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ATLS > Trauma in pregnancy and intimate partner violence > Flashcards

Trauma in pregnancy and intimate partner violence Flashcards

1
Q

Best initial treatment for the foetus

A

Resuscitation of the mother

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2
Q

Specific risks during pregnancy trauma

A

Amniotic fluid entering maternal intravascular space

Foetal risk from maternal pelvic fracture

Placental abruption due to lack of placental elasticity

Placental vasculature sensitivity to decrease in maternal intravascular volume

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3
Q

Increased blood components during pregnancy

A

Plasma volume

RBC volume

WCC

Fibrinogen and clotting factors

Arterial pH

PaO2

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4
Q

Gestation at which plasma volume plateaus

A

34 weeks

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5
Q

Decreased blood components during pregnancy

A

Haematocrit (physiological anaemia of pregnancy)

PT and APTT times
(but bleeding and clotting times unchanged)

Bicarbonate

PaCO2

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6
Q

Arterial pH range during pregnancy

vs non pregnant patients

A

7.40 - 7.45

(vs 7.35 - 7.45 in non pregnant pts)

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7
Q

Bicarbonate range during pregnancy

vs non pregnant patients

A

17 - 22

(vs 22 - 28 in non pregnant pts)

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8
Q

Changes to cardiac output during pregnancy

A

Increased due to increased plasma volume

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9
Q

Effect on cardiac output of laying supine in pregnancy

A

Reduced CO by up to 30% due to compression of vena cava

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10
Q

Changes to HR during pregnancy

A

Increases by up to 15 bpm over baseline by third trimester

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11
Q

Changes to ECG during pregnancy

A

Left axis deviation
TWI III and AVF
Ectopic beats

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12
Q

Changes to BP during pregnancy

A

Decreased in second trimester
Returns to near normal at term

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13
Q

Causes of reduced PaCO2 in pregnancy

A

Increased minute ventilation

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14
Q

Implication of upper limit of normal PaCO2 in pregnancy

A

Impending respiratory failure

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15
Q

Changes to GFR and renal blood flow during pregnancy

A

Increase

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16
Q

Changes to serum creatinine and urea during pregnancy

A

Decreased to around half of pre-pregnancy levels

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17
Q

Changes to MSK system during pregnancy

A

Widening of pubic symphysis and sacroiliac joints

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18
Q

Risk of unrestrained RTC during pregnancy

A

Increased risk of premature delivery and foetal death

19
Q

Risk of lap belt alone during pregnancy

A

Uterine rupture or placental abruption

20
Q

Risk of full seat belt - shoulder and lap restraints

A

Reduces foetal injury

21
Q

Effects of pregnancy on penetrating injury to abdomen

A

Better outcomes for mother (other abdo viscera protected by uterus)

Worse outcomes for foetus

22
Q

Specific blood tests to perform in pregnant patients

23
Q

Specific treatment to give all Rh negative mothers in pregnant trauma

A

Rh immunoglobulin (Anti-D)

24
Q

Timing of administration of Rh immunoglobulin therapy

A

Within 72 hours of injury

25
Changes to radiological investigations in pregnancy trauma
Careful considerations due to foetal risk but if required still perform
26
Positioning of pregnant patients
Left lateral lie Manual left displacement of uterus
27
Left lateral position
Restrict motion of spinal board at 15 - 30 degrees to left using bolstering device
28
Implication of normal fibrinogen level in pregnancy
Possible early DIC
29
Signs of placental abruption
PV bleeding Abdo cramps Hypovolaemia Uterine tenderness Uterine tetany Frequent contractions
30
Risk factors for foetal loss
Maternal HR > 110 Placental abruption Foetal HR >160 or <120 Injury severity score >9 Ejection from RTC
31
Signs of uterine rupture
Abdo tenderness Guarding / rigidity Abdominal foetal lie Easy palpation of foetal parts / extremities No palpable fundus
32
Alterations to diagnostic peritoneal lavage in pregnant trauma patients
Above level of umbilicus Open technique
33
Vaginal pH above 4.5 implication
Presence of amniotic fluid
34
Radiation dose of CT abdo/pelvis
25 mGy
35
Radiation dose threshold associated with foetal abnormalities / higher risk of foetal loss
>= 50 mGy
36
Use of CT in pregnant trauma patients
Can be used if there is significant concern for intra-abdominal injury
37
Criteria for hypertension in pregnancy
> 140 systolic > 90 diastolic
38
Criteria to treat hypertension in pregnancy
> 160 systolic > 110 diastolic
39
Treatment of hypertension in pregnancy
Labetalol 10-20 mg IV bolus
40
Abx used in pregnancy trauma
Ceftriaxone Clindamycin if penicillin allergy
41
Antiemetics used in pregnancy trauma
Metoclopramide Ondansetron
42
Treatment of eclamptic seizure
Magnesium Sulfate 4-6 g IV over 15 mins
43
Treatment of non-eclamptic seizure
Lorazepam 1-2 mg per minute IV

ATLS (14 decks)

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