Pregnancy and Trauma

[DFIB]

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.

I was reading an article on the hormonal cascade of pain and injury and realized it was way above my pay grade but very interesting. I began to wonder if it had any effect on pregnancy. Maybe one of the Docs will chime in.

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'...

They have to be tough, I get tired carrying 8 lbs in my backpack.

Edited August 2, 2011 by DFIB

[Kiwiology]

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?

Determining whether or not a patient needs surgery is the job of the Surgical Registrar

We do not run fluid unless the patient needs it, 99% of the time we start a lock

Those "just in case" patients can be tricky to spot, a very wise Intensive Care Officer once told me "put a drip in everybody in case they arrest on you so that way you do not have to arse around getting one" which is good advice but not really practical.

I suppose compared to the US we are a little bit conservative when it comes to harpooning people

[scubanurse]

Dwayne...

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)

Depending on how early the pregnancy it would be difficult to find a correlation between even minor trauma/stress to the body and a spontaneous abortion.

Personal anecdote being.... a woman on my hockey team <10weeks pregnant (didn't know even pregnant) played a hockey tournament, 6 games in a day and a half, and miscarried two days later... are the two related? Her doctor didn't know but quite possibly the stress her body went through that weekend was too much, or it was completely unrelated.

Point is, the fact that a woman carries to term without complications is a damn miracle. So many things can go wrong in the first trimester to cause a spontaneous abortion that I don't think we can discount the stress a broken toe and ER trip can have on a embryo/fetus.

[tniuqs]

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

ROFLMAO ! How true, took my ex carrying #2 on a Zodiac, in the open pacific, in rough seas (gale warning) from Ucluelet to broken group islands (pacific rim national park) I needed dental work after to put the fillings back in my teeth. Her complaint WHAT no bathrooms !

Point being that we should not consider "pregnancy" as a disease and often we do. I would use the v/s and s/s and clinical observation, and the history. If we are having contractions well that's a different picture.

How about the pregnant chick that cuts off the end of her finger while making dinner? (Yeah, so it's sexist..)

Dwayne its only sexist if she is making YOUR dinner and is wearing white to match the kitchen appliances.

cheers

[Kiwiology]

I think we have to use clinical judgement; a pregnant patient who has been in a road traffic accident who displays a massive seatbelt injury, abdominal pain, severe adnexal tenderness and vaginal haemorrhage has a higher suspicion of some sort of foetal endangering injury than that pregnant chick who fell over and broke her leg .... unless that broken leg happens to cause a fat emboli to break loose and travel to the placentae in turn causing placentae ischaemia, foetal death and septic retained abortion heck you never know!

Clinical judgement is required

[emtannie]

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

All pregnancy carries some risk of miscarriage – it is a fact of life. The trauma may precipitate a miscarriage. Now, that being said, even the most minor of trauma incidents, I recommend the patient go to the ER or to their doc for follow-up. They may feel fine, but going to see a doc will put any fears to rest that there is any risk to the baby. Sometimes the treatment is just directing them in the right direction so they get peace of mind.

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

As others have said – “any level” is vague. It depends on the trauma. Do they need fluids? Am I giving pain meds? Are there any health issues I need to be concerned about?

3. If not why?

Giving an IV just because they are pregnant isn’t a good enough reason. What is the reason for the IV? If we don’t need to give fluids, medications, draw blood, or are starting it so we have a patent line for hospital use or when the patient deteriorates, why are we starting it?

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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Katiebug, I always thought that hep locks were contraindicated on pregnant patients. I realize that some pregnant patients are prescribed hep due to certain medical conditions, but as a general rule, although it is a very small amount of heparin, why not just go with a saline lock instead? Please correct me and enlighten me if I am wrong.

[Just Plain Ruff]

Katiebug, I always thought that hep locks were contraindicated on pregnant patients. I realize that some pregnant patients are prescribed hep due to certain medical conditions, but as a general rule, although it is a very small amount of heparin, why not just go with a saline lock instead? Please correct me and enlighten me if I am wrong.

I suspect that Katiebug was using hep lock and saline lock interchangeably. I still hear docs on the radio or med control say start a hep lock and transport. I'm almost positive they mean the same thing in EMS. Most EMS agencies don't carry heparin for locks so I think it's sort of the same thing.

Katiebug, correct me if i'm wrong.

My wife takes heparin for our pregnancy to counteract Factor Five Lytem disorder. 10K units two times a day.

[tcripp]

Determining whether or not a patient needs surgery is the job of the Surgical Registrar

We do not run fluid unless the patient needs it, 99% of the time we start a lock

Those "just in case" patients can be tricky to spot, a very wise Intensive Care Officer once told me "put a drip in everybody in case they arrest on you so that way you do not have to arse around getting one" which is good advice but not really practical.

I suppose compared to the US we are a little bit conservative when it comes to harpooning people

Appreciate your comments. Obviously, we don't determine if someone needs surgery (or a cath, MRI, etc) but we do get a feel for it and try to anticipate when a "harpoon" might be needed. Funny, for some of my hospitals, they really get put out if we haven't started a line with at least a lock. And, at times, I've been starting IVs in the ER...not just in the field.

I did want to add to my statement, though, that in my consideration to DFib's query I don't believe I quantified my response.

When I think of 'trauma', I am thinking of serious trauma and not the cut finger/stubbed toe scenarios. I was thinking more along the lines of roll overs,falls, projectile injuries, etc. It's on these that I think the potential for miscarriage (or other) is high. Also, I didn't want you to think I started an IV on just everybody.

[brentoli]

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

I thought this was hyperbole, until I got to the bolded part.

[DwayneEMTP]

I thought this was hyperbole, until I got to the bolded part.

Yeah, it was meant to be a play on the old SNL skit, "liars club" I think? They lied about everything..starting most of their sentences with something like, "Why.....I....one time there was this school bus...and it was....full of nuns! Yeah, that's it!" And ending with "Yeah....yeah....that's the ticket!"

Dwayne

Edited August 5, 2011 by DwayneEMTP