Pregnant trauma patients need special attention
July 1, 2000 3 minutes read
Pregnant trauma patients need special attention
When you receive information from the field about an incident that involves a pregnant injured patient, do the following, according to Cindy Jimmerson, RN, trauma/transport outreach coordinator for Community Medical Center in Missoula, MT:
1. Assess the capabilities of the prehospital service. For example, they may be staffed by paid or volunteers, paramedics, EMTs, or first responders, says Jimmerson. "That way, you know what to expect of prehospital personnel in evaluation, reporting, and treatment capabilities to be offered."
Get details of trauma
2. Prompt the prehospital responders with specific questions. Ask about the following, Jimmerson recommends:
• Mechanism of injury. What exactly happened to the patient? For example, where were they sitting in the car, did they use seat belts, what type, did the airbag deploy, how much damage was there to the car? If the unit carries a Polaroid camera, a photo of the scene is very helpful to bring in with the patient.
• Is there another person who can provide information, or does the patient carry identification with information on a local OB physician, medications the patient may be taking, associated illnesses, and due date of the patient?
• The patient’s first vital signs and any subsequent vital signs or points of evaluation that will help determine before the patient arrives at the hospital the following important information: Is the patient getting better, or is the patient getting worse? This is very important in preparing for what will arrive.
• Has the mom suffered pulselessness or cessation of respirations at any time? If so, for how long? Was CPR needed, or did the mom spontaneously resume vital signs? Are the prehospital personnel able to hear fetal heart tones? Have they been repeated frequently, and is there a change in rate and regularity? When did the incident occur? What is the ETA?
If the patient arrives without notice or brief notice, you should collect this preliminary information while they also prepare for a possible emergency cesarean, says Jimmerson.
• What treatment has been initiated? Does the patient have two large bore IVs running, O2 on at a high flow rate? Is the mother positioned on her left side or with one hip elevated to reduce the pressure of the uterus on her vena cava? Is the patient being kept warm?
Prevent heat loss and stress
3. Activate the neonatal team to provide resuscitation.
Rapid transport of the infant is essential, says Renee Holleran, RN, PhD, chief flight nurse and clinical nurse specialist at Cincinnati Medical Center. "An isollette or warming lights should be used during resuscitation of the infant to prevent heat loss and stress to the neonate," she advises.
Contact the obstetrician, trauma surgeon, and OB support nurses, and assemble equipment immediately after information comes from the field that a pregnant woman has been critically injured, stresses Jimmerson.
"Time is of the greatest essence in the survival of this patient [the fetus] that we cannot see," she says. Include clinicians who can be of assistance should the patient spontaneously deliver or require emergency cesarean, says Jimmerson.
4. Prepare for emergency delivery.
If the mother is significantly injured, the body may try to expel the fetus and labor may commence, says Jimmerson. "Premature onset of labor is a frequent side-effect of maternal head injury as well, even when the mother is unconscious."
When obtaining information from the field or examining the patient initially in the ED, look for any vaginal bleeding or signs of ruptured membranes (for example, perineal wetness not confused with urine), or any other signs of early labor, Jimmerson advises.
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