Gynecologic Emergencies - NREMT Paramedic Level

1. What is the priority management for any gynecologic patient with suspected shock?

   Treat shock: oxygen/ventilation, IV access, fluids, rapid transport. Focuses on stabilizing hemodynamics and ensuring prompt definitive care, as gynecologic causes can lead to rapid deterioration.

2. Identify the correct action for a vaginal foreign body causing minor bleeding and pain.

   Do not remove; manage bleeding externally and transport. Avoids potential complications like perforation or infection, deferring extraction to hospital specialists.

3. What is the definition of metrorrhagia?

   Uterine bleeding at irregular intervals (between periods). Refers to noncyclical vaginal bleeding, often indicating underlying pathology requiring medical evaluation.

4. Which referred pain location suggests intra-abdominal bleeding from ectopic pregnancy?

   Shoulder pain (Kehr sign). Results from diaphragmatic irritation due to intraperitoneal blood accumulation, signaling significant hemorrhage.

5. Which diagnosis is suggested by sudden severe unilateral pelvic pain with nausea/vomiting?

   Ovarian torsion. Involves twisting of the ovarian pedicle, compromising blood flow and causing ischemic pain with autonomic responses.

6. What is the definition of amenorrhea?

   Absence of menstruation. Indicates potential hormonal imbalances, pregnancy, or disorders, necessitating thorough history and evaluation.

7. What is the definition of menorrhagia?

   Excessive menstrual bleeding (heavy or prolonged menses). Describes abnormal uterine bleeding exceeding normal volume or duration, potentially leading to anemia or shock.

8. Which key history question helps distinguish gynecologic from gastrointestinal causes of pelvic pain?

   Last menstrual period and pregnancy possibility. Differentiates pregnancy-related issues like ectopic from non-gynecologic causes, guiding appropriate diagnostic pathways.

9. Which intervention is contraindicated for vaginal bleeding (nonpostpartum) in the field?

   Do not pack the vagina. Risks introducing infection, causing further trauma, or obscuring diagnosis in nonpostpartum gynecologic hemorrhage.

10. Which immediate action is most important for suspected ruptured ectopic pregnancy?

    Rapid transport to surgical care while treating shock. Addresses the surgical emergency of rupture, prioritizing stabilization and expedited access to operative intervention.

11. Which action best preserves forensic evidence after sexual assault?

    Advise no bathing, douching, urinating, or changing clothes if possible. Minimizes evidence contamination or loss, facilitating effective forensic examination and legal proceedings.

12. What is the definition of dysmenorrhea?

    Painful menstruation. Involves cramping or discomfort during menses, commonly due to prostaglandin release or conditions like endometriosis.

13. Which infection is suggested by pelvic pain plus fever and cervical motion tenderness?

    Pelvic inflammatory disease (PID). Arises from ascending genital tract infection, with symptoms reflecting inflammation and possible systemic involvement.

14. What is the prehospital priority for suspected PID with systemic illness?

    Supportive care, treat sepsis/shock if present, transport. Emphasizes stabilization of complications like sepsis while facilitating hospital antibiotic therapy and evaluation.

15. Which finding most strongly indicates immediate resuscitation and rapid transport in gynecologic bleeding?

    Hypotension or altered mental status indicating hemorrhagic shock. Signals significant blood loss requiring aggressive resuscitation to prevent organ failure and death.

16. What is the correct prehospital approach to a patient reporting sexual assault?

    Ensure safety, treat injuries, preserve evidence, transport, advocate involvement. Balances medical treatment with forensic preservation and psychological support, ensuring comprehensive victim care.

17. What is the definition of dyspareunia?

    Pain with sexual intercourse. Occurs from various causes like infections or structural issues, impacting quality of life and requiring targeted assessment.

18. Which diagnosis is most associated with sudden unilateral pelvic pain after exertion or intercourse?

    Ruptured ovarian cyst. Occurs when cyst contents spill into the peritoneum, causing acute irritation often triggered by physical stress.

19. What is the prehospital management priority for suspected ovarian torsion?

    Analgesia as allowed and rapid transport (time-sensitive surgical emergency). Prioritizes pain relief and urgent surgical detorsion to prevent ovarian necrosis in this time-critical condition.

20. What is the first step when managing an impaled object in the vagina?

    Stabilize in place; do not remove. Prevents further injury or bleeding exacerbation, allowing controlled removal in a sterile surgical environment.

21. Which condition is suggested by vaginal bleeding and tissue passage in early pregnancy?

    Spontaneous abortion (miscarriage). Involves fetal loss before 20 weeks, with bleeding and tissue expulsion signaling incomplete expulsion needing medical care.

22. What classic symptom pattern most suggests a ruptured ectopic pregnancy?

    Unilateral pain with syncope and signs of shock. Indicates potential rupture causing internal bleeding and hypovolemic shock, necessitating immediate intervention.

23. What is the prehospital care for heavy vaginal bleeding from suspected miscarriage?

    Treat shock, pad external bleeding, save tissue, rapid transport. Aims to manage hemodynamic instability, control visible hemorrhage, and preserve specimens for pathological confirmation.

24. Which life-threatening diagnosis must be assumed in reproductive-age abdominal pain until excluded?

    Ectopic pregnancy. Presents high risk of rupture and life-threatening hemorrhage in women of childbearing age, requiring urgent exclusion.

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