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Eclampsia Case © 2015 EMSIMCASES.COM Page 1 This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License. Section I: Scenario Demographics Scenario Title: Eclampsia Date of Development: 06/04/2015 (DD/MM/YYYY) Target Learning Group: Juniors (PGY 1 – 2) Seniors (PGY ≥ 3) All Groups Section II: Scenario Developers Scenario Developer(s): Kyla Caners Affiliations/Institution(s): McMaster University Contact E-mail (optional): [email protected] Section III: Curriculum Integration Learning Goals & Objectives Educational Goal: To practice the management of eclampsia, a relatively rare presentation with important critical care steps in its management. CRM Objectives: Communicate effectively with team and consultants to provide expedient patient care. Medical Objectives: 1) Recognize potential pre-eclampsia/HELLP and initiate appropriate diagnostic workup. 2) Administer appropriate dose of magnesium sulfate for eclampsia, including repeated doses. 3) Recognize apnea as a possible consequence of magnesium administration and appropriately work through differential diagnosis and management of apnea. Case Summary: Brief Summary of Case Progression and Major Events 30 year-old female, G1P0 at 32 weeks, presents to the ED with headache, blurred vision, nausea, and vomiting. Her arrival BP is 165/115. As the team coordinates her initial workup, the patient will begin to seize. She will not stop seizing until magnesium sulfate is given. The patient will then require intubation for respiratory depression. The case will end post intubation when the patient has been referred to OB. References Marx, J. A., Hockberger, R. S., Walls, R. M., & Adams, J. (2013). Rosen's emergency medicine: Concepts and clinical practice. St. Louis: Mosby. Magee LA, Pels A, Helewa H, et al. SOGC Clinical Practice Guideline: Diagnosis, evaluation and management of the hypertensive disorders of pregnancy: executive summary. J Obstet Gynaecol Can 2014;36(5):416–438
Transcript of Eclampsia Case 1 - WordPress.com · 2020. 5. 28. · Medical Objectives: 1) Recognize potential...
EclampsiaCase
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SectionI:ScenarioDemographics
ScenarioTitle: EclampsiaDateofDevelopment: 06/04/2015(DD/MM/YYYY)
TargetLearningGroup: Juniors(PGY1–2) Seniors(PGY≥3) AllGroupsSectionII:ScenarioDevelopers
ScenarioDeveloper(s): KylaCaners
Affiliations/Institution(s): McMasterUniversityContactE-mail(optional): [email protected]
SectionIII:CurriculumIntegration
LearningGoals&ObjectivesEducationalGoal: Topracticethemanagementofeclampsia,arelativelyrarepresentationwith
importantcriticalcarestepsinitsmanagement.CRMObjectives: Communicateeffectivelywithteamandconsultantstoprovideexpedientpatient
care.MedicalObjectives: 1) Recognizepotentialpre-eclampsia/HELLPandinitiateappropriatediagnostic
workup.2) Administerappropriatedoseofmagnesiumsulfateforeclampsia,including
repeateddoses.3) Recognizeapneaasapossibleconsequenceofmagnesiumadministrationand
appropriatelyworkthroughdifferentialdiagnosisandmanagementofapnea.
CaseSummary:BriefSummaryofCaseProgressionandMajorEvents30year-oldfemale,G1P0at32weeks,presentstotheEDwithheadache,blurredvision,nausea,andvomiting.HerarrivalBPis165/115.Astheteamcoordinatesherinitialworkup,thepatientwillbegintoseize.Shewillnotstopseizinguntilmagnesiumsulfateisgiven.Thepatientwillthenrequireintubationforrespiratorydepression.ThecasewillendpostintubationwhenthepatienthasbeenreferredtoOB.
ReferencesMarx,J.A.,Hockberger,R.S.,Walls,R.M.,&Adams,J.(2013).Rosen'semergencymedicine:Conceptsandclinicalpractice.St.Louis:Mosby.MageeLA,PelsA,HelewaH,etal.SOGCClinicalPracticeGuideline:Diagnosis,evaluationandmanagementofthehypertensivedisordersofpregnancy:executivesummary.JObstetGynaecolCan2014;36(5):416–438
EclampsiaCase
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SectionIV:ScenarioScript
A.ScenarioCast&RealismPatient: ComputerizedMannequin Realism:
Selectmostimportantdimension(s)
ConceptualMannequin PhysicalStandardizedPatient Emotional/ExperientialHybrid Other:TaskTrainer N/A
Confederates BriefDescriptionofRoleNurse Simulatesseizureswhenappropriatebothbyshakingbedandbystating“Ithink
thepatientisseizing.”
B.RequiredMonitorsEKGLeads/Wires TemperatureProbe CentralVenousLineNIBPCuff DefibrillatorPads CapnographyPulseOximeter ArterialLine Other:
C.RequiredEquipmentGloves NasalProngs ScalpelStethoscope VenturiMask TubeThoracostomyKitDefibrillator Non-RebreatherMask CricothyroidotomyKitIVBags/Lines BagValveMask ThoracotomyKitIVPushMedications Laryngoscope CentralLineKitPOTabs VideoAssistedLaryngoscope ArterialLineKitBloodProducts ETTubes Other:IntraosseousSet-up LMA Other:
D.MoulagePillow/clothestomimicappearanceofpregnantpatient.Appropriateadjunctstohelpsimulateseizure.
