Protocol: PRE-ECLAMPSIA/ECLAMPSIA (TOXEMIA)

Original Effective Date: 01/01/2001 | Revised Date: 01/01/2002


INTRODUCTION: An enigmatic process usually occurring in the last trimester of a woman's first pregnancy (but can occur at any time) consisting of organ dysfunctions resulting in hypertension, edema proteinuria, hyperreflexia, altered mental status, and seizures. Generally referred to as pre-eclampsia until seizure occur.
BASIC LIFE SUPPORT

  1. Perform patient assessment and ABC's
  2. Administer oxygen via a device to insure adequate oxygenation.
  3. Monitor vital signs in accordance with S.O.P. protocol. Monitor SpO2.
  4. If any signs of altered LOC or history of Diabetes Mellitus or gestational diabetes, measure blood glucose level using Glucometer.
  5. Position patient at least 15 degrees left lateral recumbent.
  6. Transport patient in quiet/calm environment with dim lights (code 1).

INTERMEDIATE LIFE SUPPORT

  1. Initiate IV access using an isotonic solution, (consider using Buretrol). Use care to keep infusion rate at TKO/KVO since patient's fluid and electrolyte status is usually not clinically obvious.
  2. Request ALS Intercept.

ADVANCED LIFE SUPPORT

IF ACTIVE SEIZING OCCURS (Patient is ECLAMPTIC)

  1. Administer Diazepam 2-10 mg slow IVP. Consult with Medical Control if active seizing is not controlled. Be prepared to ventilate/intubate patient.
  2. Increase oxygen administration to 10 L/min via NRM if BVM / ATV not necessary.
  3. Attach and monitor ECG.
  4. If seizures not controlled with Diazepam, administer Magnesium Sulfate 2-4 gm mixed in 100 cc's of NS infused over 20 minutes.
  5. Monitor vital signs q 3-5 minutes. Observe for hypotension and respiratory depression.
  6. Inadvertent overloading of patient with Magnesium Sulfate may lead to flaccid paralysis, respiratory depression, hypotension and other serious effects. If you suspect this, provide respiratory support and consult with Medical Control to administer Calcium Gluconate 10%, 20 mg/kg slow IV push (over 10 minutes).

back to home page