Critical Care Transport: Blunt Polytrauma in Pregnancy.

This simulation is designed for critical care transport nurses and attending physicians. It can also be adapted for critical care transport paramedics and respiratory therapists as well as emergency medicine nurses, residents, and attending physicians. Emergency and trauma surgery practitioners routinely perform primary and secondary surveys as a systematic approach to trauma care. While this approach has broad applications, clinicians must also be versed in the nuances of caring for special populations in trauma. One such example is the obstetric patient. The incidence of trauma in pregnancy is increasing and is now the leading cause of non-obstetrical maternal death in the United States.1 Optimal maternal resuscitation depends on an understanding of the significant anatomic and physiologic changes of pregnancy and their influence on airway, breathing, and circulation.2,3,4This case presents a blunt polytrauma with unstable pelvic and lower extremity fractures precipitating hemorrhagic shock and the need for blood product transfusion. Learners must quickly adapt their clinical acumen and consider the influence of an obviously gravid patient on their resuscitation. Implementing and practicing the required skills allows for delivery of high-quality care. This session ensures that learners have a well-rounded understanding of scenarios that could occur in the resuscitation of a pregnant trauma patient. At the completion of this simulation participants will be able to 1) perform primary and secondary trauma surveys, 2) assess the neurovascular status of a tibia/fibula fracture, 3) appreciate anatomic and physiologic differences in pregnancy, 4) appropriately order analgesia and imaging, 5) recognize and treat hemorrhagic shock, 6) perform an extended focused assessment with sonography in trauma exam (eFAST) in undifferentiated hemorrhage, 7) identify a displaced pelvic fracture and properly apply a pelvic binder, and 8) obtain and interpret fetal heart rate using ultrasound. This is a high-fidelity simulation portraying a 24-year-old pregnant female who requires hemodynamic resuscitation, pelvic and extremity fracture stabilization, and assessment of fetal heart rate. After completion of the simulation, learners will participate in a debrief and small group discussion that focuses on didactic knowledge and its application to patient care, crew resource management, and interprofessional communication. Learners were required to complete a pre- and post-simulation test evaluating their knowledge of pregnant trauma patient care. The results were then compared to evaluate whether the simulation improved participants' knowledge base. Learners also completed an evaluation of the simulation case itself using a 5-point Likert scale and free response. Feedback from the first round of simulations was used to modify the simulation case prior to the second round. Our simulation included 26 participants: nine attending emergency medicine/critical care transport physicians and 17 critical care transport nurses. All participants took a pre- and post-test evaluating their medical knowledge with an average score of 60% and 93.4% correct responses respectively. In addition, participants were given the opportunity to evaluate the simulation itself via an anonymous survey. All (100%) of the participants strongly agreed that the content was relevant, met educational needs, was effective, and was appropriate for professional licensure level. This simulation, focusing on the care of a pregnant trauma patient, was well received by the learners and effectively met educational goals at an appropriate level for professional licensure. Participants demonstrated an excellent understanding of appropriate imaging evaluation/interpretation, blood product resuscitation, and use of tranexamic acid (TXA) in the pregnant trauma patient. Improvement in interpretation of fetal heart rate as well as use/application of a pelvic binder in the setting of pregnancy were seen as a result of this simulation training. Pregnant trauma, fetal heart rate, pelvic fracture, blood product transfusion, extremity fracture, critical care transport, emergency medicine simulation.