Emergency Medical Training Services Emergency Medical Technician – Paramedic Program Outlines Outline Topic: Gynecology Revised: 11/2013
21 questions on exam 8 from this outline
• Menstruation - normal periodic discharge of blood, mucus, and cellular debris from uterus.
The normal menstrual cycle lasts about 28 days.
25 to 60mL average flow.
Flow lasts usually 4 to 6 days.
Lining of the uterus is called endometrium.
Onset of menses (menarche) begins around 12 years of age.
Menopause starts at age 47 on average. But can range from 30 to 60 years of age.
Estrogen stimulates endometrium to grow and increase in thickness.
• Ovaries contain about 5 million cells to make oocytes (immature ova/eggs). At puberty 350,000 are
present. In a lifetime the ovary will release 400 through menstruation
• The release of the egg is termed ovulation. • The pituitary released FSH to stimulate the ovaries to produce estrogen. As a result of the estrogen
builds up in blood stream just before ovulation the pituitary releases luteinizing hormone to initiate the
release of eggs.
• Up to seven days after ovulation (day 21) the uterus is ready to receive an embryo if fertilization has
happened.
• Recap: Day 14 ovulation. Up to day 21 fertilization window, day 22 thru 28 period if not pregnant.
GYN emergencies are classified as:
Non-traumatic
• PID - infection entered the pelvis cavity. Most common causes are non-sterile exam equipment and if
sexually transmitted is N. Gonorrhea and Chlamydia. Lower abdominal pain, hurts with sex, vaginal
discharge and additional bleeding after period is over. Antibiotic therapy is needed.
• Ovarian cyst - can be a bleeding/shock emergency. Pelvic pain (can be one sided), one week prior to
start of period.
• Cystitis - Bladder infection. Fever, chills, pelvis/abdominal pain, hurts to urinate - stop and go.
• Dysmenorrhea/Mittelschmerz - Dysmenorrhea means pain during menstruation. signs that go with a
period. HA, dizzy, nausea, backache, and abdominal cramping. • Endometriosis - Abnormal GYN condition. Tissue growing outside the uterus. More common in women
who defer pregnancy. Avg age with endometriosis is 37.
• Ectopic Pregnancy - Life threatening bleeding requiring some form of surgery whether bleeding or not.
Most occur within 2 months of pregnancy.
Traumatic
• Vaginal bleeding - Straddle injuries, blows to the perineum, blunt force. Foreign bodies, abortion
attempts.
Sexual Assault - Crime of violence.
• One in three women will be victims.
• Only 16% of crimes reported.
• Preserve chain of evidence.
• Do not investigate the assault just document finding and care for medical emergencies present.
• Must assess the vaginal area but no internal assessment by EMS.
Gravida - number of times pregnant. Para - number of live births.
Care:
Estimate blood loss by how many pads or tampons they have used. Most patients prefer to be transported on left side in fetal position. Never pack the vagina with dressings to control bleeding. Lay a dressing over the opening of the vagina to clot the blood. Must assess the vaginal area in most cases but no internal assessment by EMS. Avoid analgesic treatment until evaluated by doctor. Provide emotional support and care for life threatening emergencies.