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1. Trauma in PregnancyEMS ProfessionsTemple College
2. 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
3. Trauma in Pregnancy Unique challenge for the provider
Two Patients each with unique needs
All female patients are pregnant until proven otherwise
4. Changes During Pregnancy
5. 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%)
6. Respiratory Respiratory rate may ? due to upward pressure of uterus on diaphragm
? Respiratory rate may ? PCO2
? Tidal volume and minute ventilation in late pregnancy
7. GI/GU Delayed gastric emptying
Movement of abdominal organs
intestines
bladder
Uterus is the largest abdominal organ
Placenta
8. 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
9. Mechanism of Injury Motor Vehicle Collisions
Penetrating Injuries
Falls
Burns
10. Assessment Mother
Initial
Rapid Trauma Assessment/ Focused Assessment
Fetus
Abdominal tenderness, guarding, rigidity, rebound tenderness
Uterus
Abnormal fetal position
Fundus
Fetal body
Contractions/Tetany
11. 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
12. 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