Download Chapter 22: Gynecologic Emergencies

Chapter 22
Gynecologic
Emergencies
National EMS Education
Standard Competencies
Medicine
Integrates assessment findings with principles
of epidemiology and pathophysiology to
formulate a field impression and implement a
comprehensive treatment disposition plan for
a patient with a medical complaint.
National EMS Education
Standard Competencies
Gynecology
Recognition and management of shock
associated with
− Vaginal bleeding
Anatomy, physiology, assessment findings,
and management of
− Vaginal bleeding
− Sexual assault
− Infections
National EMS Education
Standard Competencies
Anatomy, physiology, epidemiology,
pathophysiology, psychosocial impact,
presentations, prognosis, and management of
common or major gynecologic diseases
and/or emergencies
− Vaginal bleeding
− Sexual assault
− Infections
− Pelvic inflammatory disease
National EMS Education
Standard Competencies
Anatomy, physiology, epidemiology,
pathophysiology, psychosocial impact,
presentations, prognosis, and management of
common or major gynecologic diseases
and/or emergencies (cont’d)
− Ovarian cysts
− Dysfunctional uterine bleeding
− Vaginal foreign body
Introduction
• Gynecology
− Deals with diseases and routine care of female
reproductive system
• Obstetrics
− Deals with birth
• These branches of medicine are entwined.
Female Reproductive System
• Anatomy
− Pudendum (vulva): external genitalia
Female Reproductive System
• Vagina
− Lower portion of the birth canal
− Contains Bartholin glands
Female Reproductive System
• Hymen
− Protects vaginal orifice
− May break before first intercourse
− When hymen breaks, pain and vaginal bleeding
may occur
Female Reproductive System
• Imperforate hymen
− Hymen completely covers the vaginal orifice
− May lead to complications such as:
• Blockage of menses
• Endometriosis
− Can also be caused by sexual abuse
Female Reproductive System
• Ovaries
− Two glands
− Each ovary contains thousands of follicles.
• Normally one fallopian tube associated with
each ovary
Female Reproductive System
• Uterus
− Muscular organ where the embryo grows
• The birth canal consists of the:
− Cervix
− Vagina
Menstruation
• Menstruation
− Cyclic and periodic discharge of 25 to 65 mL of
blood, epithelial cells, mucus, and tissue
− Duration varies
− The menstrual cycle is composed of phases.
Menstruation
• Ovarian cycle
− Follicular phase
• Days 1 to 13
• First day of menstruation until ovulation
− Luteal phase
• Days 14 to 28
• Time from ovulation until first day of menstruation
Menstruation
• Uterine cycle
− Proliferative phase
• Days 5 to 14
• After menstruation to before the next ovulation
− Secretory phase
• Days 14 to 28
• Time after ovulation until menstruation
Menstruation
Menstruation
• Women experience several changes during
the menstrual cycle, including:
− Weight gain due to extracellular edema
− Hypertonicity
− Emotional changes
Menstruation
• Menarche
− Onset of first menses
• Menopause
− Last menses
− End of childbearing
age
• Menopause
symptoms include:
−
−
−
−
−
Diaphoresis
Hot flashes
Dyspnea
Vertigo
Digestive problems
Menstruation
• Due to decreased hormone production,
postmenopausal women:
− Are more susceptible to diseases like
osteoporosis
− Experience atrophy of genitourinary organs
Menstruation
• PMS
− Cluster of symptoms that occur during the
menstrual cycle
− Normally 7 to 14 days prior to menstrual flow
Menstruation
• PMS (cont’d)
− Symptoms may be exacerbated by many
factors.
− Some women may experience hypoglycemia.
− Prehospital treatment is mainly supportive.
Menstruation
• Mittelschmerz
− Abdominal pain and
cramping
− May start any time
during ovulation
− Affects approximately
20 percent of women
− Pain is usually not
severe.
• Amenorrhea
− Absence of menses
− Most common cause
is pregnancy
− Can also be due to:
• Exercise
• Drop of body fat
• Stress
• Anorexia nervosa
Patient Assessment
• Obtaining an accurate and detailed patient
assessment is very important.
− Consider a gynecologic cause in a woman who
complains of abdominal pain.
Scene Size-Up
• Ask these questions:
− Is the scene safe?
− Is assistance necessary?
− What is the type of call?
−
−
−
−
How many patients are there?
Have standard precautions been taken?
What is the MOI or NOI?
