Eclampsia Algorithm

Question 1

first 6 things you do

Answer 1

1) call for help
2) establish open airway and maintain breathing
3) oxygen
4) check blood pressure and pulse
5) left lateral decubitus position
6) IV access- 1 or 2 large bore IV catheters

Question 2

Mag sulfate administration:

Answer 2

4-6grams IV loading dose over 15-20 minutes followed by a 2 gram/hr maintenance dose if renal function is normal

Question 3

If the patient seizes again while on magnesium sulfate maintenance dose:

Answer 3

maintain airway and oxygenation

give 2nd loading dose of mag sulfate 2 grams over 15-20 minutes

observe for signs of mag toxicity

Question 4

If patient seizes again after a 2nd loading dose of mag sulfate consider

Answer 4

Midazolam

Lorazepam

Diazepam

Phenytoin (can cause QRS or QT prolongation)

Monitor respirations, BP, ECG and signs of mag toxicity

Question 5

Resolution of seizures:

Answer 5

maintain mag sulfate until 24 hrs after the last seizure or after delivery whichever is later

assess for signs of neurologic injury- head imaging should be considered if neurological injury is suspected

Once patient is stabilized, preparations should be made for delivery- mode of delivery is dependent on circumstances surrounding pregnancy