Use a systematic approach based on the ABCDE9 survey to assess and treat an acutely injured patient. The goal is to manage any life-threatening conditions and identify any emergent concerns, especially in a pregnant patient who may present with other underlying polytrauma complications.
Attempt to elicit a response from the patient.
Look for signs of airway obstruction (use of accessory muscles, paradoxical chest movements and see-saw respirations).
Listen for any upper airway noises and breath sounds. Are they absent, diminished or noisy?
Consider intubation early if there are any signs of decreased level of consciousness, unprotected airway or an uncooperative/combative patient, leading to distress and further risk of injury.
Intubation should be considered earlier in pregnant patients compared with non-pregnant patients because pregnant women desaturate more rapidly and are more susceptible to irreversible hypoxic injury. Crucially, maternal hypoxia is associated with poor fetal outcomes.
However, the likelihood of failed intubation is higher in a pregnant patient, and intubation is increasingly difficult with advanced gestation. Intubation of a pregnant patient should be attempted by the most senior and experienced airway-skilled practitioner. In the event of a failed intubation, sustained cricoid pressure should be maintained to prevent aspiration in the unprotected airway.
Preparations for a difficult intubation should start early, with fibre-optic intubation equipment available for all pregnant women, but particularly for those with a known difficult airway or facial or cervical fractures. Correct airway placement should be confirmed with auscultation, capnography and direct visualisation if possible.
Administer oxygen to achieve oxygen saturations between 94-98%.
Maternal hypoxia is associated with poor fetal outcomes.