Pregnant casualties

Question 1

Why do pregnant women have reduced residual volume and functional residual volume?

Answer 1

Pregnancy pushes on the diaphragm upwards causing lungs to shorten. Rib flaring and ligamentous relaxation compensates for this

Question 2

What impact does decreased residual volume and functional residual volume have in a pre-hospital setting?

Answer 2

Predispose to hypoxia and feeling SOB. Also pre-disposes to atelectasis

Question 3

What impact does the increased oxygen requirements of pregnant women have in a pre-hospital setting?

Answer 3

Require increased ventilation with early high-flow oxygen required

Question 4

What impact does the increased tidal volume and respiratory rate of pregnant women have in a pre-hospital setting?

Answer 4

Causes chronic hyperventilatory state and a compensated respiratory alklaosis

Question 5

Why does cardiac output and circulating volume increase, whilst peripheral vascular resistance decrease during pregnancy?

Answer 5

Catecholamine release at the end of the second trimester leads to an increased cardiac output, while progesterone in the second and third
trimester causes a relative resistance to renin and angiotensin II leading to vasodilation

Question 6

What impact does increased CO and circulating volume and decreased vascular resistance in pregnant women have in a pre-hospital setting?

Answer 6

This can mask hypovolemia, meaning a pregnant lady can lose up to 35% of blood volume before showing signs of hypovolemia

Question 7

What impact does a pregnant abdomen have in a pre-hosptial setting?

Answer 7

Can mask the signs of intraperitoneal injury - including peritoneal signs such as guarding, rigidity and rebound tenderness

Question 8

What impact does decreased GO sphincter control, delayed gastric emptying and increased gastric pressure in pregnant women have in a pre-hospital setting?

Answer 8

Increased risk of aspiration

Question 9

What impact does the risk of aortocaval compression in pregnant women have in a prehospital setting?

Answer 9

Have to treat patients in left lateral position - 15 degrees

Question 10

How would you put a pregnant woman with a suspected spinal injury in the left lateral position?

Answer 10

Secured to backboard and tilt backboard with sandbags

Question 11

How much can cardiac output drop by if a pregnant patient is not put in the left lateral position?`

Answer 11

30-40%

Question 12

When is CPR less likely to be successful in a pregnant woman?

Answer 12

Those who are 20 weeks pregnant or more

Question 13

Can CPR be conducted in left lateral position?

Answer 13

Yes

Question 14

What are important aspects of a secondary survey in a pregnant woman?

Answer 14

Complete examination of the pregnancy including:

• Full obstetric history
• Foetal assessment including fundal height, which may be enlarged in intrauterine bleeding
• Heart rate, which should be between 110-160bpm
• Feel for presence of uterine contractions and foetal movements