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Review Question - QID 886

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QID 886 (Type "886" in App Search)
A 21-year-old second-trimester pregnant female arrives in the trauma bay with a closed head injury as well as an open ankle injury. During evaluation, what positioning is recommended to limit positional hypotension?

Reverse Trendelenburg

5%

74/1380

Trendelenburg

6%

87/1380

Left lateral decubitus

78%

1078/1380

Right lateral decubitus

6%

82/1380

Supine

4%

50/1380

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An important hemodynamic consideration in the pregnant trauma patient is the potential hypotensive effect of supine positioning. This effect, which is caused by aortocaval compression by the enlarged uterus, may decrease cardiac output by 25%. Use of a right hip wedge, manual displacement of the uterus, or lateral tilt positioning of the patient may help avoid this situation. Patient positioning must be determined with a focus on the well-being of the fetus. To avoid compression of the inferior vena cava in the patient who is in her second or third trimester, the left lateral decubitus position (left side down) should be used.

The referenced review article by Flik et al reviews the appropriate physiological changes of pregnancy and covers the treatment of orthopedic trauma in the face of pregnancy.

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