2024 ATLS Module 12 Trauma in Pregnancy & Intimate Partner Violence Latest Questions With Complete Grade A Answers
- clinicians who treat pregnant trauma patients must remember....: they are treating
- patients
Answer: mother and fetus
*the best initial tx for fetus is to provide optimal resuscitation of the mother (RED text)
- what should you consider in every female of reproductive age with significant
injuries?Answer: they are considered pregnant until proven otherwise with pregnancy test of pelvic US
- who should be involved early in the eval of pregnant trauma patients?
Answer:
qualified surgeon and obstetrician *if not available, transfer to trauma center should be considered
- what week gestation does the uterus begin to rise out of the pelvis?
Answer: uterus remains intrapelvic organ until ~12 week
*20 weeks, it reaches umbilicus *34-36 weeks, it reaches costal margin *last 2 weeks, fundus frequently decends as fetal head engages the pelvis
- why are the intestines in pregnant patients more protected from trauma?
Answer: - intestines are pushed cephalad, so they lie mostly in the upper abdomen...so bowel is somewhat protected in blunt abdominal trauma
- what can be the result of amniotic fluid entering the maternal intravascular space
after trauma?
Answer: amniotic fluid embolism & disseminated intravascular coagulation
- in late gestation, what can a pelvic fracture cause?
Answer: skull fracture or serious intracranial injury to fetus
*also, the placenta does not have as much elasticity as the myometrium, so this results in vulnerability to shear forces at uteroplacental interface leading to placental abruption
- the placental vasculature is maximally dilated throughout gestation, yet it is
exquisitely sensitive to catecholamine stimulation... what can an abrupt decrease in 1 / 2
maternal intravascular volume result in?
Answer: profound increase in uterine vascular resistance... reducing fetal
oxygenation despite reasonably normal maternal vital signs
- what is a normal hematocrit in late pregnancy?
Answer: 31-35%
*plasma volume increases steadily throughout pregnancy & plateaus around 34 weeks gestation... but a smaller increase in RBC volume occurs, resulting in de- creased hematocrit level (aka physiological anemia of pregnancy)
- pregnant patients can lose up to 1200-1500 mL of blood before exhibiting
signs/symptoms... what might reflect this?
Answer: fetal distress... evidenced by abnormal fetal heart rate
- what does the WBC count do during pregnancy?
Answer: increases
- what increases after the 10th week of pregnancy due to the increase in plasma
volume and decrease in vascular resistance of uterus & placenta?
Answer: - cardiac output increases by 1-1.5 L/min
- how does the heart rate change during pregnancy?
Answer: gradually increases to a maximum of 10-15 beats per minute over baseline in 3rd trimester
- what are some of the EKG changes during pregnancy?
Answer: axis may shift leftward by ~15 degrees
*flattened or inverted T waves in lead III and AVF *ectopic beats are increased
- how does the respiratory system change during pregnancy?
Answer: minute ventilation increases primarily due to increase in tidal volume... so hypocapnia (PaCO2 of 30) is common in late pregnancy
- what might a PaCO2 of 35-40 mmHg indicate during pregnancy?
Answer: impending respiratory failure during pregnancy
*bc hypocapnia is normal during pregnancy
- why is it so important to maintain and ensure adequate arterial oxygenation
- / 2
when resuscitating injured pregnant patients?Answer: oxygen consumption increases during pregnancy