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CEN > Genitourinary, Gynecology, and Obstetrical Emergencies > Flashcards

Genitourinary, Gynecology, and Obstetrical Emergencies Flashcards

1. Explain concepts related to the assessment of an emergency department patient experiencing a GU/GYN/OB emergency. 2. Describe various patient presentations related to GU/GYN/OB emergencies. 3. List interventions necessary for a patient presenting with a GU/GYN/OB emergency.

1
Q

define renal calculi

A

kidney stone that can lead to renal colic

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2
Q

renal calculi overview

A

80% of stones are Ca

size does not correlate to ain

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3
Q

sx renal calculi

A 
sudden onset
severe, colicky flank pain
pain radiating to genitals
restlessness
CVA tenderness
urgency, frequency
dysuria, hematuria
N/V
diaphoresis, low-grade fever
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4
Q

assessing renal calculi

A

assess bruits, pulsatile masses

r/o aortic, iliac aneurysms

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5
Q

intervene renal calculi

A 
strain urine
fluids
opioids, antiemetics
NSAIDs if Cr normal
possible stent
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6
Q

define urinary retention

A

inability to completely empty bladder

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7
Q

causes of urinary retention

A 
urethral strictures
enlarged prostate
clots, calculi
neurogenic bladder
pelvic organ prolapse
MS
med side effects
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8
Q

sx urinary retention

A

low abd pain

bladder distention

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9
Q

intervene urinary retention

A

Foley

Coude catheter

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10
Q

UTI overview

A 
mostly bladder (acute cystitis) 
usually e.coli
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11
Q

risk of UTI

A

women:

  • higher than men
  • shorter urethra
  • new sexual partner

men:

  • incomplete bladder emptying
  • enlarged prostate
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12
Q

sx UTI

A 
dysuria, urgency, frequency
nocturia
suprapubic pressure
back pain
cloud, foul urine
low grade fever
retention in males
AMS in elderly
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13
Q

abx in UTI

A

trimethoprim and sulfamethoxazole
nitrofurantoin
ciprofloxacin

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14
Q

pain management in UTI

A

NSAIDs

phenazopyridine

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15
Q

urosepsis overview

A

elderly, diabetic, immunocompromised

present atypically: AMS in elderly

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16
Q

dc teaching in UTI

A

fluids

phenazopyridine will make urine orange

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17
Q

define acute pyelonephritis

A

inflammation/infection of kidneys

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18
Q

acute pyelonephritis overview

A

more common in women

can lead to urosepsis

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19
Q

causes of acute pyelonephritis

A

usually bacterial

mechanical obstruction

can be upstream from UTI and ascend down from blood infection

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20
Q

sx acute pyelonephritis

A 
CVA tenderness
F/C, HA
N/V/D
sx of lower UTI
pyuria, hematuria, bacteriuria
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21
Q

