Trauma in Pregnancy and Pediatric Injuries

Penetrating Abdominal Trauma in Pregnancy

• Penetrating abdominal trauma accounts for a significant portion of maternal mortality.
• The risk of uterine and fetal injury is highest during the third trimester due to the enlarged uterus.
• A potential consequence of penetrating trauma during pregnancy includes preterm labor, fetal demise, or maternal death.
• The increasing size and weight of the uterus during pregnancy can compress major blood vessels, leading to reduced blood flow to the heart and fetus.
• Pregnant women can lose a significant amount of blood before showing signs of shock due to increased blood volume during pregnancy.

Abdominal Trauma

• Blunt Trauma: A common complication associated with blunt trauma to the abdomen is internal bleeding.
• Pediatric Trauma: Children are more likely to suffer rib cage injuries due to their flexible rib cage structure, leading to potential organ injuries.
• Assessment: To evaluate the seriousness of an abdominal injury, assess the following:
  • Mechanism of injury
  • Vital signs
  • Abdominal examination
  • Pain level
  • Presence of bruising or swelling.

Frontal Impact Auto Crash

• During a frontal impact auto crash, the liver is most susceptible to injury due to compression against the steering wheel.

Shock

• A patient in shock who has lost significant blood volume can experience various outcomes, including:
  • Decreased blood pressure
  • Rapid heart rate
  • Altered mental status.

Gunshot Wounds

• A critical element to assess upon arrival at the scene of a gunshot wound is the potential for a second gunshot wound.
• The organs directly involved in the assessment during a rapid trauma assessment for abdominal injuries include:
  • Chest
  • Pelvis
  • Spine
  • Extremities.
• The organs NOT directly involved in the assessment during a rapid trauma assessment for abdominal injuries include:
  • Head.

Assessment and Management

• An initial assessment of a patient with suspected abdominal injury should include a primary survey and a rapid trauma assessment.
• Evaluating for entrance and exit wounds in an abdominal injury assessment helps determine the path and extent of tissue damage.
• SAMPLE history assessment helps identify:
  • Symptoms
  • Allergies
  • Medications
  • Past medical history
  • Last meal
  • Events leading to the injury.
• The recommended position for a patient with an abdominal injury, when no spinal injury is suspected, is the supine position.
• Vital signs that should be closely monitored for a critical patient during an ongoing assessment include:
  • Blood pressure
  • Pulse
  • Respiration
  • Oxygen saturation.

Contraindications and Fluid Resuscitation

• The use of a Pneumatic Anti-Shock Garment (PASG) is contraindicated in managing abdominal injuries due to the risk of increasing intra-abdominal pressure.
• Isotonic fluids are recommended for fluid resuscitation in abdominal injury patients.

Pregnancy Considerations

• Pregnant patients with suspected abdominal injuries should be observed for:
  • Preterm labor
  • Fetal distress
  • Placental abruption.
• A sign of shock that may not develop until significant blood volume has been lost is a late sign of shock, known as hypotension.

Evisceration

• The primary function of a sterile non-adherent dressing in evisceration care is to protect the exposed organs and prevent them from drying out.
• If a patient's blood pressure drops below 80 mmHg, an immediate intervention is needed to restore blood pressure, such as:
  • Fluid resuscitation
  • Medication
  • Surgery.
• The appropriate position for a patient with suspected abdominal injury without spinal injury is a supine position.

Key Considerations

• A primary assessment component when evaluating abdominal injuries is:
  • Airway, Breathing, Circulation, and Disability (ABCD)
• A key consideration when managing abdominal injuries in pregnant patients is:
  • Protecting the fetus and minimizing potential harm to the pregnancy.
• Closely monitored during ongoing assessment for a critical patient with abdominal injury:
  • Vital signs
  • Pain level
  • Abdominal examination.
• Fluid resuscitation guidelines for abdominal injury patients:
  • Rapid infusion of isotonic fluids to restore blood volume and maintain adequate blood pressure.

Rebound Tenderness and Sterile Dressing

• Rebound tenderness, a characteristic in abdominal injury, occurs when pain is exacerbated upon the release of palpation pressure.
• The purpose of applying a sterile non-adherent dressing during evisceration care is:
  • To prevent contamination and protect the exposed organs.

Shock and Abdominal Trauma

• Caregivers should be vigilant for signs of shock in patients with suspected abdominal injuries, which may include:
  • Rapid heart rate
  • Low blood pressure
  • Cool, clammy skin
  • Altered mental status.
• A crucial assessment for identifying potential trauma to the spleen is the examination of the left upper quadrant.

Initial Treatment and Mechanism of Injury

• An appropriate initial treatment for a patient suspected of having suffered abdominal trauma is:
  • Stabilize the patient by addressing life-threatening conditions, such as airway obstruction, breathing difficulties, and severe bleeding.
• Penetrating trauma, typically caused by stabbings or gunshot wounds, often produces the most visible signs of abdominal trauma.

