“Trauma In Pregnancy…” Case Conclusion April 5, 2013
Posted by Andy Jagoda, MD in: Obstetric Emergencies, Radiology, Trauma , trackback
Your radio going off as a very distraught paramedic hurriedly relates that they’re about 2 minutes out with a motor vehicle collision victim who looks sick and is tachycardic, hypotensive, and having agonal respirations. He relates that the husband is frantically screaming that she’s due next month to have a baby girl. As your team gears up for the patient about to enter your trauma room, you realize that the ambulance is going to arrive much faster than your obstetrician on call (who is coming from home). You fully appreciate that the opening moves of this drama are going to be entirely up to you.
The patient arrived to the ED with a barely palpable pulse and a fundus that was well above the umbilicus. Because she was nonresponsive to pain upon arrival, you placed a wedge under the spine board, which improved her pulse, but you decided to intubate for airway protection. This went uneventfully, and you began rapid infusion of crystalloid and called for O-negative blood. As you performed a FAST exam, you anticipated the worst and had a knife and chlorhexidine at the bedside “just in case.” With volume, her vitals improved, and she was stabilized and placed on electronic fetal monitoring, with some variable decelerations. In consultation with the surgeons, she was taken to the CT scanner, where several intra-abdominal injuries were noted, including a splenic laceration and left kidney laceration, but no evidence of placental abruption or uterine trauma was seen. She was taken to the surgical ICU, where over the next 3 weeks she had a rocky course, but ultimately she underwent a cesarean section and delivery of a healthy baby girl.
Congratulations to Dr. Brostoski, Dr. Htay, Dr. Naidu, Dr. Davids, and Dr. Krembs — this month’s winners get a free copy of the latest issue of Emergency Medicine Practice on this topic: Trauma In The Pregnant Patient: An Evidence-Based Approach To Management. Didn’t win but want to get a complete systematic, evidence-based review on this topic? Purchase the issue today including 4 CME credits!