intervene acute pyelo

A

fluids, rest
nephrostomy tube possibly
broad-spectrum abx

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22
Q

chlamydia overview

A

chlamydia trachomatis

most common STI

often w/ gonorrhea

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23
Q

sx chlamydia

A

75% asymptomatic

cervicitis
PID
endometriosis
salpingitis

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24
Q

tx for chlamydia

A

azithro PO x 1

dozycycline x 7 days

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25
syphilis overview
treponema pallidum more in females and drug users
26
sx primary syphilis
painless ulcer or chancre on mouth or anogenital area
27
sx secondary syphilis
``` 4-10 wks after primary infection myalgia lymphadenopathy flu-like sx rash on palms, soles ```
28
sx tertiary syphilis
2-19 years later if untreated | psychosis, delirium, dementia
29
sx for syphilis
penicillin IM x 1 doxycycline x 14 days tetracycline x 14 days
30
gonorrhea overview
neisseria gonorrhoeae second most common STI leading cause of cervicitis, PID in females, urethritis in males
31
complications of gonorrhea
infertility, ectopic, chronic pelvic pain
32
sx gonorrhea
UTI sx mucoid discharge from cervix/penis men may be asymptomatic
33
tx for gonorrhea
ceftriaxone IM x1 cefixime PO x1 cephalosporin IM x1 + azithro PO x1 doxycycline x 7 days
34
herpes simplex overview
chronic, incurable viral STI with remissions and exacerbations
35
sx herpes simplex
painful vesicles, ulcerations on genitalia fever, malaise myalgia lymphadenopathy dysuria 70% asymptomatic
36
dc teaching for all STIs
``` meds as prescribed PCP condoms inform sexual partners treat past sexual partners ```
37
dc teaching for chlamydia
no sex x 7 days after tx
38
dc teaching for herpes
avoid sex during outbreak increased risk of transmission to fetus - C-section recommended
39
cremasteric reflex
when inner thigh is stroked, cremaster muscle contracts raising ipsilateral testis
40
testicular torsion overview
``` urological emergency can occur in infants rare after 30 yo cremasteric reflex absent US shows ischemia ```
41
acute epididymitis overview
cremasteric reflex intact US shows increased blood flow most common cause of intrascrotal inflammation
42
define testicular tosion
twisting of testicle or spermatic cord, causing strangulation
43
onset of acute epididymitis vs testicular torsion
epididymitis: gradual torsion: sudden
44
pain in acute epididymitis
mild to severe | unilateral
45
pain in testicular torsion
severe unilateral tenderness swelling, erythema
46
cause of acute epididymitis
infection (chlamydia or gonorrhoeae)
47
causes of testicular torsion
congenital undescended testicle cold weather sex
48
common ages in acute epididymitis vs testicular torsion
epididymitis: sexually active postpubertal males torsion: 12-18
49
ureteral discharge in acute epididymitis vs testicular torsion
epididymitis: yes torsion: no
50
scrotal elevation in acute epididymitis vs testicular torsion
epididymitis: may decrease pain torsion: worsens pain
51
assessing acute epididymitis
scrotal US ureteral smear UA, culture
52
assessing testicular torsion
cremasteric reflex | doppler US
53
intervene acute epididymitis
abx | sx management
54
intervene testicular torsion
manual detorsion uro consult surgical repair
55
define priapism
prolonged, painful erection
56
common ages in priapism
any age but: 5-10 with SCC 20-50
57
causes of priapism
spinal cord injury tumors SCC meds for ED
58
sx priapism
vaso-oclusive: - persistent, painful - >4 hours non-ischemic: -erect but nontender
59
assessing priapism
penile doppler arteriography CBC if c/f malignancy
60
intervene priapism
analgesia, sedation inject epi, phenylephrine, pseudoephedrine, or terbutaline into penis irrigate corpora with NS uro consult
61
define phimosis
inability to fully retract foreskin over glans penis
62
define paraphimosis
retracted foreskin becomes entrapped, occluding blood flow to glans
63
sx paraphimosis
swollen, painful, edematous glans tight ring of skin behind glans discolored, necrotic areas hx of increasing difficulty advancing foreskin
64
intervene phimosis/paraphimosis
manual reduction small incision with local anesthesia encourage consideration of circumcision or dorsal slit NSAIDs, abx
65
define caute prostatitis
inflammation of prostate gland
66
common causes of prostatitis
