NREMT Paramedic Cognitive ExamMedicalMedium
A 28-year-old female presents with severe abdominal pain, nausea, and vomiting. She states her last menstrual period was 8 weeks ago and she had a positive home pregnancy test. On examination, she is pale, diaphoretic, and her abdomen is tender to palpation in the lower quadrants, particularly on the left. Her vital signs are BP 90/60 mmHg, HR 120 bpm, RR 22 breaths/min. What is the MOST critical immediate intervention?
- AObtain a detailed gynecological history.
- BAdminister pain medication.
- CAdminister antiemetic medication.
- DInitiate rapid intravenous fluid resuscitation.
Show answer & explanationAnswer & explanation
Correct answer: D. Initiate rapid intravenous fluid resuscitation.
The patient's presentation with severe abdominal pain, amenorrhea with a positive pregnancy test, and signs of hypovolemic shock (tachycardia, hypotension, pallor, diaphoresis) strongly suggests a ruptured ectopic pregnancy. Rapid intravenous fluid resuscitation is critical to address the hypovolemia and stabilize her before definitive surgical intervention.
Why the other options are wrong
- A. While a detailed history is important, it should not delay life-saving interventions for a patient in shock.
- B. Pain medication can be given after stabilization, but addressing the shock is the immediate priority.
- C. Antiemetics may relieve symptoms but do not address the underlying life-threatening hypovolemia.
Ruptured Ectopic Pregnancy
A ruptured ectopic pregnancy is a life-threatening condition where a fertilized egg implants outside the uterus, typically in the fallopian tube, and ruptures, causing significant internal hemorrhage.
- Classic triad: abdominal pain, amenorrhea, vaginal bleeding (though bleeding may be internal).
- Presents with signs of hypovolemic shock if ruptured.
- Requires immediate surgical intervention and fluid resuscitation.
Memory trick: Pregnant, pain, pale? Push fluids fast!