Trauma 

 

 

Considerations

 

  • Emergency/full stomach 

  • Difficult airway due to C-spine injury/immobility

  • ATLS approach to resuscitation

  • Multiple obvious & occult injuries

  • Need for ongoing assessment & resuscitation

  • Hypovolemia, hypothermia, coagulopathy, acidosis

  • Potential toxic ingestions, uncooperative patient

  • Immediately life-threatening injuries: 

    • ​Airway obstruction

    • Tension pneumothorax

    • Open pneumothorax

    • Cardiac tamponade

    • Massive hemothorax

    • Flail chest

  • Delayed/hidden injuries:

    • Thoracic aortic disruption

    • Tracheobronchial disruption

    • Myocardial contusion

    • Traumatic diaphragmatic tear

    • Esophageal disruption

    • Pulmonary contusion

 

 

Pregnancy Considerations 

 

  • ↑ risk of aspiration, difficult airway

  • Altered pattern of injury: preterm labour, abruption, uterine rupture, amniotic fluid embolism, alloimunization

  • Delayed decompensated shock secondary to physiologic changes: hypervolemic hemodilution

  • Altered ACLS:

    • IV above diaphragm

    • Chest compressions higher

    • Left uterine displacement

    • Stat cesarean section at 4 minutes post cardiac arrest 

  • 2 patients requiring:

    • Fetal monitoring

    • Obstetrics/pediatrics consults

    • Steroids for fetal lung maturity if <34 weeks GA

    • MgSO4 for fetal brain protection 

  • Considerations RE: imaging (CT, X-ray) 

 

 

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