Page 179 - PJ MED OPS Handbook 8th Ed

– By 28 weeks, the pubic symphysis widens up to 8mm, and the pelvic blood vessels are en-
gorged, supplying the uterus. This can contribute to massive hemorrhage with blunt trauma
associated with pelvic fracture.
– Follow the Hemorrhage Protocol! TXA is considered relatively safe for use in the pregnant
patient.
A: – Assess airway as in any normal, healthy adult.
– Gastric emptying is delayed in pregnancy and abdominal contents are compressed by late
2nd trimester. Early NG tube decompression may be important to avoid aspiration of gastric
contents.
R: – Decreased functional lung volume and increased oxygen demand dictate immediate use of
supplemental O2 as soon as possible. Assess oxygenation with pulse oximeter.
C: – HR is increased 10–15 BPM by early 3rd trimester. Take into account when assessing for
hypovolemia.
– BP is decreased 5–15mmHg by second trimester. This should normalize in 3rd trimester. Take
into account when assessing for hypovolemia.
– Standard IV/IO access does not change from normal, healthy adult.
H: – Assess for head trauma.

In absence of significant head trauma: headache, hypertension, blurry vision (with or with-
out seizure) should be considered eclampsia until proven otherwise. This is a Medical Emer-
gency. Administer 4g IV/IO magnesium sulfate (available in the ACLS Kit), and transport
immediately.

– Assess/Treat/Prevent hypothermia

NOTE: Because of their increased intravascular volume, pregnant patients can lose a signifi-
cant amount of blood before tachycardia, hypotension, and other signs of hypovolemia occur.
This means the fetus may be in distress/deprived of oxygen while the mother’s VS appear
stable.

Secondary Survey:
• The maternal secondary survey should follow the same pattern as a non-pregnant patient.
Pay careful attention to presence of uterine contractions, which may suggest injury to the
uterus/placenta. The vagina and perineum MUST BE VISUALLY EXAMINED.
• Immediate transport to Hospital is mandatory in the presence of vaginal bleeding, presence
of amniotic fluid, uterine contraction, abdominal pain/tenderness/cramping, or evidence of
hypovolemia.
• If delayed transport is expected, initiate antibiotic treatment with 1g Ertepenem IV/IO/IM.
• Avoid repeated vaginal examination.
• In the setting of hypotension when the patient is laying SUPINE, and no other significant
signs or injuries present, consider manually displacing the uterus to the patient’s left side, or
rolling the patient to the left. If the patient is spine-boarded, place a 4–5" bolster under the
right edge of the board to facilitate this.

Chapter 10. Pediatric Care and OB-GYN n 177