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soundofmyvendetta
04-12-2012, 08:15 PM
Looking for someone with a medical background for some information on what steps would be taken in this situation.

36 y/o pregnant female (about week 30) brought in to the hospital by ambulance, accompanied by her husband who crashed the car they were both in. The woman appears to have no major external injuries and is fully conscious, but experiencing severe cramps, as well as some confusion. The husband seems uninjured save a few cuts and bruises.

What steps would be taken when examining the woman (apart from the ABCs - what would they be monitoring/looking for?) Would they examine the man as well even though he appears fine? Are there complications that may occur - as a result of the crash - which would only present themselves several hours/days later?

If you could include some medical jargon that could be used for dialogue, that would be great :) Cheers!

narmowen
04-13-2012, 06:04 AM
They'd get ahold of L&D. No, I don't think they'd assume he's fine, though it would depend on the crash.

Headaches, neck pain, pain from the seatbelt, knee pain (from hitting the dashboard), all of those showed up days after my semi-car accident (I was in the car.)

crunchyblanket
04-13-2012, 01:07 PM
The woman would be a major cause for concern. I'd have thought they'd do an ultrasound, to check for foetal distress. I don't think they'd release her until the symptoms subsided and they were sure both mother and child were safe.

As for the man, they'd definitely examine him too, symptomatic or not. Head trauma, whiplash and internal bleeding would likely be top concerns.

bellabar
04-14-2012, 06:59 AM
Yes they would check the man over too.
As far as the woman goes, confusion is a bad sign. Unless it settles quickly she's will need a CT brain as well as CT C-spine.( neck) She'll be in a cervical collar until her neck is cleared (of injury). Abdomen will need shielding with lead during this scan to reduce the radiation to the baby. There is a degree of radiation exposure with this but confusion is a sign of intracerebral bleeding which may need surgery. (Potential for debate between surgeon and more junior staff member)
At 30 weeks, the pregnancy is viable. So they will look for the baby's heartbeat. The emergency doc will probably try first, s/he will be doing a FAST (Acronymfor something-cant remember what sorry!) ultrasound to check for abdominal trauma. This will be difficult because of gravid uterus (ie pregnant state) so they would call an OB and midwife pretty quickly. The OB will be looking for a foetal HR, normal about 120-140, and looking for signs of placental abruption, where placenta is torn from uterus causing bleeding and foetal compromise, necessitating immediate caesarean.
Trauma can be a cause of preterm labour but not always. They are likely to give her some nifedipine, to reduce the risk of going into labour early, unless she is headed for surgery straight away.

I've given you loads of jargon here. If its completely incomprehensible, let me know and I'll try and explain it more. Might also be incomprehensible coz I've just come off night shift!

nikkidj
04-15-2012, 06:57 PM
The woman would be brought in in c-spine precautions, with a c-collar on, tied to a backboard to keep her neck and spine immobilized. The backboard would be tilted to the lift, to take the weight of the uterus off of the inferior vena cava and increase blood return, in a modified left lateral decubitus position. Airway, breathing, and circulation would be checked first (the "ABC"s), followed by a "secondary survey" where neuro status is checked, along with the abdomen and all of the extremities.

Agree with a previous poster, a FAST exam with an ultrasound would be performed to look for blood in the belly, and they'd likely do a quick fetal exam to look for fetal activity and heartbeat (120-160 is normal). If she had signs of an intracranial injury (like one-sided, or unilateral, weakness or numbness, vomiting, severe headache, visual changes, dizziness) and loss of consciousness they'd do a CT scan of the head, but not if she doesn't have signs of severe trauma because of the risks of radiation to the baby. They'd check for pain along the spine, and do plain films (x-rays) of any areas that were tender.

If she checks out completely in the emergency department, they'd send her to the labor and delivery unit for monitoring for preterm labor. They'd also do a full third-trimester ultrasound to look for placental abruption and fetal well-being. If there are signs of preterm labor, they'd likely give terbutaline to stop contractions. If she'd ruptured her membranes, or had abruption, c-section would be performed (in the case of abruption, it would be emergent).

As far as the father goes, if he refuses treatment, he can just hang out with his wife and offer support. In the states, if someone refuses treatment, there's not much the staff can do. If he changes his mind, he'd go through a lot of the same procedure as the woman, just minus the stuff about pregnancy.

HTH.