Where is the patient found?
Primary Assessment
• Ask these questions (cont’d):
− What is the overall presentation of the patient?
− Are there any obvious life threats?
− Is she conscious?
−
−
−
−
Does she have breathing difficulty or injury?
What is her appearance?
What is her emotional state?
In what position did you find her?
Primary Assessment
• Protect the
patient’s
modesty.
− Limit the crowd.
• Form a general
impression.
− Assess
consciousness.
Primary Assessment
• Evaluate the airway and breathing.
− Identify and treat life threats.
• Assess circulation.
− Palpate pulse.
− Evaluate skin.
Primary Assessment
• Transport decision
− Rapid transport is warranted if signs of shock
exist because of bleeding.
• Perform the remainder of the assessment en route.
History Taking
• Determine the patient’s chief complaint.
− If excessive bleeding, obtain the gynecologic
history.
− If abdominal pain, find out more about the pain.
History Taking
• LORDS TRACHEA
mnemonic:
−
−
−
−
−
Location
Onset
Radiate
Duration
Severity
−
−
−
−
−
−
−
Timing
Relieve
Aggravates
Character
Historic
Eaten
Associated
History Taking
• Gynecologic history
− LMP?
− Possibility of pregnancy?
− Contraception use?
− Spermicides, condoms, or a diaphragm?
− Implanted devise or an IUD?
History Taking
• Gynecologic history (cont’d)
− Vaginal bleeding?
• If signs of shock are present, a fluid bolus of 100 to
200 mL should improve the status.
− Vaginal discharge?
− STD?
History Taking
• Determine obstetric history with G (gravida),
P (para), and A (abortive history).
− Gravida: number of times pregnant
− Para: number of times delivering a newborn
− Abortive history: number of elective abortions
History Taking
• Additional questions:
− How many times has she been pregnant?
− How many live births has she had?
− Any complications?
− Vaginal or cesarean deliveries?
− How much time between pregnancies?
History Taking
• Additional questions (cont’d):
− Any miscarriages or abortions?
− Any gynecologic problems?
− Any known medical conditions?
History Taking
• Gynecologic emergencies often have the
same signs and symptoms as other
abdominal emergencies.
− Use the SAMPLE mnemonic.
Secondary Assessment
• Chief concern is to identify signs of shock
− General presentation?
− Condition of skin and mucous membranes?
Secondary Assessment
• Examine the patient’s abdomen for:
− Bruising
− Surgical scarring or stretch marks
− Needle tracks
− A positive Cullen sign or Grey-Turner sign
− A swollen and distended abdomen
Secondary Assessment
• Examine the patient’s abdomen for
(cont’d):
− A flat and flaccid abdomen
− Guarding of the abdomen
− Rashes or lesions
− A symmetrical abdomen
− An enlarged liver or spleen
Secondary Assessment
• Palpate the abdomen.
− Start at the quadrant farthest from the pain.
• Rigid abdomen?
• Point tenderness?
• Does the palpation elicit more pain?
• Rebound tenderness?
• Masses?
Secondary Assessment
• Determine vital signs.
− Pulse variations
− Blood pressure
− Orthostatic changes
• General management is mostly supportive.
Reassessment
• Recheck your interventions en route to the
hospital.
− Note improvement or decline.
− Obtain serial vitals.
• Complete paperwork after delivery.
Emergency Medical Care
• Management is directed at:
− Mitigating life threats
− Being compassionate
− Protecting the patient’s modesty
Management of Gynecologic
Trauma
• The female genital area is highly vascular.
− Bleeding may be profuse.
• Applying external pressure is usually sufficient.
− Exsanguinating vaginal hemorrhage must be
treated as any exsanguinating hemorrhage.
Management of Gynecologic
Trauma
• Assessment of trauma will focus on:
− Symptoms?
− Mechanism of injury?
− Is she using sanitary pads or tampons?
− Normal blood color?
Management of Gynecologic
Trauma
• Assessment of
trauma will focus
on (cont’d):
− Do clots appear?
− Is the abdomen
tender/distended?
− Affirmative
answers may
indicate shock.
Specific Emergencies
• Life-threatening gynecologic emergencies
include:
− Ectopic pregnancy
− Ruptured ovarian cyst
− Tubo-ovarian abscess
Vaginal Bleeding
• Pathophysiology
− Dysmenorrhea: painful menses
• Primary dysmenorrhea occurs with the start of the
menstrual flow, lasting 1 to 2 days.
