Question

a female patient who is 35 weeks pregnant tripped and fell down 12 stairs. she now complains of back pain, numbness to her legs, and nausea. she is secured to a long spine board with spinal motion restriction precautions placed and is being non - emergently transported to the hospital for evaluation. en route, the patient exclaims that she is having contractions and thinks that her water may have broken. which intervention should you perform immediately? a. examine her genitalia for crowning or bleeding b. tilt the long spine board to the left side c. release her from the long spine board and prepare for delivery d. provide rapid transport and continue monitoring

Explanation:

When a pregnant patient (especially in later pregnancy like 35 - week) on a spine - board shows signs of labor (contractions, possible rupture of membranes), tilting the spine - board to the left side is crucial. This helps prevent aortocaval compression. Aortocaval compression occurs when the pregnant uterus compresses the inferior vena cava (and aorta to some extent) in the supine position. Tilting to the left displaces the uterus off these major vessels, maintaining venous return (and thus cardiac output) and placental perfusion.
Examining genitalia (option a) may not be the first step as ensuring maternal circulation (by tilting) is more urgent. Releasing from the spine - board (option c) may not be appropriate if spinal injury is still a concern (she had a fall down stairs). While providing rapid transport (option d) is important, the immediate intervention to optimize maternal and fetal physiology is tilting the board.

Answer:

B. Tilt the long spine board to the left side