The EM Educator Series: Trauma with Two Patients on Board

Author: Alex Koyfman, MD (@EMHighAK) // Edited by: Brit Long, MD (@long_brit) and Manpreet Singh, MD (@MprizzleER)

Welcome back to the EM Educator Series. These posts provide brief mini-cases followed by key questions to consider while working. The featured questions provide important learning points for those working with you, as well as vital items to consider in the evaluation and management of the specific condition discussed.

This week has another downloadable PDF document with questions, links and answers you can share with learners as educators in #MedEd. Please message us over Twitter and let us know if you have any feedback on ways to improve this for you. Enjoy!

Case #1:

A 24-year-old female at 28 gestation is brought in by EMS after an MVC. She was restrained, but her side of the vehicle was hit head-on by a large truck. She is tachycardia and complaining of generalized abdominal pain.

Case #2:

A 19-year-old female at 30 weeks gestation comes in after being found on the side of the road. She suffered several stab wounds to her abdomen. She loses pulses just as she is placed on the trauma bay bed.

Considerations:

• What should you consider in organizing the team? What are your priorities?
• How do you manage the airway? What should you consider for the pregnant airway?
• How is your assessment of Breathing different?  If you need to place a chest tube, is there anything you need to consider?
• What should you think about regarding Circulation?
• When is a resuscitative hysterotomy recommended, and how is it performed?
• Does your imaging change in pregnant trauma patients? What should you consider for FAST and CT?
• What are signs of intimate partner violence, and what are your next steps if this is suspected?

Note: Mastering neonatal resuscitation is a must; having an extra set of hands there, such as another EM physician or pediatrician, can be a big help!

From Dr. Katy Hanson at Hanson’s Anatomy:

Suggested Resources: 

• Articles:
  • emDocs – Resuscitation of the Pregnant Trauma Patient – Pearls and Pitfalls
  • emDocs – Trauma Management of the 3rd-Trimester Pregnant Patient: Pearls & Pitfalls
  • LITFL – Trauma and Pregnancy
  • LITFL – Trauma and Pregnancy Redux
  • Taming the SRU – AirCare Series: Resuscitative Hysterotomy
  • CORE EM – Peri-Mortem C-Section
  • Radiopaedia – Trauma in pregnancy
  • EMCNA – Trauma in pregnancy
• Podcasts:
  • CORE EM – Episode 34.0 – Trauma in Pregnancy
  • EM Cases – BCE 65 Intimate Partner Violence – A Silent Epidemic