Complications and Considerations in Pregnancy

• A severe complication from abdominal trauma is peritonitis, an inflammation of the peritoneum, which can be life-threatening.
• Common disadvantage of performing a supine position for a patient in the third trimester with suspected abdominal injury:
  • The weight of the uterus can compress the vena cava, reducing blood return to the heart and potentially causing hypotension.
• Mechanism of injury most likely to result in liver damage during a frontal impact auto crash is:
  • Compression of the liver against the steering wheel.

Pediatric Trauma and Assessment

• A primary consideration when conducting a rapid trauma assessment for suspected abdominal injuries:
  • Determine if there is a life-threatening condition:
    • Airway obstruction
    • Breathing difficulties
    • Severe bleeding.
• Anatomical feature in pediatric patients that increases the likelihood of internal organ injury during trauma:
  • The flexible rib cage.
• During the assessment of a trauma patient, the component of the initial assessment crucial for identifying potential drug influence is the Mental status evaluation.
• When assessing abdominal injuries, the essential detail to evaluate the potential cause of injury is the mechanism of injury.

Scene Size-up and Pregnancy-Related Concerns

• Critical information gathered during a scene size-up to assist in the assessment of an abdominal injury:
  • The mechanism of injury, such as a car accident, a fall, or an assault.
• Primary concern when assessing blunt abdominal trauma in pregnant women:
  • The potential for fetal injury and maternal complications.

Shock and Physiological Changes

• Condition particularly important to monitor in shock patients with significant blood loss,
  • The level of consciousness, as altered mental status is a late sign of shock.
• Physiological change in pregnancy that increases the risk of shock despite substantial blood loss:
  • The increased blood volume in pregnancy.
• Significant change to the uterus as pregnancy progresses that helps protect against injury:
  • The uterus rises out of the pelvis and becomes more protected by the rib cage.

Evisceration and Fetal Considerations

• The recommended first step in managing potential evisceration in an abdominal injury:
  • Cover the exposed organs with a sterile non-adherent dressing.
• Complications associated with penetrating trauma during pregnancy:
  • Fetal demise
  • Preterm labor
  • Placental abruption.
• The most critical factor to assess in a victim of penetrating abdominal trauma suspected during the third trimester:
  • The fetal heart rate.
• In the event of a gunshot wound, critical information that the first responders should seek immediately:
  • The number of shots fired and the **location of the gunshot wounds.

Seatbelt Injuries and Maternal Health

• A likely consequence of improperly worn seatbelts during auto collisions for pregnant women:
  • Uterine injury
  • Fetal injury.
• The increasing size of the uterus during pregnancy primarily affects maternal health in the context of trauma:
  • By increasing the risk of compression of the vena cava, leading to hypotension.

Risk Factors and Assessment

• A significant risk factor for maternal mortality in cases of penetrating trauma:
  • Hemorrhage
• Critical component that should be evaluated during an assessment of gunshot wounds to the abdomen in pregnant women:
  • The fetal status
  • The location of the wound
  • The presence of evisceration.

Blunt Trauma and Evisceration

• A common misconception about the effects of blunt trauma during pregnancy:
  • The common thought that blunt trauma is not as dangerous as penetrating trauma to the abdomen.
• A primary reason large volumes of blood can be lost in abdominal injuries before symptoms are noticed:
  • The presence of a large blood volume in pregnant women that masks the early signs of blood loss.

Vital Signs and Management

• A vital signs that must be closely monitored in a trauma patient with suspected abdominal injury:
  • Blood pressure:
    • to assess for signs of shock.
• Immediate action that should be prioritized for a patient showing signs of shock due to suspected abdominal trauma:
  • Administering oxygen
  • Control bleeding
  • Transport to a trauma center.

Trauma Assessment and Interventions

• The assessment that should be performed before any interventional procedures on a trauma patient with suspected abdominal injuries:
  • A complete head-to-toe assessment
  • A thorough assessment of the abdomen
• In managing an abdominal injury patient who exhibits tachycardia, this could indicate:
  • Blood loss
  • Pain
  • Shock.
• Critical to manage first in a trauma patient who has sustained an abdominal injury:
  • Airway, Breathing, and Circulation (ABC)
• During the assessment of a patient with abdominal trauma, a sign that may indicate a significant injury:
  • Rebound tenderness, which occurs when pain is exacerbated upon the release of palpation pressure.
• The first step when managing a patient with evisceration due to abdominal trauma:
  • Cover the exposed organs with a moist sterile non-adherent dressing.

History Assessment and Boundaries

• The primary role of the SAMPLE history assessment in abdominal trauma is:
  • To gather important information about the patient, including their symptoms, allergies, medications, past medical history, last meal, and events leading to the injury.
• In trauma management, the importance of understanding the boundaries of the abdominal cavity is:
  • To properly assess and manage injuries, including potential organ damage.

This quiz examines the implications of abdominal trauma during pregnancy, including risks to maternal and fetal health. It also covers the unique vulnerabilities of children in trauma situations. Test your knowledge on the assessments and complications associated with these injuries.