• Secondary dysmenorrhea is present before, during,
and after the menstrual flow.
Vaginal Bleeding
• Pathophysiology (cont’d)
− Vaginal bleeding is one of the most frequent
reasons that women consult a gynecologist.
− Hypermenorrhea: flow lasts longer than normal
or is excessive.
Vaginal Bleeding
• Pathophysiology (cont’d)
− Polymenorrhea: flow occurs more often than a
24-day interval.
− Metrorrhagia: flow or intermittent spotting
occurring irregularly but frequently
Vaginal Bleeding
• Assessment
− Depends largely on mechanism of injury
− Assess for hypovolemic shock.
• Management
− Prehospital treatment is largely supportive.
Ectopic Pregnancy
• Pathophysiology
− A fertilized oocyte
is implanted
somewhere other
than the uterus.
• In 97% of cases, it
is inside a fallopian
tube.
Ectopic Pregnancy
• Pathophysiology (cont’d)
− Tubal pregnancy
• Fertilized oocyte implants in the fallopian tube.
• Embryo runs out of room to grow.
• The tube is likely to rupture.
Ectopic Pregnancy
• Assessment
− Chief complaint of abdominal pain
• Generally localized to one side
• Crampy and intermittent in early stages
− Vaginal bleeding usually begins after pain.
Ectopic Pregnancy
• Assessment (cont’d)
− To gauge extent of internal bleeding, look for:
• A positive Cullen sign
• A positive Grey-Turner sign
• Signs of shock
• Abdominal distention and tenderness
Ectopic Pregnancy
• Management
− Treat for shock.
− Ensure adequate
airway.
− Keep the patient
left laterally
recumbent.
− Initiate IV fluid
therapy.
Ectopic Pregnancy
• Management (cont’d)
− Give nothing by mouth.
− Consider urethral catheterization.
− Anticipate vomiting.
− Keep the patient warm.
− Monitor the patient's ECG.
− Transport.
Endometritis
• Pathophysiology
− Inflammation or irritation of the endometrium
• More likely after a baby or miscarriage
• Most likely caused by an infection
Endometritis
• Assessment
− Symptoms may include:
• Malaise
• Vaginal bleeding or discharge
• Abdominal or pelvic pain
• Decreased bowel sounds
Endometritis
• Management
− Treat with antibiotics.
− Provide reassurance.
− Transport in a comfortable position.
Endometriosis
• Pathophysiology
− Endometrial tissue grows outside the uterus.
• Organs of the pelvic cavity are the most common
locations for growths.
− One of the leading causes of infertility
Endometriosis
• Assessment
− Symptoms include:
• Pain
• Dysuria
• Very heavy menstrual periods
• Bleeding between periods
Endometriosis
• Management
− Prehospital care is based on signs/symptoms.
− If the patient reports severe pain:
• Provide pain relief.
• Use dressing or towels as needed.
Pelvic Inflammatory Disease
• Pathophysiology
− Infection of the female upper organs
− Affects sexually active women most often
• Organisms enter the vagina and migrate into the
uterine cavity.
Pelvic Inflammatory Disease
(PID)
• Pathophysiology
(cont’d)
− Risk factors:
• IUD use
• Frequent sexual
activity
• History of PID
Pelvic Inflammatory Disease
(PID)
• Assessment
− Abdominal pain will be present.
• During or after normal menstruation
• Typically diffuse
− Be alert for signs of peritoneal irritation.
Pelvic Inflammatory Disease
(PID)
• Management
− Cannot be treated in the field
− Obtain a thorough history.
− Make the patient comfortable.
− Transport with a gentle ride.
Vaginitis
• Pathophysiology
− Inflammation of the vagina caused by infection
− Vaginal yeast infections
• Yeast population may increase if the vagina
becomes less acidic.
Vaginitis
• Pathophysiology (cont’d)
− Vulvovaginitis: inflammation of the external
vulva
• Patients should be evaluated by a physician.
Vaginitis
• Assessment
− Symptoms of yeast
infections:
• Itching/burning
• Soreness
• Vulvar swelling
• Thick, white vaginal
discharge
• Pain during
intercourse
− Symptoms of
vulvovaginitis:
• Redness
• Pain
• Swelling
• Discharge
• Burning
• Itching
Vaginitis
• Management
− If not treated, vaginitis can lead to:
• Infertility or preterm birth
• Endometritis
• PID
− Antibiotics are required for definitive treatment.
