#SimBlog: Eclampsia
““27-year-old female. 33/40 primigravida, brought in by ambulance. She has been fitting for 10 mins.””
Observations
A – Snoring noises
B – RR18, Sats 93% (15l)
C – HR 96 BP 187/104
D – GCS 3 BM 6.5
E – Temp 36.7°C
Clinical Findings
Unresponsive, actively seizing
Pitting oedema
Proteinuria
Why We Simulated?
"Eclampsia is defined as the occurrence of seizures in pregnancy or within 10 days of delivery, accompanied by at least two of the following features documented within 24 hours of the seizure: hypertension, proteinuria, thrombocytopenia or raised aspartate aminotransferase. Eclampsia complicates approximately one in 2000 pregnancies in the United Kingdom and it remains one of the main causes of maternal death" (Munro, 2000)
The Skeptics Guide to Emergency medicine has a podcast on Magnesium Vs Diazepam for the management of seizures in Eclampsia.
References:
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Philip T Munro: Management of Eclampsia in the Accident and Emergency Department – J Accid Emerg Med 2000; 17:7-11 doi:10.1136/emj.17.1.7
Learning Outcomes
Accessing guidelines will ensure the correct dose of drugs is used.
The treatment for seizures in eclampsia should be magnesium and to arrange for delivery. Our guideline is 4g over 15-30 mins.
Relying on the "little finger" for size of an NP airway is no longer standard practice.
Positive Feedback
Correct diagnosis recognised early
Appropriate drug started (although dose needed clarifying)
Good teamwork and verbalisation of the plan
Edit & Peer Review by Rebecca Prest
This Weeks Special Guest: SimMum
Thank you to the UHL clinical skills team for allowing us to use their SimMum Manikin. Using this manikin allowed us to achieve greater fidelity in our simulation.
...SimMum will return!