E.ApproximateTiming
Set-Up: 5min Scenario: 15min Debriefing: 20min
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SectionV:PatientDataandBaselineState
A.ClinicalVignette:ToReadAloudatBeginningofCaseMirandaHammpresentstoyourlocaltertiarycareEDcomplainingofaheadache.Sheisa30yearoldG1P0at32weeks.Shehashadaheadachesincelastnight.Thismorningshestartedfeelingnauseousandbeganvomiting.Nowhervisionfeelsblurred,soshecameforassessment.
B.PatientProfileandHistoryPatientName:MirandaHamm Age:30 Weight:75kgGender: M F CodeStatus:FullChiefComplaint:headacheHistoryofPresentingIllness:Headachesincelastnight.Circumferentialandpounding.Thoughtitwashernormalmigrainebutwasafraidtotakeanymedicationbecauseofpregnancy.Thenstartedhavingnauseaandvomiting.Didn’treallysleepallnight.Nowheadacheisworseandvisionfeelsblurry.She’sneverhadblurredvisionbefore.PastMedicalHistory: Migraines Medications: None. Allergies:None.SocialHistory:Liveswithhusband.FamilyHistory:Norelevantdisorders.ReviewofSystems: CNS: Headachesincelastnight,circumferentialandpounding.
HEENT: Blurredvisionthismorning.“FeelslikeI’mlookingthroughfog.”CVS: Nil.RESP: Nil.GI: Nauseousalldayyesterday.Vomitinglastnightandthis
morning.GU: Nil.MSK: Nil. INT: Nil.C.BaselineSimulatorStateandPhysicalExam
NoMonitorDisplay MonitorOn,nodatadisplayed MonitoronStandardDisplayHR:110/min BP:175/115 RR:20/min O2SAT:96%RARhythm:Sinustach T:36.5oC Glucose:6.4mmol/L GCS:15(E4V5M6)GeneralStatus:Well-looking,butappearsinpain.CNS: A+Ox3.Nofacialasymmetry.Nofocaldeficits.Reflexes2+.HEENT: PERLA3mm.Nopapilledema.CVS: NormalS1/S2.Nomurmur.RESP: Innodistress.Appropriatelytachypneicforpregnancy.ABDO: Gravid,non-tenderuterus.SomeRUQtenderness.IfFHRchecked,it’s160.GU: Nil.MSK: Nil. SKIN: Nil.
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SectionVI:ScenarioProgression
ScenarioStates,ModifiersandTriggersPatientState PatientStatus LearnerActions,Modifiers&TriggerstoMovetoNextState1.BaselineStateRhythm:SinustachHR:110/minBP:175/115RR:20/minO2SAT:96%T:36.5oC
A+Ox3.Answeringquestions.Slightlytachypneic.RUQtenderness.
LearnerActions- IV,monitors- AssessFHR(160)- Bloodworkandurinalysis- HxandPx
ModifiersChangestopatientconditionbasedonlearneractionTriggersForprogressiontonextstate-3minutesà2.Seizure
2.SeizureHRà130
Activelyseizing.Nursetocuelearners(Ithinkshe’sseizing!)andinitiateseizure.
LearnerActions- AdministerMgSO44givbolusthen1-2g/hriv- Checkcapsugar(6.4)- CallOB/GYNfordelivery
Modifiers-BenzogivenànochangetoseizuresTriggers-MgSO4givenà3.Apnea
3.ApneaHRà110RRà6à0O2SATà90à88%BPà165/115
Notseizing.RRslowlydecreasingwithassociateddesaturations.Notresponsive.
LearnerActions- InitiateBVM- StopMgSO4infusion- GiveCagluconate1giv- Administerinduction- Administerparalytic
Modifiers-BVMinitiatedàO2SAT93%-PropofolormidazolamforinductionàBP160/110-CalciumgluconateànoeffectTriggers-Intubatedà4.Post-intubation
4.Post-intubationHRà110RRà12(vent)O2SATà98%BPà165/115
Intubatedandsedated.
LearnerActions- CallOB/GYN- CallICU- Post-intubationCXR- RestartMgSO4infusion- Labetololorhydralazine- ConsiderCThead
Modifiers-AntihypertensiveàBP145/100Triggers-Antihypertensivegivenà5.Resolution-15minà5.Resolution
5.ResolutionBPà145/100
Intubatedandsedated.
OB/GYNarrivestotakepatientforC/S.àTeamtoexplaincasetoconsultant.Endscenario.
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SectionVIII:DebriefingGuide
GeneralDebriefingPlanIndividual Group WithVideo WithoutVideo
ObjectivesEducationalGoal: Topracticethemanagementofeclampsia,arelativelyrarepresentationwith
importantcriticalcarestepsinitsmanagement.CRMObjectives: Communicateeffectivelywithteamandconsultantstoprovideexpedient
patientcare.MedicalObjectives: 1) Recognizepotentialpre-eclampsia/HELLPandinitiateappropriate
diagnosticworkup.2) Administerappropriatedoseofmagnesiumsulfateforeclampsia,
includingrepeateddoses.3) Recognizeapneaasapossibleconsequenceofmagnesium
administrationandappropriatelyworkthroughdifferentialdiagnosisandmanagementofapnea.
SampleQuestionsforDebriefing1) Whatisthedosingformagnesiumsulfateineclampsia?Inpre-eclampsia?2) Whenshouldyouconsiderananti-hypertensiveineclampsia?3) Whydidthispatientbecomeapneic?Whataretheotherassociatedsideeffectsofmagnesium?What
isapossibletreatmenttoreversetheseeffects?KeyMoments
Recognitionofpossiblepre-eclampsiaHELLPsyndromeandinitiationofkeybloodwork.AdministeringMgSO4totreateclampsia.RecognizingapneaassideeffectofMgSO4.
