Gynecologic Emergencies - NREMT AEMT Level

1. What is the appropriate AEMT transport priority for suspected ectopic pregnancy with hypotension?

   Immediate transport to surgical-capable facility; treat for shock. Hypotension signals instability, necessitating rapid surgical intervention and en route shock management.

2. Which presentation suggests ruptured ectopic pregnancy with intra-abdominal bleeding?

   Severe abdominal pain with signs of shock; possible shoulder-tip pain. Rupture causes peritoneal irritation and hemorrhagic shock, with referred pain from diaphragmatic involvement.

3. Identify the best destination for unstable suspected ectopic pregnancy: urgent care, OB clinic, or ED with surgery.

   Emergency department with surgical capability. Unstable cases require immediate surgical access for potential laparotomy to control hemorrhage.

4. What is the highest priority in the initial management of a gynecologic emergency patient?

   Airway, breathing, circulation; treat shock early. ABCs form the foundation of emergency care, with early shock treatment preventing deterioration in bleeding cases.

5. What is the major life-threatening complication of PID that AEMTs must consider?

   Sepsis. Untreated infection can spread systemically, leading to septic shock and multi-organ failure.

6. What is the classic triad associated with ectopic pregnancy?

   Abdominal pain, vaginal bleeding, missed period (amenorrhea). These symptoms indicate possible extrauterine pregnancy, increasing risk of rupture and hemorrhage.

7. Which key history question helps identify pregnancy in gynecologic complaints?

   Date of last menstrual period (LMP) and possibility of pregnancy. These details guide differential diagnosis by assessing for pregnancy-related complications like ectopic implantation.

8. Which finding defines an incomplete miscarriage in the field assessment context?

   Vaginal bleeding with passage of tissue and continued bleeding/cramping. Persistent symptoms after tissue passage indicate retained products, risking continued hemorrhage or infection.

9. What is ovarian torsion in one phrase?

   Twisting of ovary/adnexa causing ischemia. Vascular occlusion from twisting causes acute ischemia, necessitating prompt surgical detorsion to preserve tissue.

10. Which pain pattern is most typical of ovarian torsion?

    Sudden, severe unilateral lower abdominal pain, often with nausea/vomiting. Acute, localized pain with autonomic symptoms reflects sudden ovarian ischemia from vascular compromise.

11. Identify the correct action for vaginal bleeding with shock: pads, oxygen, IV access, rapid transport.

    All of the above; treat as hemorrhagic shock and transport emergently. Integrated interventions address hypovolemic shock while facilitating urgent hospital evaluation.

12. Which finding most suggests hemorrhagic ovarian cyst rupture rather than benign cramping?

    Sudden pelvic pain with hypotension or tachycardia. Vital sign changes indicate internal bleeding, distinguishing emergent rupture from non-hemorrhagic causes.

13. Find the correct field action: remove an impaled vaginal object or stabilize and transport?

    Stabilize in place, control external bleeding, and transport. Impaled objects should not be removed prehospital to avoid exacerbating injury or bleeding.

14. What is the correct prehospital management if products of conception are found?

    Save tissue/placenta, transport with patient, do not discard. Preserving specimens allows hospital pathologic examination to confirm diagnosis and guide further treatment.

15. What is the most concerning implication of syncope with vaginal bleeding in a reproductive-age patient?

    Hemorrhagic shock from ectopic pregnancy until proven otherwise. This combination signals potential life-threatening internal hemorrhage requiring urgent evaluation.

16. Which action is contraindicated in routine prehospital evaluation of vaginal bleeding?

    Internal vaginal examination. Such exams exceed AEMT scope and may worsen bleeding or introduce infection in the prehospital setting.

17. What is pelvic inflammatory disease (PID) in one sentence?

    Ascending infection of female upper genital tract, often STI-related. PID results from bacterial ascent, commonly from gonorrhea or chlamydia, leading to inflammation and scarring.

18. What is the primary prehospital treatment goal for stable gynecologic pelvic pain?

    Pain control, supportive care, and timely transport. Prehospital care focuses on symptom relief and safe transport for definitive diagnosis and management.

19. Which symptom combination most strongly suggests PID?

    Lower abdominal pain with fever and abnormal vaginal discharge. This triad reflects infectious etiology, prompting consideration of antibiotics and gynecologic evaluation.

20. What is endometriosis as a cause of pelvic pain?

    Ectopic endometrial tissue causing cyclic pelvic pain. Aberrant tissue implants cause inflammation and adhesions, correlating pain with menstrual cycles.

21. What is the best immediate care for significant vaginal bleeding without imminent delivery?

    Apply external perineal pads; do not pack the vagina. External measures control bleeding safely without risking infection or further trauma from internal packing.

22. Which patient-centered communication approach is appropriate during a sexual assault response?

    Explain each step, obtain consent, and limit examinations/interventions. Trauma-informed practices empower the patient, reduce distress, and ensure ethical care delivery.

23. What is the most common cause of first-trimester vaginal bleeding?

    Miscarriage (spontaneous abortion). Early pregnancy loss frequently presents with bleeding due to embryonic or fetal demise.

24. What is the correct AEMT management for suspected sexual assault regarding evidence preservation?

    Do not clean patient or clothing; preserve items in paper bags. Avoiding disturbance preserves forensic evidence for collection and analysis by trained professionals.

Study these flashcards