全部 标题 作者
关键词 摘要

OALib Journal期刊
ISSN: 2333-9721
费用:99美元

查看量下载量

相关文章

更多...

A Case Report: Emergency Management of a Pregnant Trauma Patient—An Anesthesiologist’s Perspective and Role

DOI: 10.4236/ojanes.2024.142003, PP. 25-39

Keywords: Obstetric Anesthesiology, Ob Trauma, Maternal and Fetal Resuscitation

Full-Text   Cite this paper   Add to My Lib

Abstract:

Trauma is the leading cause of death for all women of childbearing age. Motor vehicle accidents account for almost two-thirds of all maternal non-obstetric, trauma-related deaths, while falls and domestic violence comprise a large percentage of the rest. The leading causes of obstetric trauma are motor vehicle accidents, falls, assaults, and gunshots, and ensuing injuries are classified as blunt abdominal trauma, pelvic fractures, or penetrating trauma . The causes are different with different life styles and different socio-economic and cultural background. Pregnant trauma victims tend to be younger, less severely injured, and more likely African American or of Hispanic descent compared with nonpregnant victims of trauma. Drugs and alcohol are a factor in about 20 percent of maternal trauma. With pregnancy comes the challenge and responsibility of caring for two patients at once, the mother and the fetus. In general, providing optimal maternal care is the best strategy to optimize fetal survival. Decision-making including the condition of the mother, gestational age, status of the fetus, and interventions are based on these key factors. Many providers are involved in the care of the pregnant patient: at the trauma scene, in the emergency department, and in the operating room. The anesthesiologist plays a key role in the care and management of the pregnant trauma patient. All anesthesiologists have ample training in obstetric anesthesia during their residency and frequently cover obstetric units in hospitals where pregnant patients are cared for. On the other hand, most nonobstetric physicians have little obstetric exposure and may be uncomfortable caring for the pregnant patient because of unfamiliarity with the physiologic changes of pregnancy or the evaluation of fetal well-being. This is not only a source of stress for other trauma providers, but can put maternal well-being at risk. Non-obstetric physicians may hesitate to order necessary diagnostic and therapeutic interventions for fear of doing the “wrong thing,” all because the patient is pregnant. A multidisciplinary approach to the pregnant trauma patient involving trauma surgeons, obstetricians, anesthesiologists, emergency medicine, and other providers, is critical to deliver optimal care and achieve the best outcomes for both the mother and the baby. In summary, a multidisciplinary approach to provide optimal maternal care will facilitate to achieve the best outcomes for the mother and is also the best strategy for optimizing fetal survival. The following is a case report of a pregnant

