Presentation on theme: "Chapter 11 Trauma in Women zA: Anatomic y12 weeks - rise out of pelvis y20 weeks - at umbilicus y34-36 weeks - at the costal margin y2nd trimester- amniotic."— Presentation transcript:
Chapter 11 Trauma in Women zA: Anatomic y12 weeks - rise out of pelvis y20 weeks - at umbilicus y34-36 weeks - at the costal margin y2nd trimester- amniotic fluid embolism y3rd trimester- abruptio placentae
yB. Blood Volume and Composition y1.Volume: ml -signs of hypovolemia y2. Increased in WBC, fibrinogen, clotting factors y3. Decreased in Hb, PT, aPTT, albumin y4. Blood pressure falls 5-15 mmHg y in 2nd trimester y5. CVP is variable y6. ECG: flattened or inverted T waves y in leads II, III, AVF
yC. respiratory yIncreased in tidal volume yDecreased in residual volume yHypocapnea ( Pco2 of 30 mmHG) y in late pregnancy yD. Musculoskeletal y7th months: the symphysis pubis widens (4-8mm) y The sacroiliac-joint space increased
yMechanism of Injury yA. Blunt Injury y 1. Direct Injury y 2. Indirect Injury y Abrutio Placentae & Uterine Rupture y Seat belt: forward flexion and uterine compression yB. Penetrating Injury y Dense uterine musculature & Amnion y Low incidence of maternal visceral injury
zAssessment and Management yA: Primary Survey and Resuscitation y1. Maternal: Hyperventilation y inches elevation of right buttock y Fetus may be in shock before y maternal hypovolemia shock signs y Vasopressors - fetal hypoxia yB: Fetus: Uterine rupture y Abruptio placentae y Continued fetal heart tones y wks of gestation
zB. Adjuncts to primary survey yMaternal: yMonitor on her left side after physical examination yMonitor of the CVP response to fluid yMaternal bicarbonate is usually low yFetus: y20-24 wks heart tones: beats / min yContinous monitor with cardiotocodynamometry yConsultation if abnormal fetal heart rates y
zC. Secondary Assessment y1. DPL: perform above the umbilicus y Presence of uterine contractions y2.Vaginal Examination: y Amniotic fluid with PH of : y ruptured of chorioamniotic membrane y Bleeding in 3rd trimester: y disruption of placenta y impending fetal death yThe fetus may be in jeopardy even with apparent, minor maternal injury
zD. Definite Care yUterine rupture: shock or no s/s yPlacental abruptio: leading cause of fetal death y 30% no vaginal bleeding yAll pregnant Rh-negative trauma patient should considered for RH immunoglobulin therapy. yInitial management is directed at resuscitation and stabilization of the pregnant patient. yPerimortem c/s may be successful if it is done within 4-5 mins arrest.
zRadiography in Pregnant Women yNo fetus risk: rad. yThe maximum risk attributable to 10 rad of exposure is approx. 0.1 % yAfter 20th weeks of gestation: cause no fetal abnormalities. yRoutine C-spine, CXR, Pelvis obtained with shielding: negligible fetal exposure yCT beam in direct line to fetus: rad. yCT scan above uterus: < 3 rad to fetus.
zRadiography to fetus varies: y1. The type of study y2. The size of patient y3. Position of the fetus y4. Type of machine y5. Method of shielding y6. The number of section obtained y7. Fetal/uterine size y8. Coned x-ray beam aimed > 10 cm away from y fetus are not dangerous.
Estimated Radiation Dose to the Pelvic Uterus/ Radiography xType of examination Dose (mrad) xLow dose group xHead < 1 xC- spine < 1 xT-Spine < 1 xCXR < 1 xExtremities < 1 xHigh Dose Group xL-spine xPelvis xHip and Femoral ( proximal) xIVP xUrethrocystography 1500 xAbdomen ( KUB)
Upper-Limit Fetal Dose From Angiography and CT Scan Studies zType of examination Dose (mrad) zAngiography zCerebral < 100 zCardiac Cath < 500 zAortography < 100 zCT scanning zHead ( 1 cm slices) < 50 zChest ( 1 cm slices) < 1000 zUpper abdomen( 20 1-cm slices < 3000 z> 2.5 cm from uterus) zLower Abdomen ( 10 1-cm slices zdirectly over the uterus/fetus