Читать книгу Emergency Medical Services - Группа авторов - Страница 435

Females of childbearing age represent a particular challenge because the number of problems that cause abdominal pain in this population must be expanded to include conditions involving the pelvic organs. Specifically, ectopic pregnancy, ovarian torsion, ruptured ovarian cyst, and tubo‐ovarian abscess (TOA) as a consequence of pelvic inflammatory disease are significant causes of pain in this population. The difficulty in evaluating these possibilities lies in the fact that neither pelvic examination nor pregnancy testing are routinely available in the prehospital setting. Many patients do not know they are pregnant, and the physical exam is not reliable in establishing the diagnosis of pregnancy.

Ectopic pregnancy is one of the leading causes of pregnancy‐related deaths in women. Hemorrhagic shock from a ruptured ectopic pregnancy should be considered in any female of appropriate age with hypotension and abdominal pain. A past history of PID, known tubal pregnancy, prior tubal surgery, or intrauterine device use increases the likelihood of ectopic pregnancy.

Pelvic pain caused by ovarian torsion tends to be sudden in onset in reproductive‐age females. It is typically described as sharp and knife‐like. Right‐sided torsion is more common. The signs and symptoms of a ruptured ovarian cyst are difficult to distinguish from torsion. TOA occurs in approximately 1%‐4% of patients with PID [39]. The pain is more insidious in onset, and rupture of the abscess causes signs of peritonitis. Rupture of a TOA carries a mortality of approximately 10% [40].