Trauma in Pregnancy

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Added: October 18, 2008 This Presentation is Public 
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Trauma in PregnancyEMS ProfessionsTemple College :Trauma in PregnancyEMS ProfessionsTemple College


Morbidity & Mortality Rates :Morbidity & Mortality Rates Accidental Injury complicates 6-7% of all pregnancies. Most common cause of death of fetus is the death of the mother fetal death with maternal survival occurs with placental seperation or ruptured uterus fetal skull fractures are more common than maternal pelvic fractures


Trauma in Pregnancy :Trauma in Pregnancy Unique challenge for the provider Two Patients each with unique needs All female patients are pregnant until proven otherwise


Changes During Pregnancy :Changes During Pregnancy


Cardiovascular :Cardiovascular Cardiac output increase 20 - 30 % Heart rate increases by 10 - 15 bpm Systolic and Diastolic pressure decrease 10 -15 mmHg “Hypervolemia” of pregnancy  red blood cells and plasma (45%) relative anemia (greater  of plasma than RBC) Increased blood flow to uterus (2% to 20%)


Respiratory :Respiratory Respiratory rate may  due to upward pressure of uterus on diaphragm  Respiratory rate may  PCO2  Tidal volume and minute ventilation in late pregnancy


GI/GU :GI/GU Delayed gastric emptying Movement of abdominal organs intestines bladder Uterus is the largest abdominal organ Placenta


Shock :Shock Body protects the mother uterine vasoconstriction (20-30%) decreased blood flow to fetus Loss of 30 - 35% blood volume before developing hypotension Slower onset of sign/symptoms


Mechanism of Injury :Mechanism of Injury Motor Vehicle Collisions Penetrating Injuries Falls Burns


Assessment :Assessment Mother Initial Rapid Trauma Assessment/ Focused Assessment Fetus Abdominal tenderness, guarding, rigidity, rebound tenderness Uterus Abnormal fetal position Fundus Fetal body Contractions/Tetany


Management :Management C-Spine Motion Restriction IF indicated Airway Assist ventilations if needed High flow O2 O2 requirements 10 - 20 % greater Control External Bleeding Transport on left side to appropriate Facility


Management :Management En route Treat shock MAST/PASG application w/o inflation May be helpful in pelvic fracture IV of LR/NS enroute Titrate fluids to BP ~ 90 - 100mm Hg Aggressive fluid therapy