Maternity Considerations

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Maternity considerations

-       Are at an increased risk for placental abruption and cesarean delivery

-       Complications include: maternal death, fetal death, uterine rupture, or abruption, prenatal injury,

-       Assessment:

o   Primary assessment of mother: it is important to stabilize the mother first and then turn attention to the pregnancy and fetus.

o   Primary assessment includes: ABCDE

§  A-airway: immobilize the cervical spine, clear obstruction or secretions, maintain neutral head position, use laryngeal mask airway or endotracheal tube if needed.

§  B-breathing: check respiratory rate and effort, supply supplemental oxygen in most cases.

§  C-circulation: assess pulse

§  D:disability:  report alterness.

§  Expose the patient: remove all clothing; inspect the entire body for wounds or ecchymoses.

o   Secondary assessment: after stabilization (victim stabilization should be done in side-lying position on left side to prevent compromised circulation to the fetus), evaluate for specific maternal injuries and assess fetal well-being.

-       If the mother is unstable and the fetus is greater than 20 weeks old, preterm delivery may be considered. 

For Full Chapter: 

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Interventions for Internal Abdominal Injuries

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Management

-patients with multiple trauma should be assumed to have a spinal cord injury until it is proven otherwise

-immobilize the spine.

Initial Interventions

1. Carefully position the victim on his or her back and loosen any tight clothing.
2. Allow the victim to bend knees slightly if this eases the pain; put support under the knees (unless you suspect a spinal injury).
3. Call 911.
4. Treat the victim for shock and monitor the victim's breathing. 
*Do not let the victim eat or drink*

Ongoing Monitoring

-Monitor pulse

-Level of consciousness

-Maintain patient warmth using blankets or anything else available

Manifestations/Assessment Findings of Internal Abdominal Injuries

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Clinical Manifestations

-guarding and splinting of the abdominal wall (indicating peritonitis)

-a hard, distended abdomen (indicating intraabdominal bleeding) -

-decreased or absent bowel sounds contusions

-abrasions, or bruising over the abdomen

-abdominal pain

-pain over the scapula caused by irritation of the phrenic nerve by free blood in the abdomen

-hematemesis or hematuria and signs of hypovolemic shock 

-Ecchymosis around the umbilicus (Cullun’s sign) or flanks (Grey-Turner’s sign) may indicate retroperitoneal hemorrhage. 

Assessment Findings

-hypovolemic shock

-abrasions or ecchymoses on abdominal wall

-nausea/vomiting

-bloody urine

-abdominal distention

-abdominal rigidity

-abdominal pain with palpation

-rebound tenderness

-pain radiation to shoulder and back  

Interventions for Flail Chest

Treatment 

1. Have person lie down or sit in position of easiest breathing.
2. Splint the flail area with a small pillow or thick padding loosely bandaged in place (but not completely around the chest). 
3. Position the victim lying on the injured side to give more support to the area. 
*If padding is not available to splint the flail area, support it with pressure from your hand. Monitor the victim until help arrives.

A Little Extra Information on Internal Abdominal Injuries

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Good to know: Intraabdominal injuries are often associated with low rib fractures, fractured femur, fractured pelvis, and thoracic in jury. If any of these injuries are present, the patient should be observed for abdominal trauma.

     "Trauma is the fourth leading cause of death in the United States. Trauma is the leading cause of death in children and in adults younger than 44 years." 

       "If forensic evidence is to be collected nurses must be careful not to cut through or disrupt any tears, holes, blood stains, or dirt present on the clothing if criminal activity is suspected."

Two types of intraabdominal trauma: Compression and shearing injuries.

            -Compression injuries are any direct blows to the abdomen or when an external force is applied to the body and an organ is compressed between two hard surfaces

            -Shearing/deceleration injuries are caused by a rapid deceleration allowing some tissue to move forward while other tissues are held stationary, as in motor vehicle accidents.

Common injuries to the abdomen include: lacerated liver, ruptured spleen, pancreatic trauma, mesenteric artery tears, diaphragm rupture, urinary bladder rupture, great vessel tears, renal injury, and stomach or intestine rupture.