Search
  • Dr. Nour Khatib, MDCM CCFP(EM) MBA

Trauma in a Pregnant Patient


Reference: SOGC, Guidelines for the Management of a Pregnant Trauma Patient.

You are working as a rural emergency physician and EMS patches in announcing that they are 10 minutes away with a 28-year-old female at 36-week gestation. She was involved in a multi-vehicle accident, airbags were deployed and there was one death on scene. The nearest tertiary center is 3 hours away. Her vital signs are BP: 74/48, HR 127, O2 sat 92%, RR 33 and a GCS of 12. Her vitals remain the same despite 1 L of NS given with paramedics and O2 2 L Nasal prongs.

What are your initial steps before this patient arrives?

Pre-Primary survey: before the patient arrives do/prepare for the following:

  • Personal Protective equipment (PPE) for yourself and all staff involved

  • Ensure the trauma bay is cleared, stocked and the adult and neonatal crash cart is ready

  • Call for backup, mobilize your resources and assign clear roles (e.g. RT at the head of the bed, recorder, CPR staff, nurse in charge of delivering medications)

  • Ultrasound at the bedside

  • Fetal monitoring equipment at the bedside

  • Neonatal warmer

  • Avoid hypothermia in any trauma patient

  • Warm IV Fluids

  • Increase the room temperature

  • Bair Hugger or equivalent

  • Call and inform OB and pediatrics of unstable pregnant trauma patient. Request their presence.

  • Call the blood bank for massive transfusion protocol: Ask for O negative blood

  • Check that all the equipment works

Every female of reproductive age should be considered pregnant until proven otherwise.

When you are faced with a trauma in a pregnant patient perform your usual ATLS algorithm with some adjustments:

  • Stabilizing the pregnant female is the priority, for a fetus >= 23 weeks place fetal monitoring equipment and consult OB stat.

  • Anti-D Immune Globulin if Rh-negative

  • If a Chest tube is required, it must be placed 1-2 spaces higher than usual i.e. 2nd or 3rd intercostal space

  • Nasogastric tube for decreased LOC to prevent aspiration of gastric fluids

  • Ensure O2 sat >95% for adequate fetal oxygenation

  • Left lateral position (increases preload to the heart)

  • After 20 weeks gestation, reposition the uterus to the left (increases preload to the heart)

  • O negative blood should be used for transfusion

  • No vaginal exam until placenta previa is ruled out

  • Tetanus vaccine is safe in pregnancy

  • Document domestic violence

  • Vasopressors decrease uteroplacental perfusion and should only be used if your patient is unresponsive to fluids


0 views
Previous and future planned cities include:
Vancouver - The Review Course in Family Medicine Exam Prep
Calgary  - The Review Course in Family Medicine Exam Prep
edmonton-77799_640.jpg
sunset-370244_640.jpg
winnipeg-165374_640.jpg
Toronto - The Review Course in Family Medicine Exam Prep
Calgary  - The Review Course in Family Medicine Exam Prep
Vancouver - The Review Course in Family Medicine Exam Prep

© The Review Course in Family Medicine Inc. | About Us | Privacy Policy

Disclosures: The Review Course founders have no conflicting commercial interests. As is the case with any private events hosted on a university campus or hospital, this event is not affiliated with nor endorsed by the host venues. Our materials are peer-reviewed and prepared by Canadian physicians; we do not guarantee that our preparation materials are representative of any Canadian examination and we do not provide questions from any other examination nor are they intended as medical advice. The College of Family Physicians of Canada does not affiliate with nor endorse any exam preparation course.

Highly Rated - Thousands of Attendees
  • Wix Facebook page
  • Wix Twitter page
  • Instagram