Trauma in Pregnancy and Intimate Partner Violence - 10th Edition

Explore the impact of trauma in pregnancy and intimate partner violence on patient care through interactive discussion, case scenarios, and critical questioning. Understand the unique challenges in resuscitating pregnant trauma patients and identifying signs of intimate partner violence. Gain insights into management priorities and the role of RH immunoglobulin therapy in these cases.

• Trauma
• Pregnancy
• Intimate Partner Violence
• Resuscitation
• RH Immunoglobulin

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Uploaded on Apr 07, 2024 | 3 Views

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1. 12 Trauma in Pregnancy and Intimate Partner Violence Tenth Edition

2. 12 Trauma in Pregnancy and Intimate Partner Violence Although pregnancy causes alterations in normal physiology and responses to injury and resuscitation, the sequence of the initial assessment and management of pregnant patients remains the same as for all trauma patients. 2 of 15

3. 12 Trauma in Pregnancy and Intimate Partner Violence Objectives By the end of this interactive discussion, you will be able to: 1. Recognize that the approach to the care of pregnant trauma patients is the same as for all other trauma patients. 2. Identify the physiologic changes of pregnancy and their impact on the successful resuscitation of the mother and her pregnancy. 3. Determine management priorities regarding mother and fetus in a trauma case scenario. 4. Identify when to administer RH immunoglobulin therapy. 5. Recognize signs of intimate partner violence as a potential cause of injury in a pregnant trauma patient. 3 of 15

4. 12 Trauma in Pregnancy and Intimate Partner Violence Case Scenario 35-year-old female transported to ED; husband reports patient tripped while walking down stairs; appears to be in the second trimester of pregnancy M I S T Unconscious None reported Spinal motion restricted on long spine board 4 of 15

5. 12 Trauma in Pregnancy and Intimate Partner Violence Discussion Questions: Case Details 1. How might the patient s pregnancy affect the performance of the primary survey? 35-year-old female transported to ED; husband reports patient tripped while walking down stairs; appears to be in the second trimester of pregnancy M 2. How might the patient s pregnancy affect the presenting signs and symptoms of the trauma? I Unconscious S None reported 3. What additional information would you want in regard to the mechanism of injury? T Spinal motion restricted on long spine board 5 of 15

6. 12 Trauma in Pregnancy and Intimate Partner Violence Case Scenario Progression Patient given high-flow oxygen Unable to respond to questions Vital signs: RR 28; HR 130; BP110/50; GCS V1 E2 M4 6 of 15

7. 12 Trauma in Pregnancy and Intimate Partner Violence Discussion Questions: Case Details Patient given high-flow oxygen 1. What are the first steps in the primary survey in this patient? Unable to respond to questions 2. What laboratory and radiologic tests should be ordered? Vital signs: RR 28; HR 130; BP110/50; GCS V1 E2 M4 7 of 15

8. 12 Trauma in Pregnancy and Intimate Partner Violence Discussion Question: Case Details Patient given high-flow oxygen 3. While assessment and management of the mother continue, what steps should be taken to evaluate the fetus? Unable to respond to questions Vital signs: RR 28; HR 130; BP110/50; GCS 7 8 of 15

9. 12 Trauma in Pregnancy and Intimate Partner Violence Case Scenario Progression Patient undergoes drug-assisted intubation due to low GCS Vital signs: HR 130; BP 90/60 IV access obtained, given 1 L crystalloid Uterus displaced to the left Patient responds to crystalloid resuscitation; HR decreases to 100 Head CT: small intraparenchymal contusions, moderate amount of subarachnoid blood Neurosurgeon consulted, decision to transfer to ICU for monitoring Physical exam: multiple old bruises Chest x-ray: Old, healed clavicle fracture; inconsistent injury history from husband and other family members 9 of 15

10. 12 Trauma in Pregnancy and Intimate Partner Violence Discussion Questions: Case Details Patient undergoes drug-assisted intubation due to low GCS Vital signs: HR 130; BP 90/60 IV access obtained, given 1 L crystalloid Uterus displaced to the left Patient responds to crystalloid resuscitation; HR decreases to 100 Head CT: small intraparenchymal contusions, moderate amount of subarachnoid blood Neurosurgeon consulted, decision to transfer to ICU for monitoring Physical exam: multiple old bruises Chest x-ray: Old, healed clavicle fracture; inconsistent injury history from husband and other family members 1. What aspects of this case raise concerns about intimate partner violence? 2. If you suspect intimate partner violence, what course of action should you take? 10 of 15

11. 12 Trauma in Pregnancy and Intimate Partner Violence Case Scenario Conclusion Repeat CT scan 24 hours later: no worsening of findings Decision made to lighten sedation Patient woke, was extubated, remained confused for 7 days Recovered after 2 weeks, delivered full-term baby boy by C- section Social services involved; police charge husband with assault 11 of 15

12. 12 Trauma in Pregnancy and Intimate Partner Violence Any Questions? ? 12 of 15

13. 12 Trauma in Pregnancy and Intimate Partner Violence Review Objectives By the end of this interactive discussion, you will be able to: 1. Recognize that the approach to the care of pregnant trauma patients is the same as for all other trauma patients. 2. Identify the physiologic changes of pregnancy and their impact on the successful resuscitation of the mother and her pregnancy. 3. Determine management priorities regarding mother and fetus in a trauma case scenario. 4. Identify when to administer RH immunoglobulin therapy. 5. Recognize signs of intimate partner violence as a potential cause of injury in a pregnant trauma patient. 13 of 15

14. 12 Trauma in Pregnancy and Intimate Partner Violence Key Learning Points 1. The goals and approach to the care of pregnant patients are the same as for all other trauma patients: Utilizing the ABCDE approach of the primary survey to identify and treat life-threatening problems, followed by the thorough head-to- toe assessment of the secondary survey. 2. Knowledge and understanding of the physiologic changes of pregnancy are key to the successful resuscitation of the mother and her pregnancy. 3. Fetal outcome is dependent upon successful maternal outcome; resuscitate the mother first, and then assess the fetus. 14 of 15

15. 12 Trauma in Pregnancy and Intimate Partner Violence Key Learning Points 4. All pregnant Rh-negative trauma patients should receive Rh immunoglobulin therapy unless the injury is remote from the uterus. 5. Intimate partner violence is a major cause of injury in women at all times during their lives and should always be considered, especially when the story and the injuries are inconsistent; the patient exhibits diminished self-image, depression or suicidal ideation/attempts; there are frequent ED and doctor s office visits; and/or there are signs of substance abuse. 15 of 15