Bartholin Abscess
• Pathophysiology
− Two small ducts just inside the lower vagina
• Lead to the Bartholin glands
• Bacterial infections may cause the openings to
become abscessed and cystic.
Bartholin Abscess
• Assessment
− Patients may report:
• Painful lump and/or irritation
• Painful intercourse
• Fever
• Management
− May need surgical removal
Gardnerella Vaginitis
• Pathophysiology
− Caused by too many Gardnerella bacterium in
the genital area
• Mainly affects young, sexually active women
• Recent use of antibiotics can increase risk.
• Can cause complications in pregnant women
Gardnerella Vaginitis
• Assessment
− Signs and symptoms:
• “Fishy” odor
• Itching and/or irritation
• Smooth, thin, sticky, white or gray discharge
• Management
− Patients should see a physician.
Ruptured Ovarian Cyst, Ovarian
Torsion, and Tubo-ovarian Abscess
• Pathophysiology
− Ovarian cyst
• Fluid-filled sac on or within an ovary
• Functional cyst is the most common
• Corpus luteum cyst develops if the sac seals itself
after release of the oocyte.
Ruptured Ovarian Cyst, Ovarian
Torsion, and Tubo-ovarian Abscess
• Pathophysiology (cont’d)
− If the cycle of forming sacs is repeated
excessively, polycystic ovaries may develop.
• Lack of progesterone and high levels of androgens
Ruptured Ovarian Cyst, Ovarian
Torsion, and Tubo-ovarian Abscess
• Pathophysiology (cont’d)
− Ovarian torsion occurs when a cyst does not
self-resolve and grows to a significant size.
• Sudden onset of severe lower abdominal pain
• Nausea and vomiting
Ruptured Ovarian Cyst, Ovarian
Torsion, and Tubo-ovarian Abscess
• Pathophysiology (cont’d)
− Tubo-ovarian abscess is encountered
secondary to a primary infectious agent.
• Fallopian tubes or ovaries become blocked by an
infectious mass.
Ruptured Ovarian Cyst, Ovarian
Torsion, and Tubo-ovarian Abscess
• Assessment
− A patient with an ovarian cyst may report:
• Dull, achy pain in the lower back and thighs
• Abdominal pain or pressure
• Nausea and vomiting
• Breast tenderness
• Abnormal bleeding and painful menstruation
Ruptured Ovarian Cyst, Ovarian
Torsion, and Tubo-ovarian Abscess
• Assessment (cont’d)
− A ruptured ovarian cyst usually presents:
• Lower abdominal pain (sharp)
• Abdominal distention and tenderness
• Dizziness
• Weakness
• Syncopal episode
Ruptured Ovarian Cyst, Ovarian
Torsion, and Tubo-ovarian Abscess
• Assessment (cont’d)
− A tubo-ovarian abscess may present with:
• Severe abdominal pain
• Guarding and rebound tenderness
• Nausea and vomiting
• Abdominal distention
• Fever
Ruptured Ovarian Cyst, Ovarian
Torsion, and Tubo-ovarian Abscess
• Management
− Treat a ruptured ovarian cyst or tubo-ovarian
abscess the same as an ectopic pregnancy.
− For patients with ovarian torsion:
• Start an IV for pain medications and dehydration.
• Administer antiemetics.
Prolapsed Uterus
• Pathophysiology
− Uterus drops from its normal position
− Many women who have been through childbirth
experience this condition.
− Varying degrees of prolapse
Prolapsed Uterus
• Assessment
− Patients report may include:
• Vaginal and pelvic pain or low back pain
• Dysuria
• Incontinence
• Discharge
− Assess for any signs of shock.
Prolapsed Uterus
• Management
− Prehospital treatment is limited to:
• Pain management
• Treatment for shock
• Care for any tissue or the uterus itself
− Do not replace any tissue.
Toxic Shock Syndrome
• Pathophysiology
− A form of septic shock caused by Streptococcus
pyogenes or Staphylococcus aureus
− Can include several body systems
− Can progress from minor infections
− Particularly affects menstruating women
Toxic Shock Syndrome
• Assessment
− Initial symptoms may include:
• Syncope
• Myalgia
• Diarrhea and/or vomiting
• Sore throat
Toxic Shock Syndrome
• Management
− Rapid transport is indicated.
