Introduction: Pregnant patients with an acute injury present challenges to healthcare teams; one with a burn poses unique challenges when considering the balance of fluid resuscitation with a tendency toward extravasation due to hematologic changes in pregnancy, along with managing a patient in dual hyperdynamic states. When a patient presents in active labor, burn resuscitation is complicated by hemodynamic changes related to the pregnancy and active labor, and we must account for fetal responses in relation to a massive burn. We discuss the unique challenges presented when admitting a laboring woman with a significant burn injury. Description: She presented to our ED a 56% TBSA from an outdoor fire and was intubated prior to transfer. Per report, she was estimated to be 38 weeks pregnant. She was evaluated in the ED by the trauma, burn, and OB teams. The OB team noted that she was in active labor, as was evident by exam and regular uterine contractions on tocometry monitoring. In-depth discussions were held regarding the most appropriate admission location for this patient (Labor she was ultimately admitted to the L such literature is lacking in burn care. In this case, our patient and her fetus were cared for simultaneously, however turning the L&D unit into a Burn ICU room presented logistical challenges with many frustrations among the multiple disciplines involved. This situation highlighted both an institutional and larger specialty need for standardized approaches to laboring women that require both the immediate availability of the OB team as well as critical care trained providers.
Hollowell et al. (Sun,) studied this question.