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• W1480937788 abstract "CS gravida 1 para 0, had a full-term gestation at the time of the accident. She was the passenger and was wearing a restraint, both the lap belt and the shoulder harness, at the time of the accident. The paramedics assessed her mental status as fully oriented. She did not lose consciousness. Her initial examination in the field revealed a diaphoretic, pregnant woman complaining of severe abdominal pain. She had obvious seat-belt-induced contusions to the anterior abdomen and the right and left lower quadrants. She was noted to have a small amount of vaginal bleeding. Her vital signs were as follows: blood pressure, 90/P mm Hg; pulse, 80 beats/min; respirations, 2O/min. The paramedics started a large-bore IV line of normal saline solution and immediately transported the patient to the nearest trauma center. With a 6-minute estimated arrival time, the emergency staff was able to mobilize the trauma team and the obstetrics team. All were present in the trauma room when the patient arrived. On arriv(s1 in the emergency department, Mrs. K. was given oxygen, 6 L/min, per nasal cannula, and the cardiac monitor and two addition large-bore IV lines were started. Routine trauma laboratory tests were performed. Mrs. K. was awake and complained of severe abdominal pain. Examination of her chest revealed clear bilateral breath sounds. Her abdominal examination revealed a gravid uterus. The patient had decreased bowel sounds and diffuse abdominal tenderness. F’etal heart tones (FHTs) were auscultated at 130 beats/min. There were large contusions on the mother’s abdomen. Although there was no active vaginal bleeding, dried blood was noted on her thighs. Examination of the extremities revealed a closed deformity of the left distal forearm with good distal pulses. Results of a neurologic examination were normal. Blood pressure was 118/80 mm Hg; pulse, 76 beats/min; and respirations, 24/min. Cervical spine, chest, and pelvic radiographs obtained in the trauma room were negative for injury. The only fracture was of the left distal radius and ulna. Her initial hematocrit was 37.2%. A concurrent examination by the obstetrics team revealed probable abruptio placentae because of the continuous uterine contraction and the mechanism of injury. The FHTs decreased from 130 to 100 to 80 beatsfmin. Both teams agreed on the plan of action. Within 15 minutes of arrival at the trauma center Mrs. K. was taken to the operating room by both teams for an emergent cesarean section and exploratory laparotomy. Immediately preceding the operation the FHTs decreased to 60 beats/min. There was no evidence of intraabdominal bleeding, and the cesarean section proceeded without complication for the delivery of a live baby girl. The placenta was detached from the uterine wall. No major intraabdominal bleeding was noted, and the procedure was completed. Twenty minutes after the operation Mrs. K. became hemodynamically unstable and was rapidly resuscitated with fluids. She was transferred to the surgical intensive care unit where she was noted to have a large amount of bleeding and oozing from all puncture sites and from the vagina, indicating disseminated intravascular coagulation (DIC), possibly caused by an amniotic fluid embolus. She was taken back to the operating room for reexploration of her abdomen. When anesthetic was administered Mrs. K. became pulseless, and closed compressions were begun. She was successfully resuscitated with blood and blood products. Her abdomen was explored. The source of bleeding was her large flaccid uterus, and a hysterectomy was performed. Despite vigorous resuscitation with bIood and blood products, there was delayed clotting. She also had minimal urine output. When her abdomen was closed she again became hemodynamically unstable and was resuscitated with fluid and pressors. Because she had had closed compressions and she exhibited a narrow pulse pressure, cardiac tamponade was suspected. The chest cavity was entered subxyphoid, and a pericardial window was formed. Clear pericardial" @default.
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• W1480937788 date "1989-11-01" @default.
• W1480937788 modified "2023-09-26" @default.
• W1480937788 title "Blunt trauma in the pregnant patient." @default.
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