bacterial infection that ascended via ureter or refluxed from bladder associated with acute cystitis
67
sx prostatitis
``` sudden onset dysuria, malaise frequency, urgency perineal pain low abd, penile, suprapubic discomfort f/c hematospermia ```
68
assessing prostatitis
UA, cultures prostate-specific antigen boggy, tender prostate
69
intervene prostatitis
analgesia Foley abx - fluoroquinolones fluid intake
70
causes of renal trauma
blunt trauma (MVC) fall w/ lower rib fractures penetrating trauma
71
types of renal trauma
laceration contusion vascular injury
72
sx renal trauma
abd, flank, back pain flank ecchymosis hematuria
73
intervene renal trauma
bed rest observe fluids surgery for lacs or uterine extravasation
74
types of urethral/bladder trauma
contusion | rupture
75
causes of urethral/bladder trauma
straddle injury genital trauma foreign bodies
76
what injuries are associated with urethral/bladder trauma?
full bladder pelvic fractures pediatric patients
77
sx urethral/bladder trauma
``` inability, difficulty voiding suprapubic, perineal, genital pain with voiding blood at urinary meatus hematuria hypovolemia low abd or peritoneal hematoma bladder distension ```
78
characteristics of urethral/bladder trauma
"pop" after blow to bladder pelvic fx with bony fragment cystogram no urine in Foley
79
intervene urethral/bladder trauma
analgesia, abx cath only by urologist surgery
80
reasons for surgery in urethral/bladder trauma
hemodynamic instability renal pedicle damage most injuries
81
define penile fracture
rupture of tunic albuginea or corpus cavernosa of penile shaft d/t torque
82
causes of penile fracture
during sex direct trauma fall
83
sx penile fracture
``` "pop" at time of injjry penile pain, loss of erection BRB from urethra ecchymosis edema ```
84
intervene penile fracture
surgery w/in 24-36 hours | supportive measures
85
causes of pelvic pain
``` ectopic kidney stones UTI Mittelschmerz ruptured ovarian cyst endometriosis PID diverticulitis appendicitis ovarian neoplasm ```
86
causes of abnormal uterine bleeding
``` hormone dysfxn hemorrhagic cystitis coagulopathies neoplasms trauma uterine/vaginal foreign body sexual assault uterine, cervical polyps uterine fibroids urethral prolapse gyn infections pregnancy complications ```
87
gyn infections causing abnormal uterine bleeding
gonorrhea chlamydia trich cervicitis
88
pregnancy complications causing abnormal uterine bleeding
``` ectopic spontaneous abortion placental abruption placenta previa postpartum hemorrhage ```
89
define bartholin cyst
obstruction of Bartholin duct unilateral
90
complications of bartholin cyst
infections caused by STI, vaginal organisms
91
sx bartholin cyst
painful, unilateral cystic mass
92
intervene bartholin cyst
``` warm compress sitz bath I and D, drainage abx r/o carcinoma if over 40 yo ```
93
define dysfunctional uterine bleeding
irregular uterine bleeding from vagina that occurs in absence of recognizable pelvic pathology, general medical disease, or pregnancy
94
dyspareunia
painful bleeding or pain with intercourse usually associated with endometriosis
95
causes of dysfunctional uterine bleeding
``` uterine fibroids trauma infection malignancy coagulopathies hormone replacement therapy steroids, androgens digitalis, anticoags low caloric diets, obesity rapid weight change thyroid, adrenal disorders cirrhosis HTN ```
96
sx dysfunctional uterine bleeding
fewer than 21 days between episodes usually painless
97
normal menses
25-60 ml/day for 4-5 days average tampon holds 20-30 ml if saturated
98
intervene dysfunctional uterine bleeding
low dose PO contraceptive iron supplements IV fluids suction, curettage
99
define ovarian cyst
pockets on ovaries which may contain fluid, semi-fluid, solid material
100
types of ovarian cysts
``` follicular corpus luteum Mittelschmerz polycystic ovarian syndrome chocolate cysts dermoid cysts ```
101
follicular cyst rupture
with strenuous exercise or sexual intercourse w/in first 2 weeks of menstrual cycle
102
corpus luteum cyst rupture
last 2 weeks of menstrual cycle
103
Mitelschmerz cyst rupture
mid-cycle, unilateral pain
104
chocolate cyst
caused by endometriosis
105
dermoid cyst
contains teeth, hair
106
sx ovarian cyst
``` varies pain w/ sex sharp, unilateral days to weeks of pain biopsy to r/o uterine CA hypovolemia if blood-filled cyst ```
107
intervene ovarian cyst
