Transcript of 13 Trauma in Pregnancy - Copy
• PathophysiologyPathophysiology
TRAUMA PATIENTTRAUMA PATIENT
– Mother
– Fetus
– Support mother
OF PREGNANCY OF PREGNANCY
• Changes related to gestationalChanges related to gestational
ageage
• Major shift of circulatory systemMajor shift of circulatory
system to provide blood flow to uterusto provide blood flow to
uterus
• Mother at more riskMother at more risk
– Inre!sed ris" of in#ury
– $ess !%&e to ompens!te for sho"
Y CHANGES Y CHANGES
• PulsePulse increasesincreases by %!"%&by %!"%&
beats'minutebeats'minute
• (P(P decreasesdecreases by %!"%&mm)gby
%!"%&mm)g
• Increased resting respiratory rateIncreased resting respiratory
rate
• Increased red cell volumeIncreased red cell volume
• (lood volume increases *&"&!$(lood volume increases
*&"&!$
• ++Anemia of Pregnancy,Anemia of Pregnancy,
– Rise in p&!sm! 'o&ume is (re!ter th!n the rise in
red e&& 'o&ume
– Resu&ts in ! )re&!ti'e* !nemi!
– Inre!sed ris" of 'omitin( !nd !spir!tion
• .terus becomes the largest.terus becomes the largest abdominal
organabdominal organ
CHANGESCHANGES
• (ladder is displaced upward and(ladder is displaced upward and
forward by enlarging uterusforward by enlarging uterus
UTERUSUTERUS CHANGES IN THECHANGES IN THE
UTERUSUTERUS
– Nonpre(n!nt + ,- !rdi! output
– Pre(n!nt + ,.- !rdi! output
– Ris" fet!& hypo2i! !nd de!th
SUPINESUPINE
HYPOTENSIONHYPOTENSION
SYNDROMESYNDROME
• The enlarging uterus canThe enlarging uterus can compress the
inferior vena cavacompress the inferior vena cava when the mother
is in the supinewhen the mother is in the supine
positionposition
– Redues 'enous return !nd !rdi! output %y up to 0.-
CAUSECAUSE
CAUSECAUSE
TRAUMA PATIENTSTRAUMA PATIENTS PACKAGING OF PREGNANTPACKAGING OF
PREGNANT
TRAUMA PATIENTSTRAUMA PATIENTS
• Tilt backboard !"#! degrees to theTilt backboard !"#! degrees to
the leftleft
• May manually displace the uterus toMay manually displace the
uterus to the left but not as effectivethe left but not as
effective
• Assessment se3uence same as forAssessment se3uence same as for
nonpregnant patientsnonpregnant patients
– 3T$S Prim!ry Sur'ey
– 4et!i&ed E2!m
NORMAL VITALNORMAL VITAL
SIGNS INSIGNS IN
PREGNANCY FORPREGNANCY FOR
NORMAL VITALNORMAL VITAL
SIGNS INSIGNS IN
PREGNANCY FORPREGNANCY FOR
• Pulse is %!"%& beats'min4 faster Pulse is %!"%&
beats'min4 faster
• (P is %!"%&mm)g lower (P is %!"%&mm)g
lower
PREGNANCY PREGNANCY
• Can lose #!$ of blood volumeCan lose #!$ of blood volume before
having significant changebefore having significant change in (Pin
(P
• Can have significant occultCan have significant occult
intrauterine or abdominal bleedingintrauterine or abdominal
bleeding
– Uterus is 'ery '!su&!r
• Transport with full spinalTransport with full spinal
packagingpackaging
– Ti&t %!"%o!rd to the &eft
• Treat specific injuriesTreat specific injuries
SHOCK SHOCK
– T1o &!r(e %ore I6s of NS or R$
• May re3uire larger volume ofMay re3uire larger volume of fluids
for resuscitationfluids for resuscitation
– 3&ood shou&d %e (i'en e!r&y
• Manage same as the nonpregnantManage same as the nonpregnant
patientpatient
• Perform CP9Perform CP9
• Physiologic changes increase the riskPhysiologic changes increase
the risk of injury and shockof injury and shock
• Treat shock earlyTreat shock early
• Prevent and treat hypo5iaPrevent and treat hypo5ia
• Prevent supine hypotension syndromePrevent supine hypotension
syndrome
• 1re3uent reassessment1re3uent reassessment