Advanced Trauma Life Support ATLS Student Course Manual 2018

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CHAPTER 12 n Trauma in Pregnancy and Intimate Partner Violence
••
The team must remember that, although there
are two patients, the team’s primary mission is
to ensure optimal resuscitation of the mother.
••
The team leader should notify the on-call
obstetrician and the obstetrics unit of the
impending arrival of an injured pregnant
patient as soon as possible while continuing to
direct the overall resuscitation.
••
The team must maintain an appropriately high
index of suspicion for the presence of intimate
partner violence, carefully documenting
all injuries.
Chapter Summary
1. Important and predictable anatomical and
physiological changes occur during pregnancy
and can influence the assessment and treatment
of injured pregnant patients. Attention also must
be directed toward the fetus, the second patient
of this unique duo, after its environment is
stabilized. A qualified surgeon and an obstetrician
should be consulted early in the evaluation of
pregnant trauma patients. If obstetric services
are not available, consider early transfer to a
trauma center with obstetrical services. agree
with edit.
2. The abdominal wall, uterine myometrium,
and amniotic fluid act as buffers to direct fetal
injury from blunt trauma. As the gravid
uterus increases in size, other abdominal viscera
are relatively protected from penetrating
injury, whereas the likelihood of uterine
injury increases.
3. Appropriate volume resuscitation should be
given to correct and prevent maternal and fetal
hypovolemic shock. Assess and resuscitate the
mother first, and then assess the fetus before
conducting a secondary survey of the mother.
4. A search should be made for conditions unique
to the injured pregnant patient, such as blunt or
penetrating uterine trauma, abruptio placentae,
amniotic fluid embolism, isoimmunization, and
premature rupture of membranes.
5. Minor degrees of fetomaternal hemorrhage are
capable of sensitizing the Rh-negative mother.
All pregnant Rh-negative trauma patients should
receive Rh immunoglobulin therapy unless the
injury is remote from the uterus.
6. Presence of indicators that suggest intimate
partner violence should serve to initiate further
investigation and protection of the victim.
Additional Resources
ConceRNing Intimate
pARtner Violence
National Coalition Against Domestic Violence, PO Box
18749, Denver, CO 80218-0749; 303-839-1852
https://www.ted.com/talks/leslie_morgan_steiner
_why_domestic_violence_victims_don_t_leave
http://phpa.dhmh.maryland.gov/mch/Pages/IPV.aspx
http://www.cdc.gov/violenceprevention/intimate
partnerviolence/
http://www.cdc.gov/violenceprevention/pdf/ipv
-nisvs-factsheet-v5-a.pdf
Bibliography
1. ACEP Clinical Policies Committee and Clinical
Policies Subcommittee on Early Pregnancy.
American College of Emergency Physicians.
Clinical policy: critical issues in the initial
evaluation and management of patients
presenting to the emergency department in early
pregnancy. Ann Emerg Med 2003;41:122–133.
2. Adler G, Duchinski T, Jasinska A, et al. Fibrinogen
fractions in the third trimester of pregnancy and
in puerperium. Thromb Res 2000;97:405–410.
3. American College of Emergency Physicians.
Clinical and Practice Management Resources.
Trauma in the Obstetric Patient: A Bedside Tool.
http://www.acep.org. Accessed May 16, 2016.
4. American College of Radiology. Practice
Parameter. http://www.acr.org/~/media/
9e2ed55531fc4b4fa53ef3b6d3b25df8.pdf.
Accessed May 17, 2016.
5. Berry MJ, McMurray RG, Katz VL. Pulmonary and
ventilatory responses to pregnancy, immersion,
and exercise. J Appl Physiol 1989;66(2):857–862.
6. Chames MC, Perlman MD. Trauma
during pregnancy: outcomes and clinical
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