limiting physical exams to brief surveys for life-threatening injuries. • Preserve evidence by not cutting through clothing or throwing away items from the scene. • Discourage patients from using hand sanitizer, urinating, changing clothes, or rinsing their mouth before transport. • Offer to call a local Rape Crisis center for patients and follow protocol concerning this type of call. • Be aware of drugs used to facilitate rape, such as those that can be put into drinks and may go undetected, causing hypotension, bradycardia, difficulty breathing, seizures, and even death. • Vaginal foreign bodies are the most common sexual gynecologic emergency, requiring patients to be kept calm and transported without attempting to remove foreign objects.