NSAIDs, opioids | surgery
108
complication of ovarian cysts
fallopian tube torsion with ovarian ischemia
109
sx fallopian tube torsion
sudden, sharp, unilateral pain fever dysuria N/V
110
define sexual assault/battery
involuntary sexual act threatened, coerced, forced sexual contact w/w/o penetration
111
who should assess possible victim of sexual assault/battery?
SANE - sexual assault nurse examiner
112
define PID
polymicrobial infection of upper genital tract
113
examples of PID
endometriosis salpingitis tubo-ovarian abscess pelvic peritonitis
114
common causes of PID
gonorrhea | chlamydia
115
risk factors for PID
``` IUD previous STIs multiple partners substance use frequent douching ```
116
sx PID
abd pain, dyspareunia abnormal vag discharge fever cervical motion tenderness
117
intervene PID
``` abx, analgesia admission for: -not responsive to tx -unstable -tubo-ovarian abscess -pregnant ```
118
dc instructions for PID
increased risk of ectopic can result in infertility PCP in 72 hours
119
define tubo-ovarian abscess
complication of PID | surgery emergency if ruptures
120
sx tubo-ovarian abscess
ill appearing severe abd pain peritoneal signs w/ palpation fever
121
intervene tubo-ovarian abscess
admit surgery -hysterectomy, oophorectomy possible abx
122
define toxic shock syndrome
toxin-mediated systemic response usually d/t Staph aureus
123
causes of TSS
retained tampon, sponge strep infections necrotizing fasciitis burns
124
sx TSS
``` sudden onset f/c hypotension N/V/D HA, myalgia classic rash confusion multisystem organ failure ```
125
intervene TSS
``` contact iso ABCs, intubation fluids, pressors remove infection abx art line, CVC ICU ```
126
sx vulvovaginal candidiasis
irritation, itching inflammation cottage-cheese discharge
127
diagnosing vulvovaginal candidiasis and trich
wet prep
128
tx vulvovaginal candidiasis
OTC creams, suppositores | diflucan PO x 1
129
dc teaching vulvovaginal candidiasis
diflucan contraindicated in pregnancy PCP
130
sx trich
vulvar irritation dyspareunia "fishy" odor yellow/green discharge
131
tx trich
metronidazole PO x1 or | tinidazole PO x1
132
dc teaching trich
no alcohol with metronidazole treat sexual partners PCP
133
sx bacterial vaginosis
"fishy" odor | gray discharge
134
diagnosing bacterial vaginosis
discharge that smoothly coats vaginal wall clue cells ph > 4.5 + "whiff" test
135
tx bacterial vaginosis
metronidazole 7 days or metronidazole gel 5 days or clinda cream 7 days
136
dc teaching bacterial vaginosis
partners don't need tx meds as directed PCP avoid douching, bubble baths
137
complications with diaphragm
unable to remove - use ring forceps
138
complications with IUD
unable to remove lost string partial expulsion abnormal cavity migration
139
intervening for IUD complications
remove with ring forceps imaging additional contraception poss. exploratory laparotomy
140
define spontaneous abortion
death or expulsion of fetus or products of conception before age of viability 15-20% of all pregnancies
141
complications of spontaneous abortion
bleeding vag bleeding should improve and stop infection
142
causes of spontaneous abortion
``` first trimester: -chromosomal after first trimester: -infection -endocrine disorder -anatomic abnormalities of mother ```
143
define threatened abortion
cervical os closed despite bleeding/cramping
144
define inevitable abortion
cervical os open bleeding/cramping membranes ruptured
145
define incomplete abortion
cervical os open tissue in cervix incomplete expulsion of products
146
define complete abortion
complete expulsion of products of conception
147
define missed abortion
prolonged retention of dead products of conception after os closed
148
define septic abortion
intrauterine infection d/t retained products of conception
149
intervene spontaneous abortion
``` labs, US oxytocin, abx suction curettage uterine evacuation psychosocial care referrals ```
150
dc instructions for spontaneous abortion
``` vag bleeding 1-2 weeks slight cramping x few days avoid douching, tampons, sex x 2 weeks rest 2-3 days temp bid x 5 days ```
151
reasons to seek medical care after spontaneous abortion
fever > 100F chills severe N/V, cramps excessive bleeding
152
define excessive bleeding after spontaneous abortion
consistently soaking pad in < 1 hr bleeding > normal period clots > quarter sized
153
define ectopic pregnancy