References

[1]  Petrone, P., Talving, P., Browder, T., Teixeira, P.G., Fisher, O., Lozornio, A., et al. (2011) Abdominal Injuries in Pregnancy: A 155-Month Study at Two Level 1 Trauma Centers. Injury, 42, 47-49.
https://doi.org/10.1016/j.injury.2010.06.026
[2]  Kuhlmann, R.D. and Cruikshank, D.P. (1994) Maternal Trauma during Pregnancy. Clinical Obstetrics and Gynecology, 37, 274-293.
https://doi.org/10.1097/00003081-199406000-00006
[3]  Mendez-Figueroa, H., Dahlke, J.D., Vrees, R.A. and Rouse, D.J. (2011) Trauma in Pregnancy: An Updated Systematic Review. American Journal of Obstetrics & Gynecology, 209, 1-10.
https://doi.org/10.1016/j.ajog.2013.01.021
[4]  Weinber, L., Steele, R.G., Pugh, R., Higgins, S., Herbert, M. and Story, D. (2005) The Pregnant Trauma Patient. Anaesthesia and Intensive Care, 33, 167-180.
https://doi.org/10.1177/0310057X0503300204
[5]  Lavery, J.P. and Staten-McCormick, M. (1995) Management of Moderate to Severe Trauma in Pregnancy. Obstetrics and Gynecology Clinics of North America, 22, 69-90.
https://doi.org/10.1016/S0889-8545(21)00556-8
[6]  Poole, G.V., Martin, J.N., Perry, K.G., Griswold, J.A., Lambert, C.J. and Rhodes, R.S. (1996) Trauma in Pregnancy: The Role of Interpersonal Violence. American Journal of Obstetrics & Gynecology, 174, 1873-1878.
https://doi.org/10.1016/S0002-9378(96)70223-5
[7]  Jain, V., Chari, R., Maslovita, S. and Farine, D.J. (2015) Guidelines for the Management of a Pregnant Trauma Patient. Journal of Obstetrics and Gynaecology Canada, 37, 553-574.
https://doi.org/10.1016/S1701-2163(15)30232-2
[8]  Barraco, R.D., Chiu, W.C., Clancy, T.V., Como, J.J., Ebert, J.B., Hess, L.W., et al. (2010) Pregnancy and Trauma. Eastern Association for the Surgery of Trauma. The Journal of Trauma, 69, 211-214.
https://doi.org/10.1097/TA.0b013e3181dbe1ea
[9]  Henry, S., Brasel, K. and Stewart, R.M. (2018) ATLS® Advanced Trauma Life Support, Student Course Manual. 10th Edition, ACS American College of Surgeons, Chicago.
[10]  Agency for Healthcare Research and Quality AHRQ (2012) The Quick Reference Guide to TeamSTEPPS® Action Planning: TeamSTEPPS® Implementation Guide. AHRQ, Rockville.
https://www.ahrq.gov/sites/default/files/publications/files/lepguide.pdf
[11]  Oxford, C.M. and Ludmir, J. (2009) Imaging in Pregnancy—“Trauma in Pregnancy”. Clinical Obstetrics and Gynecology, 52, 611-629.
https://doi.org/10.1097/GRF.0b013e3181c11edf
[12]  Varela, Y.B., Zietlow, S.P., Bannon, M.P., et al. (2000) Trauma in Pregnancy. Mayo Clinic Proceedings, 75, 1243-1248.
https://doi.org/10.4065/75.12.1243
[13]  (1993) Trauma during Pregnancy. ACOG Technical Bulletin Number 161-November 1991. International Journal of Gynecology & Obstetrics, 40, 165-170.
https://doi.org/10.1016/0020-7292(93)90381-6
[14]  Weiss, H., Songer, T. and Fabio, A. (2001) Fetal Deaths Related to Maternal Injury. JAMA, 286, 1863-1868.
https://doi.org/10.1001/jama.286.15.1863
[15]  Hill, D.A. and Lense, J.J. (1996) Abdominal Trauma in the Pregnant Patient. American Family Physician, 53, 1269-1274.
[16]  O’Brien, E. and Wilson, W. (2015) Trauma Airway Management. In: Smith, C., Ed., Trauma Anesthesia, Cambridge University Press, Cambridge, 27-64.
https://doi.org/10.1017/CBO9781139814713.008
[17]  Clark, S.L., Cotton, D.B., Privarnik, J.M., Lee, W., Hankins, G.D., Benedelti, T.J. and Phelan, J.P. (1991) Positional Changes and Central Hemodynamic Profile during Normal Third Trimester, Pregnancy, and Post Partum. American Journal of Obstetrics & Gynecology, 164, 883-887.
https://doi.org/10.1016/S0002-9378(11)90534-1
[18]  Esposito, T.J. (1994) Trauma during Pregnancy. Emergency Medicine Clinics of North America, 12, 167-199.
https://doi.org/10.1016/S0733-8627(20)30457-0
[19]  Murphy, N. and Reed, S. (2000) Maternal Resuscitation and Trauma. In: Damos, J.R. and Eisinger, S.H., Eds., Advanced Life Support in Obstetrics (ALSO) Provider Course Syllabus, American Academy of Family Physicians, Leawood, 1-25.
[20]  Selden, B.S. and Burke, T.J. (1988) Complete Maternal and Fetal Recovery after Prolonged Cardiac Arrest. Annals of Emergency Medicine, 17, 346-349.
https://doi.org/10.1016/S0196-0644(88)80779-0
[21]  Runnebaum, I.B., Holeberg, G. and Katz, M. (1998) Pregnancy Outcome after Repeated Blunt Abdominal Trauma. The European Journal of Obstetrics & Gynecology and Reproductive Biology, 80, 85-86.
https://doi.org/10.1016/S0301-2115(98)00100-6
[22]  Tweddale, C.J. (2006) Trauma during Pregnancy. Critical Care Nursing Quarterly, 29, 53-67.
[23]  Katz, V., Dotters, D. and Droegemueller, W. (1986) Perimortem Cesarean Delivery. Obstetrics & Gynecology, 68, 571-576.
[24]  Lee, R., Rodgers, B., White, L. and Harvey, R. (1986) Cardiopulmonary Resuscitation of Pregnant Women. The American Journal of Medicine, 81, 311-318.
https://doi.org/10.1016/0002-9343(86)90268-8
[25]  Fisgus, J., Tyagaraj, K. and Levesque, V. (2015) Trauma in Pregnancy. In: Smith, C., Ed., Trauma Anesthesia, Cambridge University Press, Cambridge, 623-639.
https://doi.org/10.1017/CBO9781139814713.042

Full-Text

Contact Us

service@oalib.com

QQ:3279437679

WhatsApp +8615387084133