• 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