36 – Obstetric Trauma

Scenario in a Nutshell

Obstetric trauma with injury to chest, abdomen and pelvis.

Stage 1: A front-seat passenger in a road traffic accident (RTA) arrives in A+E, haemodynamically compromised and in pain (left chest, left hip and abdomen).

Stage 2: Haemodynamically compromised despite resuscitation secondary to splenic laceration and pelvic fracture.

Stage 3: Maternal and fetal deterioration secondary to massive haemorrhage. Requires transfer to theatre for emergency laparotomy, pelvic fracture management and caesarean section.

Target Learner Groups

All members of the multidisciplinary obstetric team: anaesthetists, midwives, obstetricians. All members of the multidisciplinary A+E emergency team.

Specific learning opportunities
Recognise the importance of a structured handover in trauma
Understand the modifications of management in trauma for obstetric population
Consideration of teams to be called
Orientation to where obstetric emergency equipment is in your A+E department (delivery packs/drugs/checklists)
Specific skills able to be incorporated Manual uterine displacement Chest drain insertion Intubation with in-line stabilisation FAST scan performance and interpretation

Suggested learners (to represent their normal roles)	In the room from the start
Anaesthetic ST3+	√
Operating Department Practitioner (ODP)/anaesthetic nurse	√
Obstetric ST3+		√
Midwife		√
Surgical trauma team (as many as can attend)	√
A+E trauma team (as many as can attend)	√
Trauma team leader	√
Neonatal team		√
Suggested facilitators
Faculty to play role of lead paramedic	√

Details for Facilitators

Patient Demographics

Name: Jessie

Age: 24

Gestation: 30

Booking weight: 58 kg

Parity: P0

Scenario Summary for Facilitators

Patient in RTA. Car vs. van. Patient front-seat passenger (not wearing seatbelt) in a car T-boned by a van at 50 mph. Impact to passenger side. Airbags deployed. Paramedics report significant intrusion into front-seat passenger side of car. Passenger was extricated from vehicle by Fire crew and Paramedics. Spinal immobilisation maintained during extrication. Patient conscious throughout.

The Paramedic crew send a pre-alert trauma call through control.

Scenario starts when patient arrives in A+E with AT-MIST-structured handover.

Haemodynamically compromised, with severe pain in left side of chest, abdomen and left hip.

Injuries sustained include simple left-sided pneumothorax, splenic laceration and pelvic fracture.

Haemorrhagic shock, which initially responds to fluid resuscitation but then patient deteriorates.

Scenario ends with agreement for transfer to theatre for laparotomy, pelvic fracture management and caesarean section.

Set-up Overview for Facilitators

Clinical setting	In A+E resuscitation bay
Patient position	Supine, on trolley, on spinal board with cervical collar and head straps
Initial monitoring in place	Pulse oximetry NIBP cuff ECG
Other equipment	Oxygen 15 l via non-rebreathe mask No IV access
Useful manikin features	Abnormal breath sounds (pneumothorax)

Medical Equipment

For core equipment checklist see Chapter 9.

Additional equipment specific to scenario
Spinal board	Hard collar	Blocks/tape	Rapid fluid infusor
Other simulated blood components	O-negative blood	Chest drain kit	External pelvic binder
Drugs Tranexamic acid Anaesthetic drugs box	Arterial line	Pen torch

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36 – Obstetric Trauma