whats an easy guide to detrmine which tirmester a pregnant women is in if unconscious?
1st - all in the pelvis
2nd - below the umbilical
3rd - above umbilical
how many weeks are in each trimester
1st - <12 weeks
2nd - 12 - 27 weeks
3rd - 27 - delivery
what cardiovascular changes do you see in prego women?
- anatomical position of the heart increases to 4th intercostal space by 36 weeks
ECG changes:
- t waves flattened in lead 3
- t waves may be inverted in lead 3
- possible Q waves in 3
- increase in ectopic beats
- decreased pulmonary vascular resistance (greater volume movnign through, more o2 exchange)
- increased CO until end of 2nd trimester
- increased HR
- reduction in SBP & DBP
- blood volume increases by 50%
- haemodilution & increase in Hb concentration
- increase in clotting factors
- fibrinogen levels double
- increased flow through tricuspid valve or mitral valve
- clinical shock may not occur until 30-35% of blood volume is lost
what respiratory changes do you see in prego women?
increased sensitivity to co2 insp capacity increased by 300ml expiratory reserve decreases by 200ml Tidal volume increases - 500 - 700ml o2 consumption increases by 15%
what GIT changes do you see in prego women?
poor cardiac sphincter tone
increase gastric reflux
decresed gastric emptying
- increased risk of aspiration
what Genitourinary changes do you see in prego women?
bladder capacity doubles
increased renal blood flow
uterers dilated and partially obstructed by 3rd trimester
what muscle and skeletal changes do you see in prego women?
more relaxin in 3rd trimester
general ligamentous relaxation
increased risk of dislocations and subluxations
change in centre of gravity - increased risk of falling
what endocrine changes do you see in prego women?
progesterone:
- relaxes smooth muscle
- more ability to get rid of co2
what psych issues do you see in prego women?
risk of being assaulted by a partner
patients off meds
drug abuse often continues
What are you concerned about with mechanism of injury with preggos?
- increased risk of placental abruption
- risk of injury to organs not usually susceptible (uterus/bladder)
what are the main mechanisms for placental abruption?
- spontaneous
- separation from placental wall
- can occur with even minor trauma
- MVA speed >50kmh is significant
how much blood perfuses the uterus in an at term patient?
2-4 litres
what do you need to consider with preggo vital signs?
Hypotension = significant blood loss
can compensate well
what do you do if a preggo is hypotensive?
tilt them 15-30degrees, remove uterus from squashing inferior vena cava
or shift placenta to the left
what mgmt do you give for preggo?
15l non rebreather o2
IV - start early - large bore cannula in vein
will need large amounts of fluid
Transport to royal melbourne
when does a ceasarian need to be performed in cardiac arrest for best outcome?
within 5 mins of maternal cardiac arrest