− Provide:
• High-flow supplemental oxygen
• IV therapy
• Pressors
• Cardiac monitoring
Sexually Transmitted Diseases
• PID is typically secondary to an STD.
− If indicated:
• Apply oxygen.
• Control bleeding.
• Start an IV line.
• Administer analgesics and antiemetics.
Sexually Transmitted Diseases
• Bacterial vaginosis
− Normal bacteria in the vagina are replaced by
other bacterial forms.
− Symptoms may include:
• Itching, burning, pain
• A “fishy,” foul-smelling discharge
Sexually Transmitted Diseases
• Bacterial vaginosis (cont’d)
− Left untreated, can lead to:
• Premature birth or low birthweight
• Increased susceptibility to infections
• PID
− Treat with metronidazole.
Sexually Transmitted Diseases
• Chancroid
− Caused by infection with Haemophilus ducreyi
− May cause painful sores or lymph glands or
may be asymptomatic
− Prehospital treatment is supportive.
Sexually Transmitted Diseases
• Chlamydia
− Caused by the Chlamydia trachomatis
− Symptoms may include:
• Lower abdominal or back pain
• Pain during intercourse
• Bleeding between menstrual periods
Sexually Transmitted Diseases
• Cytomegalovirus (CMV)
− Member of the herpes family
− No known cure
− Symptoms may include:
• Prolonged high fever
• Malaise
• Enlarged spleen
Sexually Transmitted Diseases
• Cytomegalovirus (CMV) (cont’d)
− People with an increased risk include:
• Those with immune disorders
• People receiving chemotherapy
• Pregnant women
− Newborns may acquire CMV.
Sexually Transmitted Diseases
• Genital herpes
− Infection of the genitals, buttocks, or anal area
caused by herpes simplex virus
• Type I: infects the mouth and lips
• Type II: primary cause of genital herpes
Sexually Transmitted Diseases
• Genital herpes (cont’d)
− In an outbreak, symptoms can last several
weeks and may include:
• Tingling or sores where the virus entered the body
• Small red bumps that develop into small blisters and
painful sores
Sexually Transmitted Diseases
• Gonorrhea
− 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
Sexually Transmitted Diseases
• Gonorrhea (cont’d)
− 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
Sexually Transmitted Diseases
• Genital warts
− Caused by HPV
• Causative agent in cervical, vulvar, and anal
cancers
− In pregnant women, warts may impede urination
or obstruct the birth canal.
− Some infected people have no symptoms.
Sexually Transmitted Diseases
• Syphilis
− Caused by Treponema pallidum
− Signs and symptoms mimic other diseases.
− Manifests in three stages
− Transmission occurs through direct contact.
Sexually Transmitted Diseases
• Syphilis (cont’d)
− Primary stage: appearance of a single sore
− Secondary stage: development of mucous
membrane lesions and a skin rash
− Late stage: internal damage
Sexually Transmitted Diseases
• Syphilis (cont’d)
− Pregnant women with syphilis may have:
• Stillborn babies
• Babies who are born blind
• Developmentally delayed babies
• Babies who die shortly after birth
Sexually Transmitted Diseases
• Trichomoniasis
− Caused by Trichomonas vaginalis
− Symptoms may include:
• A frothy, yellow-green vaginal discharge
• Irritation and itching
• Discomfort during intercourse
Sexual Assault
• Pathophysiology
− Rape is the most common form.
− Police involvement should be expected.
− Victim may “shut down.”
• If possible, a female paramedic should be optional.
Sexual Assault
• Assessment
− Ask if patient would be more comfortable with a
female or male paramedic.
− Limit examination to a brief survey.
− Protect the patient's privacy.
Sexual Assault
• Management
− You have a responsibility to preserve evidence.
− Discourage the patient from doing anything that
will possibly corrupt any evidence.
− Offer to call the local rape crisis center.
Sexual Assault
• Management (cont’d)
− The patient care report is a legal document.
− Record the following observations:
• The patient's emotional state
• The condition of her clothing
• Any obvious injuries
Sexual Assault
• Drugs used to facilitate rape
− Alcohol
− Club drugs
• GHB
• Ketamine
• Ecstasy
• Rohypnol
Sexual Practices and Vaginal
Foreign Bodies
• Pathophysiology
− Foreign objects stuck in the vagina or anus
• Keep the patient calm.
• Protect his or her dignity.
• Do not attempt to remove any foreign object.
• Do not let the patient walk.
