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Operational Obstetrics & Gynecology The Health Care of Women in Military Settings. Captain Mike Hughey, MC, USNR. Operational Medicine is not Identical to Civilian Medicine. Isolated Settings. Minimal Support Limited Consultation Long MEDEVAC times. Limited Resources. - PowerPoint PPT Presentation
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Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 1
Operational Obstetrics & GynecologyThe Health Care of Women in Military Settings
Captain Mike Hughey, MC, USNR
Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 2
Operational Medicine is not Identical to Civilian Medicine
Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 3
Isolated Settings
• Minimal Support• Limited Consultation• Long MEDEVAC times
Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 4
Limited Resources
• What did you bring with you?
• Resupply? Maybe• Whatever you use up today
you won’t have tomorrow.• IV antibiotics often mean
transfer.
Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 5
Operational Commitments
• Medical care is not the first priority.• It may not be the second priority
either.
Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 6
Then sometimes, medical care is the mission
• Medical personnel, supplies and equipment for combat are different than those used for humanitarian missions.
• Before deployment, learn as much as you can about everything.
Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 7
Field Expedient GYN Exam Table
• Litter• Litter Stands• IV Poles• Small Battle Dressings
Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 8
Field Expedient Vaginal Speculum
• GI mess kit spoons (2) bent at 45° angle, or
• Two spoons joined by rubber band
Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 9
Ectopic Pregnancy ManagementNaval Hospital Pensacola FL
• Transvaginal ultrasound• Quantitative HCG• Serial hgb• Laparoscopy• Methotrexate• Blood bank
Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 10
Ectopic Pregnancy Management
Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 11
• Laparotomy (sometimes)
Non-surgical management• IV fluids• Mast suit• Donor-to-victim blood
transfusion
Ectopic Pregnancy ManagementOperational Setting
Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 12
Field Expedient Vaginitis Rx
• If it itches, it’s yeast. (Monistat)• If it smells bad, it’s BV. (Flagyl)
Dry, curdy, yeast
Mucopurulent, chlamydia
Bubbly, frothy, trichomonas
Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 13
Urinary Tract Infections
• Treat UTI’s based on symptoms.
• Cultures and dipsticks in many operational settings are, at best a waste of time, and may be misleading and dangerous.
Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 14
Unknown Lesions of the Vulva• Each of these requires some unavailable test to
confirm the diagnosis. • What is the test for each of them?
Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 15
Bartholin Duct Cyst and Abscess
• Drain it or leave it alone?
Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 16
Draining a Bartholin Cyst
Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 17
Operational Obstetrics & Gynecology
Operational Obstetrics & Gynecology - CAPT Mike Hughey, MC, USNR Slide 18