embryo implants at site other than endometrium of uterus
154
ectopic pregnancy overview
usually in fallopian tube and will eventually rupture usually 6th week of gestation 2% of all pregnancies
155
locations for ectopic pregnancies
``` peritoneal corneal isthmic tubal ampullar tuba fimbric tubal ovarial cervical intramural ```
156
sx ectopic pregnancy
``` late, irregular period abnormal vag bleeding sudden onset unilateral pelvic pain palpable pelvic mass + pregnancy N/V ```
157
sx ruptured ectopic pregnancy
shoulder pain (Kehr sign) signs of shock decreased LOC
158
labs in ectopic pregnancy
+ hcg | progesterone > 25
159
intervene ectopic pregnancy
fluids, Rhogam surgery if rupture methotrexate
160
contraindications for methotrexate after spontaneous abortion
unstable bleeding unreliable patient
161
methotrexate overview
cytotoxic don't handle if pregnant wear PPE, chemo gloves
162
pharm overview of methotrexate
interferes with DNA synthesis and disrupts cell multiplication
163
define placenta previa
implantation of placenta in lower uterine segment or over internal os
164
complications of placenta previa
placenta may bleed as fetus grows and uterus expands associated with life threatening hemorrhage, fetal loss
165
sx placenta previa
sudden, painless bleeding BRB maternal hemorrhagic shock
166
intervene placent previa
``` urgent ob consult recumbent position IVs, fluids CBC, T and S, Rh no vag exam until after US poss. C-section ```
167
define abruptio placentae
placental separation from uterine wall
168
pathophysiology of abruptio placentae
arterial vessel rupture hemorrhagic, hypovolemic shock inhibits oxygen, nutrient supply to fetus most common cause of fetal demise 2/2 maternal trauma
169
sx abruptio placentae
backache, painful contractions, abd pain uterine rigidity frank, dark-red vag bleeding or concealed bleeding maternal hemorrhagic shock abnormal fetal heart tones
170
lab results in abruptio placentae
elevated d-dimer | decreased platelets
171
intervene abruptio placentae
``` continuous fetal heart monitor OB transport high flow O2 fluids, transfusion emergent delivery ```
172
define hyperemesis gravidarum
intractable N/V, dehydration in pregnancy leading to electrolyte imbalances, malnutrition
173
causes of hyperemesis gravidarum
suspected elevated hcg
174
define preeclampsia
multisystem disorder associated with decreased oxygenation and perfusion
175
preeclampsia overview
associated with coagulopathies, liver fxn abnormalities characterized by gestational HTN, gestational proteinuria mild to severe uncommon postpartum
176
sx mild-moderate preeclampsia
``` SBP >140 or DBP >90 protineuria, oliguria edema weight gain 2+ lb/week HA, N epigastric, RUQ pain ```
177
sx severe preeclampsia
``` SBP>160, DBP>110 proteinuria >2g/24hr Cr > 1.2 platelets < 100,000 elevated LDH, ALT, AST persistent HA, visual disturbance, epigastric pain oliguria pulm edema ```
178
intervene preeclampsia
minimize stimulation antiHTN OB admit mag sulfate
179
administering mag sulfate for preeclampsia
loading dose VS q5 min neuro status qh monitor urine output
180
sx magnesium toxicity (in preeclampsia)
``` loss of patellar reflexes SOB, hypoxia CNS depression N treat w/ calcium gluconate ```
181
define HELLP syndrome
life threatening pregnancy complication considered as a variant of severe preeclampsia that involves liver
182
sx in HELLP
H - hemolysis EL - elevated liver enzymes LP - low platelets
183
define eclampsia
preeclampsia progressing to convulsive state
184
risks of eclampsia
delivery only cure at risk for up to 3 weeks postpartum
185
sx eclampsia
preeclampsia sx generalized SZs significant HTN decreased fetal HR
186
intevene eclampsia
``` ABCs, high flow continuous fetal monitor mag sulfate antiHTN meds OB admit ```
187
causes of obstetrical trauma
MVCs, falls, domestic violence
188
risks of obstetrical trauma
risk of death comparable for pregnant vs non pregnant risk of death for fetus 5-7x greater with traumatic injury
189
priority with obstetrical trauma
maternal resuscitation - provides fetus best chance of survival
190
complications of obstetrical trauma
``` placental abruption preterm labor uterine rupture fetal skull, liver injuries perimortem C-section deliery ```
191
assessing obstetrical trauma
fetal US doppler US for fetal HR monitor for min 4hours if pregnancy viable
192
intervene obsstetrical trauma
