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International Trauma Life Support for Emergency Care Providers CHAPTER seventh edition Trauma in Pregnancy 19.

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Presentation on theme: "International Trauma Life Support for Emergency Care Providers CHAPTER seventh edition Trauma in Pregnancy 19."— Presentation transcript:

1 International Trauma Life Support for Emergency Care Providers CHAPTER seventh edition Trauma in Pregnancy 19

2 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Trauma in Pregnancy Courtesy of Bonnie U. Gruenberg

3 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Overview Dual goals in managing pregnant trauma Physiological changes of pregnancy –Response to hypovolemia Types of injuries most commonly associated Initial assessment and management Trauma prevention in pregnancy

4 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Trauma in Pregnancy Unique challenges –Vulnerability of pregnant trauma patient –Potential injuries to unborn child Dual roles –Provide care to mother –Provide care to fetus

5 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Trauma in Pregnancy Leading cause of morbidity and mortality –6–7% of pregnancies experience some trauma  1 in 12 injured experience significant trauma –Major causes  Motor-vehicle collisions  Falls  Abuse and domestic violence  Penetrating injuries  Burns

6 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Pregnant Patient Increased risk for trauma –Fainting spells, hyperventilation, excess fatigue commonly associated with early pregnancy –Balance and coordination affected by changes throughout pregnancy

7 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Fetal Development

8 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Viability Assessment

9 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Physiologic Changes

10 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Physiologic Changes Respiratory system –Diaphragm elevated due to uterine size –Decreased thoracic volume –Relative alkalosis –Predisposed to hyperventilation

11 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Vital Signs in Pregnancy Do not mistake normal vital signs for signs of shock. –Normal pulse: 10–15 beats faster –Blood pressure: 10–15 mmHg lower –30–35% blood loss before significant blood pressure change Be alert to all signs of shock –Frequent ITLS Ongoing Exams

12 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Response to Hypovolemia Vasoconstriction and tachycardia –Reduction of uterine blood flow by 20–30% –Fetal heart rate and blood flow decrease –Fetus becomes hypoxemic High-flow oxygen is essential –Maternal shock has 80% fetal mortality rate

13 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Trauma in Pregnancy ITLS Primary and Secondary Surveys Optimize maternal and fetal outcome –High-flow oxygen rapidly administered  Fetal hypoxia occurs before maternal hypoxia –Fluid administration must be prompt  Fluid volume needed is greater –Frequent Ongoing Exams  Mortality of fetus related to maternal treatment

14 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Pregnant Trauma Arrest Treated same as for other victims –Defibrillation settings are same –Drug dosages are same –Fluid volume needed increases  4 liters normal saline rapid infusion during transport If mother unsalvageable: –Continue CPR –Notify hospital of possible cesarean section

15 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Supine Hypotension Venous return decreases 30% in supine position with 20-week or larger uterus –Acute hypotension –Syncope –Fetal bradycardia

16 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Supine Hypotension Transport position –Tilt or rotate backboard 15–30° to patient's left –Elevate right hip 4–6 inches (10–15 cm) with towel  Manually displace uterus to left Courtesy of Louis B. Mallory, MBA, REMT-P

17 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Supine Hypotension Transport position –Better stabilized with vacuum backboard –More comfortable than standard backboard © Pearson

18 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Evaluation of Uterine Size

19 International Trauma Life Support for Prehospital Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Relatively minor abdominal trauma can cause fetal death. Maternal death is most common cause of fetal death. Relatively minor abdominal trauma can cause fetal death. Maternal death is most common cause of fetal death. Fetal Death

20 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Types of Trauma Motor-vehicle collisions Penetrating injuries Domestic violence Falls Burns

21 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Motor-Vehicle Collisions 65–75% of pregnancy-related trauma –<1% injured when minor vehicle damage –Seatbelts significantly decrease mortality  Have not shown any increase in uterine injury Courtesy of Louis B. Mallory, MBA, REMT-P

22 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Motor-Vehicle Collisions Maternal death –Head injury  Most common –Uncontrolled hemorrhage  Second most common  Assess pelvis Fetal injury –Fetal distress –Fetal death –Placental abruption –Uterine rupture –Preterm labor

23 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Abdominal Trauma Physiologic changes –Decreased sensitivity  Gradual stretching  Hormonal changes  Uterus very vascular Clinical presentation –Guarding, rigidity, rebound response absent  Abdominal trauma requires ED evaluation

24 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Penetrating Injuries Gunshot wounds and stabbings –Entry below fundus  Uterus absorbs force, protects maternal organs  High fetal mortality rate: 40–70%  Lower maternal mortality rate: 4–10% –Entry above fundus  Bowel injury due to displacement

25 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Domestic Violence 10% experience abuse during pregnancy –Proximal and midline injuries  Face and neck most common –Low birth weight –Abused by spouse or boyfriend: 70–85% (U.S.)

26 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Falls Injury from falls –Increase with progression of pregnancy  Center of gravity altered –Proportionate to force and body part impacted –Pelvic injuries  Placental separation  Fetal fractures

27 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Burns Fluid volume needed increases –Mortality and morbidity  Maternal mortality same as non-pregnant  Fetal mortality increases with >20% BSA

28 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Trauma Prevention Proper seat-belt use Report domestic violence Counseling for domestic violence Patient education –Multiple changes associated with pregnancy  Physiological, anatomical, emotional

29 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Summary Trauma in pregnancy –Knowledge of physiological changes  Hypotension and hemorrhage easily overlooked –Rapid evaluation and interventions to stabilize  Aggressive oxygen administration  Aggressive fluid resuscitation –Prevent supine hypotension Fetal care depends on maternal care


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