ITLS In Pregnancy 5 — Questions and Answers
Question 1: A 34-week pregnant patient in shock has an obvious open femur fracture. After controlling hemorrhage and managing the airway, what transport decision is most appropriate?
- Nearest emergency department
- Nearest facility with orthopedic surgery
- Trauma center with obstetric capability (Correct answer)
- Scene stabilization before transport
Correct answer: Trauma center with obstetric capability
Pregnant trauma patients in shock should be transported to a facility that can provide simultaneous trauma and obstetric care.
Question 2: Which pregnant patient is at HIGHEST risk for significant injury from seemingly minor blunt abdominal trauma?
- A patient at 10 weeks gestation after a low-speed MVC
- A patient at 36 weeks who was assaulted with a punch to the abdomen (Correct answer)
- A patient at 24 weeks who slipped on ice
- A patient at 18 weeks who fell from standing height
Correct answer: A patient at 36 weeks who was assaulted with a punch to the abdomen
Intimate partner violence (assault) is associated with directed blows to the gravid uterus and carries high risk of placental abruption regardless of gestational age.
Question 3: What change in normal vital sign ranges for a pregnant patient might lead a provider to UNDERESTIMATE shock severity?
- Baseline systolic BP is normally higher in pregnancy
- Heart rate is normally higher and BP normally lower in pregnancy (Correct answer)
- Respiratory rate is normally lower in pregnancy
- SpO2 is normally lower in pregnancy
Correct answer: Heart rate is normally higher and BP normally lower in pregnancy
Pregnancy normally causes a baseline HR increase of 10–20 bpm and BP decrease of 10–15 mmHg, so typical shock thresholds may not apply.
Question 4: Which intervention for a pregnant patient in traumatic cardiac arrest should be performed SIMULTANEOUSLY with standard ACLS measures?
- Emergent thoracotomy
- Manual left uterine displacement and preparation for perimortem cesarean (Correct answer)
- Bilateral chest decompression
- High-dose epinephrine administration
Correct answer: Manual left uterine displacement and preparation for perimortem cesarean
Manual uterine displacement to relieve aortocaval compression should begin immediately alongside CPR, and PMCD should be prepared if arrest persists beyond 4 minutes.
Question 5: A pregnant trauma patient at 26 weeks is given IV fluids. What is a potential complication of aggressive crystalloid resuscitation in this population?
- Fetal hyperglycemia
- Pulmonary edema due to reduced oncotic pressure (Correct answer)
- Placental calcification
- Maternal hyperkalemia
Correct answer: Pulmonary edema due to reduced oncotic pressure
Pregnancy lowers serum albumin and oncotic pressure, making pregnant patients more susceptible to pulmonary edema with aggressive crystalloid administration.
Question 6: What is the recommended initial fluid bolus for a pregnant trauma patient in hemorrhagic shock according to ITLS principles?
- 3 liters of NS rapidly
- 1–2 liters of isotonic crystalloid titrated to response (Correct answer)
- 500 mL colloid solution
- Withhold fluids until blood products available
Correct answer: 1–2 liters of isotonic crystalloid titrated to response
ITLS recommends 1–2 L of isotonic crystalloid as initial resuscitation, titrated to clinical response while minimizing over-resuscitation risk.
Question 7: Which sign in a pregnant trauma patient best indicates uterine rupture rather than placental abruption?
- Painful vaginal bleeding
- Fetal parts palpable outside the uterus or abnormal uterine contour (Correct answer)
- Uterine rigidity without bleeding
- Fetal tachycardia with maternal tachycardia
Correct answer: Fetal parts palpable outside the uterus or abnormal uterine contour
Palpation of fetal parts outside the normal uterine contour or an irregularly shaped uterus strongly suggests uterine rupture.
ITLS In Pregnancy 5
A 34-week pregnant patient in shock has an obvious open femur fracture.
After controlling hemorrhage and managing the airway, what transport decision is most appropriate?