Chapter 16, The Pregnant Trauma Patient Flashcards
Who should be considered pregnant?
Every woman of reproductive age until confirmed by pregnancy test or US.
What is the most common injury resulting in fetal death?
Pelvic fractures
What is the most common cause of maternal death due to trauma?
Hemorrhage
What is the most common cause of fetal death?
Maternal death.
Are pregnant women at risk to experience violent trauma?
Yes.
Twice as likely.
What are some cardiovascular changes that occur during pregnancy?
Total blood volume increases
Resting HR increases 10-20 BPM
Increased estrogen & progesterone causing vasodilation
Supine hypotension syndrome (aortocaval compression)
ECG changes (ectopy, inverted T waves, ST Segment depression, left axis shift of QRS)
Increased blood flow to uterus and placenta (engorged pelvic vessels)
What are some respiratory changes that occur in pregnancy?
Increased minute ventilation (d/t respiratory rate increase and tidal volume decrease)
Oxygen consumption increases
Respiratory alkalosis
Why is the pregnant patient at higher risk for thromboembolism and DIC?
Increased fibrinogen levels and clotting factors.
What is a normal fetal heart rate?
120-160 BPM
What is the incidence of preterm labor in the pregnant trauma patient?
Occurs in 25% of patients.
What should the nurse document regarding rupture of membranes?
Date and time of rupture.
What is the triad of abruptio placentae?
Vaginal bleeding
Abdominal pain
Uterine irritability
What fetal HR should increase suspicion of abruptio placentae?
Fetal HR < 110 or > 160 BPM.
What are the priorities for pregnant women in cardiac arrest?
High quality CPR
Relief of aortocaval compression with lateral uterine displacement
ID and address the cause
How should the caregiver manually displace the uterus during chest compressions when the pregnant patient is greater than 20 weeks gestation?
Displace uterus to the left and upward.
Why is the pregnant patient at higher risk for upper airway edema?
Estrogen-mediated fluid retention.
Is cricoid pressure recommended in the pregnant patient?
Yes.
What should be done prior to intubation because of altered respiratory physiology?
Adequate preoxygenation.
What is the recommended oxygen saturation to ensure adequate fetal oxygenation?
≥ 96%
Where should chest tube placement occur on the pregnant patient?
1-2 intercostal spaces higher in the 3rd or 4th intercostal space and anterior to the midaxillary line.
How should the pregnant patient be positioned to maximize circulation?
On the side.
Left lateral position is preferred.
At what gestation should fetal heart rate and uterine contractions be monitored?
> 20 weeks gestation.
In the event of altered level of consciousness or seizure, what should be evaluated in addition to maternal head injury?
Eclampsia.
What can D also stand for in the pregnant patient?
Displacement.
What vaginal fluid pH is suggestive of amniotic fluid?
PH of > 4.5
When should RhoGAM be administered?
Within 72 hours in pregnant trauma patients who are Rh negative and at risk of fetal-maternal hemorrhage.
How long should cardiotocographic monitoring be in place for women of greater than 20 weeks gestation who experience trauma?
A minimum of 6 hours.
