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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

A

Rh status

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
Q

Changes to radiological investigations in pregnancy trauma

A

Careful considerations due to foetal risk but if required still perform

26
Q

Positioning of pregnant patients

A

Left lateral lie
Manual left displacement of uterus

27
Q

Left lateral position

A

Restrict motion of spinal board at 15 - 30 degrees to left using bolstering device

28
Q

Implication of normal fibrinogen level in pregnancy

A

Possible early DIC

29
Q

Signs of placental abruption

A

PV bleeding
Abdo cramps
Hypovolaemia
Uterine tenderness
Uterine tetany
Frequent contractions

30
Q

Risk factors for foetal loss

A

Maternal HR > 110
Placental abruption
Foetal HR >160 or <120
Injury severity score >9
Ejection from RTC

31
Q

Signs of uterine rupture

A

Abdo tenderness
Guarding / rigidity
Abdominal foetal lie
Easy palpation of foetal parts / extremities
No palpable fundus

32
Q

Alterations to diagnostic peritoneal lavage in pregnant trauma patients

A

Above level of umbilicus
Open technique

33
Q

Vaginal pH above 4.5 implication

A

Presence of amniotic fluid

34
Q

Radiation dose of CT abdo/pelvis

A

25 mGy

35
Q

Radiation dose threshold associated with foetal abnormalities / higher risk of foetal loss

A

> = 50 mGy

36
Q

Use of CT in pregnant trauma patients

A

Can be used if there is significant concern for intra-abdominal injury

37
Q

Criteria for hypertension in pregnancy

A

> 140 systolic
90 diastolic

38
Q

Criteria to treat hypertension in pregnancy

A

> 160 systolic
110 diastolic

39
Q

Treatment of hypertension in pregnancy

A

Labetalol 10-20 mg IV bolus

40
Q

Abx used in pregnancy trauma

A

Ceftriaxone
Clindamycin if penicillin allergy

41
Q

Antiemetics used in pregnancy trauma

A

Metoclopramide
Ondansetron

42
Q

Treatment of eclamptic seizure

A

Magnesium Sulfate 4-6 g IV over 15 mins

43
Q

Treatment of non-eclamptic seizure

A

Lorazepam 1-2 mg per minute IV

ATLS (14 decks)

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