Transcript Eclampsia drill

Eclampsia Drill
Dr Sharda Patra( Asso. Prof)
Prof Manju Puri
Department of Obstetrics & Gynecology
Lady Hardinge Medical College & Smt SK Hospital
New Delhi
Eclampsia Drill
Eclampsia is an important obstetric
emergency which if not managed promptly
can lead to life-threatening complications
like cerebral haemorrhage, pulmonary
edema, abruptio placentae maternal and
fetal death
Any pregnant woman presenting
with convulsions in later half of
pregnancy should be treated as
eclampsia until proved otherwise
The management of eclampsia
involves
Immediate management
 Subsequent management
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One should remember that first few
minutes following a fit are very crucial and
should be handled very fast due to risk of
cerebral hypoxia and aspiration which can
have serious consequences.
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Immediate management….
Principles
 Speed
 Skills
 Priorities
Immediate management …..
Stabilize the woman
Call for Help
Remember A; B; C of
resuscitation
 Control convulsion
 Control blood pressure
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Initial Resuscitation
Airway
 Place the woman on her left side to reduce the risk of
aspiration of secretions, vomit and blood
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Put an airway in between the tongue and palate to
prevent tongue bite and falling of tongue
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Suction of the secretions is done through this airway by
connecting it to a suction machine.
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Give oxygen (if available15 l /min ) and continue longer if
cyanosis persists
Stay with the patient to ensure that her airway is
clear
Initial Resuscitation
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Breathing Assess – count respiratory rate .Look,
Listen, Feel. Ventilate if necessary
Circulation
Assess pulse , BP. CPR if necessary
Secure intravenous access with a cannula (16G )
Send blood for BG, CBC, platelets, clotting screen,
KFT, LFT, Uric acid, Serum electrolytes
Catheterize the patient to empty the bladder , record
output and monitor output subsequently
Do a urine examination for proteins
Treat and prevent further fits
Administer Magnesium Sulphate
(MgS04)
Regimes: Pritchard or Zuspan
Pritchard
Loading dose
Maintenance dose
4g IV 20% solution over 5
to 10min plus 10g IM
(5 g 50% solution deep
I/M in each buttock)
5g I/M every 4h in
alternate buttock till 24
hrs after the last seizure
or delivery which ever is
later
Zuspan
Loading dose
Maintenance dose
Loading dose 4g IV 20%
solution over 5 to 10min
1 to 2 g / h by controlled
infusion pump x 24h
after the last seizure
Mg So4 :Preparation and
Administration
MagSo4 available in 25%, 50% strength
 Initial loading dose 14gms
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14gms
4gm IV
10 gms IM
Preparation and administration
25% ampoules
(2ml) contains
0.5 gm magso4
IV 4gms
50% amps (2ml)
contains 1gm of
magso4
Take 4amps (8ml)
dilute with 12ml
saline to make it
20ml
Take 8amps (16ml)
dilute with 4ml saline
to make it 20ml
20ml solution contains 4gms
Magso4
( 4gm/20ml 20% Sol)
IV 4gm
20ml is given slow IV
over 5-10mins
Keep an eye on
respiratory rate ,
facial flushing ,
Preparation and Administration
10gms IM
50% amps (2ml)
contains 1gm of
magso4
Take 5amps
(10ml)
undiluted
5gms deep
IM(10ml) in each
buttock
If convulsion recurs
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Give 2gm IV 20% solution over 5-10mins
and continue the maintenance dose
Monitoring during magnesium sulphate
Therapy
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Respiratory rate >14/ min
Presence of patellar reflexes (knee jerk)
Urinary output- 25ml/hr or 100ml/4hrs
Repeat doses of magnesium sulphate
must be withheld or delayed if:
The respiratory rate is less than 14 per
minute
Patellar reflexes are absent
Urinary output is less than 100 ml over
preceding 4 hours
Antidote:
In case of respiratory depression or
arrest:
 Give calcium gluconate 1 g (10 ml of 10%
solution) IV slowly
 Assisted ventilation using mask and bag,
anesthetic apparatus or intubation
CAUTION
Magnesium sulfate should be used with
caution in women with
 Impaired renal function.
 Patients with a heart block or myocardial
damage including a history of cardiac
ischaemia
Controlling blood pressure
Antihypertensive drugs should be given if
the diastolic blood pressure is 110 mmHg
or more.
 The aim is to keep the diastolic blood
pressure between 90–100 mmHg to
prevent cerebral haemorrhage
 Drug of choice- Labetolol, Nifedepin
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Labetolol
1.
20 mg I.V over 2mins
wait for 10 mins if no response
40 mg iv
80 mg iv
(can be increased upto 220 mg)
2.
10 mg IV
20 mg iv
40 mg iv
Target :
Decrease in diastolic BP
To 90-100 mgHg
40 mg iv
80 mg iv
Nifedipine
10 mg tabs orally to repeat every 20
mins up to a maximum dose of
200 mg
Subsequent management
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Once the patient is stabilized and fits have
ceased , then a pervaginum examination is
done to assess cervical status
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Consider for termination of pregnancy if
not in labor
Essential care
Turning the woman two–hourly to avoid
hypostatic pneumonia
 mouth care, (no oral fluids are given)
 monitor the urinary output.
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Observations:
Restlessness or twitching which may herald
the onset of another fit
 Color is observed for cyanosis which
indicates the need for oxygen
 Temperature four hourly. Hyperpyrexia may
occur
 Pulse and respirations are recorded hourly,
or more often
 Blood pressure is recorded at least hourly
earlier if >=160/110
 Ut contractions and FHS is checked
 Input output is recorded accurately.
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A
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H
M
Do not leave the patient
alone
Place in left lateral position
CALL FOR HELP
Airway
Assess
Maintain patency
Give oxygen
Breathing
Assess
Protect Airway
Ventilate if required
Circulation
Evaluate pulse and BP
Secure IV access
Control of
convulsions
Control of
Hypertension
Loading dose :
4gm IV
20ml is given slow IV over 5-10mins followed by 10gms ,
5gms deep IM (10ml) in each buttock
If fits recur- 2gms , 20% IV
Maintenance dose- 5gms IM in alternate buttocks 4 hourly
Monitor- Resp rate>16
Presence of Knee jerk
Urinary output >25ml/1hr
If Mag toxicity- Inj Calcium Gluconate , 10% 10ml , 10mins
IV
Labetolol
10mg IV , give 20mg IV if noresponse after 10mins, then
40mg, 40mg, 80mg max 220mg
Nifedipine
10mg orally , repeat after 20mins if noresponse , max 200
mg, target BP- dbp-90-100 mmHg
Delivery
A DRILL …….. Eclampsia
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The need for good clinical skills to be able to
recognize and act promptly
Be in control of the situation
Need to care for the family, who will be
extremely distressed to see the woman have
a fit;
Need for gentleness, so as not to harm the
woman if she is unconscious, or stimulate
further fits;
Need to respect the woman’s dignity at all
times;
Need for strict attention
Thanks