Pregnancy and Trauma

[DFIB]

I have three questions.

1, Do any of you guys consider pregnant patients with any level of trauma as a risk for miscarriage?

2. Do you start IVs on all pregnant trauma patients?

3. If not why?

Edited to check spelling.

Edited August 2, 2011 by DFIB

[scubanurse]

1) depends on how far along, but should go to a center that can preferably do both OB and trauma

2) all trauma patients should get at least one IV

[tcripp]

1, yes

2. I start IVs on all trauma patients...and, depending on the situation, I try to start the two large bore IVs as you will be taught in your next round of education.

3. I'm curious to see your thought process on why you think you wouldn't...especially for the pregnant patient.

[Kiwiology]

1. No; abdo or pelvic trauma, RTA, fall from height etc yes but trauma is a leading cause of placentae abruptio not miscarriage

2. No unless there is a need for fluid or medicine, remember cold salty water does not clot or carry oxygen

3. See #2

[tcripp]

2. No unless there is a need for fluid or medicine, remember cold salty water does not clot or carry oxygen

Curious. Obviously dependent upon the patient, but do you not start a saline lock at the least for those who may need surgery...with or without IV solution attached? Or, just in case your patient crashes on you and may need the fluid or medications?

[Katiebug]

1. Any level of trauma? Then no. They're not as fragile as that.

2. I always start at least a hep lock on trauma patients.

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[DFIB]

1, yes

2. I start IVs on all trauma patients...and, depending on the situation, I try to start the two large bore IVs as you will be taught in your next round of education.

3. I'm curious to see your thought process on why you think you wouldn't...especially for the pregnant patient.

I think all pregnant trauma patients are at risk of miscarriage and should get at least one IV line and should be treated as high priority patients, It is an idea I am forming and wondered if I was on the right track.

I was thinking that simply the adrenergic effect of pain could possibly be sufficient to trigger labor through catecholamine production and it's general systemic interaction, but catecholamines inhibit the production of oxitocin I know it doesn't always occur but heard of a pregnant patient that sustained an ankle dislocation without direct abdominal trauma, and miscarried hours after. I am not sure what the mechanism is but think pregnancy and the prospect of new life merits extreme care.

I haven't figured out the mechanism .... any thoughts?

[DwayneEMTP]

...1, Do any of you guys consider pregnant patients with any level of trauma as a risk for miscarriage?

No. For two reasons. First, there are a million types and severities of trauma. Would you consider a woman that broke her toe kicking at her dog at risk for spontaneous abortion? How about the pregnant chick that cuts off the end of her finger while making dinner? (Yeah, so it's sexist..bite me)

Second, there is no evidence to show, at least that I've ever seen or can find now, that trauma short of causing significant, life threatening damage to the mother causes additional risk of Sp. abortion. Medical and chemical elements, but not so much with trauma. Of course I'm not saying that it doesn't happen. Only that I have no reason to consider it a significant additional risk factor as, again, the vast majority of trauma is minor.

...2. Do you start IVs on all pregnant trauma patients?

No, for the reasons stated above.

...Edited to check spelling.

You're my hero!

Dwayne

Curious. Obviously dependent upon the patient, but do you not start a saline lock at the least for those who may need surgery...with or without IV solution attached? Or, just in case your patient crashes on you and may need the fluid or medications?

Not my question I know, but yeah. I start IVs on any significant traumas. But that wasn't the question, what it asked was ANY trauma, you assumed it would be significant and need treatment.. (Neener Neener)

At my last gig I always started locks on anyone I thought might need drugs/blood products/fluids but almost always attached a bag to it. The reason being that our drip sets didn't match the hospitals, but our locks did. It's also way, way easier on very ill pts or arrests when it comes time to move from the house. Detach, run to the truck, reattach.

Good thread. I'm afraid I can't help you with the cascade of hormonal effects that may begin with pain and end with abortion my friend...But I'm confident that chbare's ears are burning as we speak, or maybe one of the docs. No disrespect to anyone else...but man..it's been a while since I considered what triggered or retarded pregnancy hormones and can't imagine it's been on the front of most others minds either...

Dwayne

I think all pregnant trauma patients are at risk of miscarriage...

What makes you think that?

Have you spent much time around pregnant women? Mean as snakes I tell you!, and twice as tough! Why...I....once saw a pregger chick get hit by a truck! She flipped it over, ate the drivers sack lunch, and went about her way, all the time mumbling that she was pissed that the truck pushed her belly and made her have to pee...again....Just sayin'...

Dwayne

And for the record, I really hate that this editor stacks individual replies into one post...

Just sayin..

[Vorenus]

Most of it has been answered. Still, just my thoughts:

I have three questions.

1, Do any of you guys consider pregnant patients with any level of trauma as a risk for miscarriage?

With any level of trauma - no. As stated above, there are tons of possibilities of different traumas. With abdomnial trauma, or with accidents where the patient fell (out of lower or higher heights) and with car accidents I`d be more careful. Also, any pregnant woman with abdomnial pain after an incident that is not actually focused on the abdomen, I`d consider a possible candidate.

Àlthough, with high risk pregnancies I`m more cautious.

2. Do you start IVs on all pregnant trauma patients?

No.

3. If not why?

Who`s not in need of an IV, doesn`t get one from me. With minor traumas you often don`t need one.

Edited August 2, 2011 by Vorenus

[Bernhard]

1, Do any of you guys consider pregnant patients with any level of trauma as a risk for miscarriage?

Real any? No.

But even if I don't consider it as a risk of miscarriage, I would treat pregnant woman with care. As Dwayne stated, simply for scene safety reasons, a rampaging pregnant just because I weren't friendly enough is nothing what I want to have in my ambulance.

But I would (and in reality I try as much to real do) treat any patient with enough care to have him comfortable, not more injured and pain free. This should not be restricted to pregnant woman.

I mean, what is the business with "cosidering miscarriage"? It most probably will not happen in my hands between scene and hospital. It's my responsibility to take care for any patient, but not to prevent things for anytime in the future even on "special" ones.

There may be cases I memorize all emergency birth sections of my book or think of where the newborn equipment is stocked today. It is the same for thinking of probable intubation or any other possible needed intervention with critical patients. If likelyhood for a crisis is higher, than the plan may include more action in the next steps. But not as a general rule "pregnant = horror" - that simple equation is something the soon-to-be-father has to care about, not me... - or even "pregnant and any trauma = risk for miscarriaging in my ambulance". My rule would be "pregnant with abdominal pain or fluids running = think of possible escalation and hope to be in the hospital before things happen" (worked already...).

2. Do you start IVs on all pregnant trauma patients?

No.

3. If not why?

Because it's that with all of our actions: risk/benefit calculation. If "benefit" equals zero then the equation blows up, even if "risk" may be low. No fun to have an i.v. go bad (low risk, but well, it happens) just because I "wanted to have a line" without real reason.

Usually I'm very restrictive with far too simple "If then" rules, and especially with statements containing "always" or "any".