Term 6 Week 5 (w/c 27/5/13)
Hi, and welcome to a new week of Gasclass. Last week we dealt with post-operative seizures and generated differentials and action plans. We are working on making a Storify summary of your contributions.
This weeks case starts as follows:
You are on call and are paged to the trauma bay. A 33 yo woman was the single driver in a high-speed MVC and is enroute to the hospital. The TTL says she is also pregnant.
What are the implications of pregnancy on the management of trauma?
Lots of great input today! Patient arrives, and you can tell she is late pregnancy, maybe 30+ weeks. She is breathing spontaneously, collared and on backboard. GCS is E1M4V2. Vitals are HR 120 BP 100/50, SpO2 – poor waveform cannot pickup. You have paged the obstetrics resident to the trauma bay, but they have not arrived yet.
What would be your course of action during the primary survey?
She is intubated and has two large bore IVs. On secondary survey, she is found to have an open book pelvic fracture and a FAST that is positive in multiple quadrants. Her pressure drops and the TTL starts blood transfusion. OB has arrived and fetal heart rate is found to be in the 60s. They want to take her to OR stat.
What sort of difficulties might you anticipate? What resources or personnel would you ask for?
The patient is in the OR, and they have started the laparotomy. The baby is delivered quickly, and was found to have suffered a complete placental abruption. NICU is there, and are resuscitating the baby in another room nextdoor. There are liver and splenic lacerations. The patient starts to become more hypotensive and tachycardic. OB asks for a bolus of oxytocin because the uterus is very boggy.
What might you do next? What potential backup plans are you anticipating?
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