ABCs, trauma interventions left later recumbent position imaging
193
indicators of fetal stress/distress during obstetrical trauma
fetal HR > 160 or < 110 no FHR accels w/w/o contractions periodic FHR decels w/w/o contractions decreased fetal movement
194
intervene for fetal distress during obstetrical trauma
``` O2 life side, manually displace uterus to L fluids emergent C-section maternal steroid injection ```
195
mechanism of injury in uterine rupture
sudden deceleration severe abd compression
196
complications of uterine rupture
usually causes fetal demise < 1% of pregnant patients with major trauma
197
sx uterine rupture
``` sudden onset severe abd pain vag bleeding fetal parts outside uterus fetal bradycardia, asystole maternal hypovolemic shock ```
198
intervene uterine rupture
emergent C-section | possible hysterectomy
199
define preterm labor
regular contractions < 37 weeks gestation
200
complications of preterm labor
risk for preterm birth most common OB complication after trauma
201
sx preterm labor
``` contracts q10 min or less abd cramping, backache pelvic pressure change in vag discharge onset of vag bleeding ```
202
assessing preterm labor
pelvic exam fetal monitoring assess contractions
203
intervene preterm labor
terbutaline if viable at 20-35 weeks
204
sx emergent delivery
``` bloody show ruptured membranes frequent painful contractions bulging membranes crowning fetal head ```
205
mother statements during emergent delivery
desire to bear down, push need to have a BM "the baby is coming"
206
mother interventions for emergent deliery
low fowler, knees bent or side lying, buttocks raised clean perineum have mother pant to decrease chance of explosive delivery gentle pressure while delivering head assess membranes, nuchal cord, position and presentation direct head down to deliver anterior shoulder and up to deliver posterior shoulder
207
neonate interventions for emergent delivery
clamp cord 4-5 cm from abdomen and 4-5 cm towards mother 30 seconds after pulsating stops thoroughly dry- #1 assess breathing, suction gentle stimulation, resuscitation if not breathing APGAR at 1 and 5 min warm newborn
208
APGAR
``` appearance (color) pulse grimace (muscle tone) activity (reflex irritability) resp effort ```
209
0 points in APGAR
``` A: blue, pale P: absent HR G: limp A: absent activity R: absent resp effort ```
210
1 point in APGAR
``` A: pink body, blue extremities P: < 100 bpm G: some flexion A: some motion R: weak cry ```
211
2 points in APGAR
``` A: pink P: > 100 bpm G: good flexion A: good motion R: strong cry ```
212
APGAR scores indicating outcome
7-10: good 4-6: moderate 1-3: poor
213
define prolapsed cord
umbilical cord precedes the neonate out of vagina, reducing or eliminating blood flow
214
intervene prolapsed cord
``` knee-to-chest position insert hand to elevate fetal head do not handle or replace cord wrap exposed cord in saline gauze immediate C-section ```
215
characteristics of neonatal resuscitation
two-thumb encircling technique depress 1/2 AP diameter of chest chest recoil
216
meds for neonatal resuscitation
epi naloxone glucose IV fluids 10 ml/kg
217
define postpartum hemorrhage
excessive vaginal bleeding after delivery or abortion for up to 6 weeks
218
parameters of postpartum hemorrhage
losses > 500 ml w/in 24 hours of delivery primary postpartum hemorrhage is w/in 24 hours of delivery
219
four Ts of postpartum hemorrhage
tone - uterine atony trauma - vaginal, perineal, rectal tearing tissue - retained products thrombin - DIC
220
sx postpartum hemorrhage
``` steady BRB nausea pale, clammy skin soft, boggy uterus signs of shock ```
221
intervene postpartum hemorrhage
uterus massage manual pressure to lacs treat hemorrhagic shock oxytocin
222
define postpartum infection
fever > 24 hours and up to 10 days postpartum with confirmed infection
223
causes of postpartum infection
``` endometriosis laceration episiotomy surgical site infection retained uterine tissue UTI mastitis ```
224
sx postpartum infection
``` fever redness pain, tenderness foul smelling lochia drainage from surgical site erythema, pain, engorgement of breasts ```
225
risk factors for postpartum infection
delivery hx premature membrane rupture hx antepartum infection
226
intervene postpartum infection
fluids sepsis protocols abx

CEN (12 decks)

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