Sexual Practices and Vaginal
Foreign Bodies
• Pathophysiology (cont’d)
− Fisting
• Organ rupture is likely.
− Insertion of live animals into the vagina
Sexual Practices and Vaginal
Foreign Bodies
• Assessment
− Maintain your patient's privacy.
− Inspection of the genital area may be
necessary.
− Conduct a thorough patient assessment.
Sexual Practices and Vaginal
Foreign Bodies
• Management
− Treat as you would with any foreign object.
• Remain nonjudgmental
• Transport.
• Do not attempt to retrieve the object.
− Transport with knees-flexed, legs-together.
Summary
• Gynecology is the study of and care for
diseases of the female reproductive system.
• External female genitalia is sometimes
referred to as the pudendum and has many
different parts.
• The vagina, Bartholin glands, cervix, uterus,
fallopian tubes, and ovaries make up the
internal female genitalia.
Summary
• Menstruation is the vaginal discharge of
primarily blood, which usually occurs
monthly.
• A woman can experience many physical
changes during the menstrual cycle.
• The last menses is called menopause.
• When assessing a patient with a
gynecologic emergency, begin by focusing
on the ABCs.
Summary
• Protect the patient’s modesty at all times.
• If the chief complaint is abdominal pain,
investigate the pain by following the
mnemonic LORDS TRACHEA.
• Determine when the patient had her LMP, if
it was unusual in any way, whether she
could be pregnant, and whether she uses
contraception.
Summary
• Vaginal bleeding that does not occur during
the course of regular menstruation is cause
for concern.
• Obtain the patient’s obstetric history,
including any previous pregnancies,
miscarriages, or abortions and a description
of any vaginal discharge.
Summary
• General management for gynecologic
emergencies includes addressing life
threats, being supportive, and protecting a
patient’s modesty.
• Ectopic pregnancy, ruptured ovarian cyst,
and tubo-ovarian abscess are lifethreatening gynecologic emergencies.
Summary
• Mittelschmerz is abdominal pain and cramping
that occur about 2 weeks before menstruation.
Dysmenorrhea is painful menstruation.
• Amenorrhea is the absence or cessations of
menses usually from pregnancy.
• Endometritis is inflammation of the
endometrium.
• Endometriosis is the growth of endometrial
tissue outside of the uterus.
Summary
• Endometriosis is the growth of endometrial
tissue outside of the uterus.
• PID is a common infection of the female
upper reproductive organs that causes
abdominal pain in women.
• Patients with PID will present with
abdominal pain starting during or after
menstruation.
Summary
• Vaginitis and vulvovaginitis are
inflammations of the vaginal tissues and
external vulva caused by an infection.
• A Bartholin abscess will cause a painful
lump, irritation, painful intercourse, and
possibly fever. The abscess may need to be
drained by a physician.
• In ectopic pregnancy, a fertilized oocyte
implants somewhere other than the uterus.
Summary
• Ruptured ovarian cyst, tubo-ovarian
abscess, and ovarian torsion are other
gynecologic conditions that can become an
emergency.
• A prolapsed uterus is when the uterus drops
into the vagina.
• TSS is a form of septic shock that can result
from an infection in the body.
Summary
• STDs include bacterial vaginosis,
chancroid, chlamydia, cytomegalovirus,
genital herpes, gonorrhea, syphilis, and
trichomoniasis.
• There are many different symptoms
associated with STDs.
• Sexual assault is a category of crime that
includes molestation and rape.
Summary
• It may be difficult to obtain a history from a
victim of rape. Have a same-sex paramedic
treat the patient when possible.
• Limit physical examinations to lifethreatening injuries in sexually assaulted
victims, and ask only medical questions.
Summary
• Preserve evidence when possible.
• Document cases of sexual assault properly
and professionally.
• Drugs are often used to facilitate rape.
• Sexual emergencies may involve foreign
objects stuck in the vagina or anus.
Credits
• Chapter opener: © Jones & Bartlett Learning. Courtesy of
MIEMSS.
• Backgrounds: Orange—© Keith Brofsky/Photodisc/Getty
Images; Green—Jones & Bartlett Learning; Purple—
Courtesy of Rhonda Beck; Lime—© Photodisc.
• Unless otherwise indicated, all photographs and
illustrations are under copyright of Jones & Bartlett
Learning, courtesy of Maryland Institute for Emergency
Medical Services Systems, or have been provided by the
American Academy of Orthopaedic Surgeons.