Eclampsia Flashcards
Scenario
You are the midwife on duty in the inpatient ward. Louise is a prim who has had a venous delivery 6 hours ago. She had previously been attending Daycare for blood pressure monitoring as she has hypertension in the antenatal period. Louise was talking to one of the woman in th ward and informed her that she had a really sore head and could not see properly and this terrible upper abdominal pain and could she get the midwife. The woman also alerts you to the fact that louise has started to shake and appears to be having a seizure.
What do you suspect may be happening in this scenario?
Eclamptic seizure.
What led you to this conclusion?
Hypertension in the antenatal period.
Really sore head.
Blurred vision
Upper abdominal pain
Shaking what looks like a seizure
Demonstrate and discuss how you would manage this situation.
Taking a safe approach- making sure there is no unsafe situations around the area ie; wires and bed rails- It is safe to enter.
Introduce yourself and press emergency buzzer the make 2222 call- for the purpose of osce have to leave woman’s bedside however in real life stay with the woman.
Put into recovery position
2222- obstetric emergency in room 2- seniors obstetrician, charge midwife, anaesthetist, hemotoligist.
Once help arrives- give my SBAR give recommendation- ABCDE approach
once help arrives
Get emergency trolly
Give SBAR
Give recommendations- Mange the seizures, site cannulas and catheters, take an ABCDE approach and MOVE acronym to make sure she in a safe space when stable
Move bed down, remove pillow so she is flat, take back of bed off.
Apply PPE
AVPU and Airway
im going to use AVPU to asses her responsiveness and to see if she is reacting to me through voice pain or if she’s unconscious.
AIRWAY- I’m then going to asses her airway- If she is taking and maintaining her own airway then she is alert . i can also use a jaw thrust to check to see if there is anything obstructions her airway- if so i can use a tongue sweep to remove.
As she’s having seizures im going to insert and airway to we can ensure to maintain the airway. Measure from the jaw to the chin and insert upside down as a tongue depressor and the rotate and insert fully.
Breathing
Use look listen and feel method
Look to see if there is chest wall movement and it’s symmetrical
Listen to see if there is any wheezing or striders which can be common following seizure.
Feel the breaths against my cheek to see if i can feel like air.
Do this for one minute
Can the give oxygen through a facial trauma mask and put it to 15l
Circulations
Check capillary refill which should be under 2 seconds and can be done but pressing on the nail bed and watching the blood refill.
Check observations- BP, o2, stats and pulse- docketed on a MEWS chart every 5 minutes.
Cannulation- on both arms using a grey cannulations using an a septic non touch technique with a sterile dressing that is dated and timed and the flushed by a trained professionals.
Off the back of the cannulas I’m going to take bloods- Full blood count ( white cell count, haemoglobin, platelets), Group and save (to know blood group and in case of transfusion, Use and E ( to make use her kidneys are functioning), LFTs (to ensure her liver is functioning), Coagulation (incase she goes onto to develop a coagulation disorder or HELLP) Glucose (to check is the seizure os anything to do with hypoglycaemia)
Drugs to give to help stop the seizure- Magnesium sulphate Loading (4g IV over 5-15 mins) then a maintenance dose through a syringe driver (1g/h i’ve over 25 hrs), if continuing to seize then give another bolos dose of magnesium sulphate (2g IV over 5mins) i can also increase the infusion rate ( to 1.5-2g/hr) of the syringe driver. To reduce BP, labetalol bolos (IV 50mg over one minute then 50mg every 5 mins with a max of 200mg per course) aswell as if infusion (IVI initially 2mg/minute 50-200mg)
Also going to put a bag of heartmans fluid that is in date and not cloudy- slowly and to avoid fluid retention or oedema.
Then we will catheterise louise using an a septic non touch technique in a sterile environment- use a size 10 indwelling catheter with a euro meter attached to measure fluid output- over 25mls per hour- Document on fluid balance chart, Can also send a custom to see how much protein is in urine.
Disability
Using Avpu to ensure she is still alert
Magnesium sulphate can become toxic and cause respiratory depression, cardiac problems,reduce of mobility.
Ensure resps are being counted every 5 mins and should be between 12-20
Check reflexes to ensure they are still working
If developing magnesium toxicity- stop the infusion and give calcium glauconite ( 1 gram IV over 3mins)
Exposure
Check temperate and document
Check how she feels to touch warm clammy
Louise is now stabilised
MOVE accrynum
Mobiles- on the bed with appropriate monitors.
Oxygen- can use a portable tank of oxygen while moving
Venous access- we have already got venous access with our two cannulas
Expertise- all of out professionals are aware of louise and will be present in HDU on arrival.
Documentation
Date and time i was made aware of seizure
When emergency buzzer
When 2222- who i called for and who came
The roles they had when arrived
Observations on the mews chart
Drugs given- the dose route and the type and the effect
Fluids administered
Time of cannulation and catheterisation
When moved to HDU
Maternal outcome
Date time and sign
