Advanced Trauma Life Support ATLS Student Course Manual 2018

MECHANISMS OF INJURY 231
In patients with advanced pregnancy, when chest
tube placement is required it should be positioned
higher to avoid intraabdominal placement given the
elevation of the diaphragm. Administer supplemental
oxygen to maintain a saturation of 95%. The fetus is
very sensitive to maternal hypoxia, and maternal basal
oxygen consumption is elevated at baseline.
Gastrointestinal System
Gastric emptying is delayed during pregnancy, so
early gastric tube decompression may be particularly
important to prevent aspiration of gastric contents.
The mother’s intestines are relocated to the upper part
of the abdomen and may be shielded by the uterus.
The solid viscera remain essentially in their usual
anatomic positions.
The large, engorged pelvic vessels surrounding the
gravid uterus can contribute to massive retroperitoneal
bleeding after blunt trauma with associated
pelvic fractures.
Neurological System
Eclampsia is a complication of late pregnancy that
can mimic head injury. It may be present if seizures
occur with associated hypertension, hyperreflexia,
proteinuria, and peripheral edema. Expert neurological
and obstetrical consultation frequently is helpful in
differentiating among eclampsia and other causes
of seizures.
Pitfall
prevention
Urinary System
The glomerular filtration rate and renal blood flow
increase during pregnancy, whereas levels of serum
creatinine and urea nitrogen fall to approximately
one-half of normal pre-pregnancy levels. Glycosuria
is common during pregnancy.
Musculoskeletal System
Mistaking eclampsia
for head injury
• Obtain a CT of the head to
exclude intracranial bleeding.
• Maintain a high index of
suspicion for eclampsia
when seizures are accompanied
by hypertension,
proteinuria, hyperreflexia,
and peripheral edema in
pregnant trauma patients.
The symphysis pubis widens to 4 to 8 mm, and the
sacroiliac joint spaces increase by the seventh month
of gestation. These factors must be considered in
interpreting x-ray films of the pelvis (n FIGURE 12-3).
MechANisms of Injury
n TABLE 12-2 outlines the distribution of mechanisms
of injury in pregnancy. Most mechanisms of injury
table 12-2 distribution of mechanisms
of injury in pregnancy
MECHANISM
PERCENTAGE
Motor vehicle collision 49
Fall 25
Assault 18
Gunshot wound 4
n FIGURE 12-3 Radiograph demonstrating fetal head engaged in
the pelvis with a normal symphysis pubis and mildly widened right
sacroiliac joint.
Burn 1
Source: Chames MC, Pearlman MD. Trauma during pregnancy:
outcomes and clinical management. Clin Obstet Gynecol, 2008;51:398
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