Eclampsia/Pre-Eclampsia

 

History:

 

  • Past medical history
  • Hypertension medications
  • Prenatal care
  • Prior pregnancies/births
  • Gravida/para

 

Significant Findings:

 

  • Vaginal bleeding
  • Abdominal pain
  • Hypertension
  • Severe Headache
  • Blurred vision
  • Edema of hands and face
  • Seizures
  • Dizziness
  • Confusion

 

Differential:

 

  • Preeclampsia/eclampsia
  • Placenta previa (placenta covers cervical opening)
  • Placenta abruption (separation of placenta from uterine wall) Spontaneous abortion
  • Ectopic pregnancy

 

Treatment:

 

 

 

  • Oxygen

 

 

 

  • Initiate IV

 

 

 

  • 12-Lead EKG

 

Eclampsia:

 

Seizure or seizure-like activity ?

 

  • Yes

 

 

 

    • Obtain BGL

 

 

 

 

 

 

 

 

Improvement ?

 

  • No

 

 

 

 

  • Yes

 

    • Transport left lateral recumbent and notify receiving facility or contact Medical Control

 

Pre-Eclampsia: ?

 

    • Severe headache
    • Vision changes
    • RUQ pain
    • Hypertension
    • Edema of hands and feet
    • Sudden weight gain

 

  • Yes

 

    • Continue to monitor

 

    • Transport left lateral recumbent and notify receiving facility or contact Medical Control

 

PEARLS:

 

  • Typically seen after the 20th week of pregnancy.
  • If IV is unobtainable:
  • Magnesium Sulfate can be administered IM
  • Administer 4 grams / 8 mL in each dorsogluteal muscle (upper buttocks) for a total of 8 grams / 16 mL (5 mL max each site).
  • Multiple sites are necessary
  • Magnesium Sulfate can cause hypotension and respiratory depression; be prepared to aggressively manage the patient's airway and blood pressure.
  • In the setting of pregnancy, hypertension is defined as a systolic blood pressure greater than 160 or diastolic blood pressure greater than 90, or a relative increase of 30 systolic and 20 diastolic from the patient's normal (pre-pregnancy) blood pressure.

 

Placenta Abruptio

 

  • usually occurs after 20 weeks gestation.
  • S/S: painful 3rd trimester dark red vaginal bleeding, hypotension, tachycardia.

 

Placenta Previa

 

  • can occur during 2nd and 3rd trimester.
  • S/S: painless bright red vaginal bleeding, possible hypotension, tachycardia.

 

Physiologic changes during pregnancy:

 

  • Tachycardia
  • Tachypnea
  • T wave changes in II, avF, avL.

 

 

NREMR

National Registry Emergency Medical Responder

NREMT-I

National Registry EMT-Intermediate

NREMT

National Registry Emergency Medical Technician

NREMT

National Registry Emergency Medical Technician

NREMT-I

National Registry EMT-Intermediate

NRP

National Registry Paramedic

NRP

National Registry Paramedic