Pregnant Patient Considerations For Medications Commonly Used In Trauma Care

Physiologic Changes in Pregnancy

Management Of The Pregnant Trauma Patient: Risk Management Pitfalls

Risk Management Pitfalls:

1. Failing to obtain a pregnancy test in any woman of childbearing age. A female trauma patient may be either unaware or unable to communicate that she is pregnant. A positive pregnancy test has important impli­cations for the subsequent management of the patient including avoiding unnecessary radia­tion, monitoring the fetus, and assessment of potential pregnancy complications.

2. Leaving a trauma patient in the later stages of pregnancy in a supine position. After 20 weeks, the gravid uterus can compress the vena cava, which reduces cardiac output and results in hypotension, when the patient is positioned on her back. reducing cardiac output with resulting hypotension.

3. Failing to anticipate a difficult airway when intubating a pregnant trauma patient. Pregnant patients present a potentially difficult airway for several reasons including soft tis­sue edema, decreased pulmonary reserves, and increased aspiration risk.

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Management Of The Pregnant Trauma Patient: Case Study

Case Study:

 A radio call interrupts your otherwise routine night shift. The EMS driver reports, “We are en route to your emergency department with a 31-year-old female, G2P1 at 33 weeks, belted driver, in a moderate-speed motor vehicle collision. Patient’s car was heavily damaged in the front, and the airbag did deploy. Following a brief loss of consciousness, patient is now awake but slightly confused. She has an obvious deformity of the right ankle and is complaining of lower abdominal pain and mild shortness of breath. Patient’s vital signs are as follows: heart rate is 110 and BP is 100/45. Our arrival time to your facility is approximately 3 minutes.” You now have 3 minutes to collect your thoughts and prepare your team for what is sure to be a challenging resuscitation.

Case Study Conclusion:

Upon arrival to the ED, your patient is awake and protecting her airway. Two 14-gauge IV catheters are placed and she is given 2 liters of crystalloid. The patient’s initial blood pressure is 90 /40 systolic; a nurse manually displaces the uterus to the left, and the next pressure is 105/60. A portable chest x-ray reveals a 30% pneumothorax on the patient’s right side. A chest tube is placed in the right 4th intercostal space. OB-GYN is consulted upon the patient’s arrival and a cardiac toco monitor is placed. The fetal heart rate pattern is reassuring, but a couple of uterine contrac-tions are noted. The patient has no appreciable abdomi¬nal tenderness, and a bedside FAST exam reveals no intraperitoneal hemorrhage. Vaginal exam reveals no evidence of bleeding or amniotic fluid. Given the loss of consciousness, the patient has a CT of the head which is negative, and a right ankle film reveals a right tib/fib fracture which is splinted. The patient receives pain medication and a dose of Rhogam is administered. She is admitted to the hospital and after a 24-hour period of monitoring reveals no other uterine contrac¬tions, she is taken to the operating room for repair of her ankle fracture. She is discharged from the hospital 5 days later and delivers a healthy baby 6 weeks later.

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