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ATLS in Woman
ATLS in Woman
ATLS in Woman
Introduction
Any female patient between ages of 10 and 50 years
can be pregnant.
Penetrating trauma
Penetrating trauma to upper
abdomen result in complex intestinal injury
Cardiac output : increase plasma volume and decrease PVR of the uterus and
placenta
HR : Consider when interpreting tachycardia response to hypovolemia BP during second trimester Supine hypotension syndrome : compression of IVC Variable CVP, response to volume is the same as in the nonpregnant state
Diaphragm elevate : reduce residual volume Increase inspiratory capacity FVC slightly change Increase O2 consumption
Mechanism of Injury
abdominal wall, uterine myometrium,
amniotic fluid buffer
Blunt Injury
Incidence
Mechanism of Injury
Collisions
Unrestrained pregnant women
higher risk of premature delivery and fetal
death
Blunt Injury
Restrain
Lap belt alone
forward flexion and uterine compression Uterine rupture or abruptio placentae
Mechanism of Injury
Blunt Injury
Mechanism of Injury
enetrating Injury
Enlarged gravid uterus
other viscera injury uterine injury
Severity of Injury
Determine
Maternal and fetal outcome Treatment method
Major injury typically associated with fetal injury admit to facility with trauma + obstetric
capability Minor trauma
Severity of Injury
Determine
Maternal and fetal outcome Treatment method
Major injury Minor trauma occasionally associated with abruptio
placentae and fetal loss closely observed
Proper immobilization in pregnant patient Log roll 4-6 inches or 15 to the left
Fluid resuscitation
Physiologic hypervolemia
Significant blood loss before
hypovolemic signs occur Fetal and placenta deprived of blood while maternal condition and V/S stable Crystalloid and early type-specific blood are indicated
Fetal death
Most common : Maternal shock & death Second most common : Abruptio
placentae Abruptio placentae Vaginal bleeding (70%) Uterine tenderness Frequent uterine contractions Uterine tetany Uterine iritability
Investigation : U/S
Fetal death
Rare cause : Uterine rupture
Uterine rupture Abdominal tenderness, guarding, rigidity, or rebound tenderness Profound shock Abnormal fetal lie; transverse or oblique Easy palpation of fetal part Inability to readily palpate the uterine fundus Investigation : X-ray extended fetal extremities, abnormal fetal position, and free
Risk factor for fetal loss Maternal HR > 110/min Injury severity score > 9 Evidence of placental
abruption Fetal HR > 160 or < 120 Ejection during a motor vehicle accident Motorcycle or pedestrian collisions
CVP monitoring
uesful in maintaining the relative
hypervolemia required in pregnancy
Consult OB
Fetal distress can occur any time
Cardiac tocodynamometer
Useful after GA 20-24 wk
DPL
Catheter should be placed above the umbilicus with open technique
Fetomaternal hemorrhage
Fetal anemia and death Isoimmunization in Rh-negative mother Mg : Rh immunoglobuin therapy within 72 hr of injury in all pregnant Rh negative trauma patient unless the injury is remote from uterus
time of injury and presentation for medical care same or different EDs.
Perioral injury Injury to the genital or perianal area Fracture of long bones in children younger than 3
years of age
Ruptured internal viscera without antecedent major blunt trauma Multiple subdural hematoma, especially without a fresh skull fracture Retinal hemorrhages Bizarre injuries : bite, cigarette burns, rope marks Sharply demarcated second-third degree burn in unusual area