MKrys
04-15-2012, 08:00 PM
Yes they would check the man over too.
As far as the woman goes, confusion is a bad sign. Unless it settles quickly she's will need a CT brain as well as CT C-spine.( neck) She'll be in a cervical collar until her neck is cleared (of injury). Abdomen will need shielding with lead during this scan to reduce the radiation to the baby. There is a degree of radiation exposure with this but confusion is a sign of intracerebral bleeding which may need surgery. (Potential for debate between surgeon and more junior staff member)
At 30 weeks, the pregnancy is viable. So they will look for the baby's heartbeat. The emergency doc will probably try first, s/he will be doing a FAST (Acronymfor something-cant remember what sorry!) ultrasound to check for abdominal trauma. This will be difficult because of gravid uterus (ie pregnant state) so they would call an OB and midwife pretty quickly. The OB will be looking for a foetal HR, normal about 120-140, and looking for signs of placental abruption, where placenta is torn from uterus causing bleeding and foetal compromise, necessitating immediate caesarean.
Trauma can be a cause of preterm labour but not always. They are likely to give her some nifedipine, to reduce the risk of going into labour early, unless she is headed for surgery straight away.

I've given you loads of jargon here. If its completely incomprehensible, let me know and I'll try and explain it more. Might also be incomprehensible coz I've just come off night shift!

This is correct. I'm a neonatal intensive care nurse in my other life. (Actually, I'm shamefully a work right now...)

nikkidj
04-17-2012, 01:32 AM
Oh, and I think FAST stands for Focused Abdominal Sonogram in Trauma. But I could be wrong.

Lebby
05-11-2012, 02:18 AM
A few years ago I was hit by a car while walking with a friend. He was hit by it too, but appeared uninjured, while I was bleeding. We both pointed out to the ambulance and emergency room staff that he had been hit by a car, but they never examined him beyond asking if he was OK. Which he was, but I would have assumed they'd question it more.

Amber Nae
05-15-2012, 08:16 AM
I am also a registered nurse and I agree with everything posted by bellabar earlier. If there did seem to be any problems with the fetus they may decide to put in an internal fetal monitor if they were expecting her to go into labor. Her confusion would be a big indicator that something is wrong neurologically.

As for the man, injuries that could become a problem later would be internal hemorrhage from some of the major organs, especially in the brain, that may not present themselves right away. If there were a slow bleed in the brain then it would increase intracranial pressure, signs could be delayed for hours or days. A concussion could also be a possibility. However, in the States if a patient refuses treatment you can not force it upon them, unless they are incapable of making that decision. (mental state usually being the main reason)

BAY
05-16-2012, 07:42 AM
Seatbelts or no? Air bags or no? Crashed into another car, a ditch, or a tree? Docs would ask the woman about her seatbelt (some pregnant women slip the shoulder harness off for comfort). If she removed the shoulder harness her head might have struck the dash. If air bags deploy it tells staff the force of the accident but also that the passengers were semi-protected (for the woman it would save her from head injury).

Both husband and wife would arrive as another poster stated on a back board with c-collars on until they're cleared for neck injuries. After ABC, clearing spinal cord injuries is next. When you come to the ED in c-collars, you aren't allowed to opt out until you're cleared from spinal injuries. No hospital would risk it.

If she's confused, staff will ask her her name, where is she, and even who is president. If she asks where she is, staff will say "You're at General Hospital in London. You were in a car accident. I'm Doctor Gaines. Are you hurting anywhere?

There is no secret code speak between staff and patient. There is medical slang between staff like "get me an H&H stat (for suspected bleeding) and put her on 2 liters of O2 (light oxygen delivered by cannula)."

Type of trauma often dictates how long they're held for observation. After the man's neck is cleared he can ask to be with his wife if she's taken to L&D. He'd be discharged unless he asked for something for pain, then he'd have to wait a bit if he received a narcotic pain killer.

Hope this helps.

Trebor1415
05-23-2012, 11:40 AM
Just a note: In the U.S. they wouldn't call a midwife to the ER. An OB/GYN specialist, yes. Relatively few U.S. hospitals use midwives and they aren't generally considered emergency specialists.

GeorgeK
05-24-2012, 03:09 AM
Abdomen will need shielding with lead during this scan to reduce the radiation to the baby.

It depends. The modern late generation CT machines deliver less radiation than a standard plain X-Ray from 15 years ago. 25 years ago a three shot IVP was considered well within acceptable risk. If they go to a full trauma center, they very well might CT the belly and pelvis because the information is worth the miniscule risk especially in a patient where physical exam will be compromised. Remember that this is an emergency, not a routine thing. If they're in an older hospital they might go with a peritoneal lavage, but few surgeons under the age of 50 have ever even performed an ER Abd Lavage. It's not that it's a dangerous or technically difficult procedure it's just that it's more of a historical note rendered obsolete by modern technology.