A twenty-two year old female in her third trimester of pregnancy was involved in a motor vehicle accident. She was belted. Paramedics report the patient was alert and oriented and her vital signs were stable. In the ER, she complains of pain on the left rib cage and shortness of breath. Physical examination is significant for increased jugular venous pressure, hypotension, and paradoxical pulse of 20 mmHg. EKG monitoring shows amplitude change with her heart beat (electrical alternans).
Hi there, I have understood your concern and I will suggest you the best possible treatment options. Looking at the history of the accidental trauma, in my opinion the patient should be treated at well-equipped tertiary care institution. As concerned with her hypotension, it should be taken seriously. Along with trauma to ribs there can be element of internal bleeding. May be in the thoracic area or in the abdomen or accidental bleeding from behind the placenta. She needs trauma care intensive care unit treatment. As during pregnancy hemodynamic parameters are already altered, traumatic bleeding or placental bleeding needs close attention and prompt treatment. I hope this answer helps you. Thanks.