Rapid Sequence Intubation Section 1 Copy

Case Presentation

A 37 year-old female calls 911 due to a severe headache and blurry vision.  She reports that she is 37 weeks pregnant with her first child.  When paramedics arrive they find a gravid female in moderate distress.  Her headache began gradually this morning and has gotten progressively worse over the last few hours.  She feels nauseated and light makes the headache worse.  She called 911 when her vision began to get blurry and she started to see dark spots.  She has no chronic medical problems, but her obstetrician diagnosed her with gestational diabetes.  She was told that everything was well during her routine obstetric visit 4 days ago.   On examination, she is alert and oriented, PERRL, and has no facial droop or other focal neurological deficits.  Her legs have 2+ edema and her hands appear swollen.  Her vital signs are HR 118, BP 175/110, RR 22, O2 saturation 99% on RA.

1. What are the next steps in the management of this patient?

The patient is in her last trimester of pregnancy with hypertension.  Her symptoms are consistent with severe preeclampsia.  The diagnosis of preeclampsia should be considered in any pregnant woman ≥ 20 weeks gestation with blood pressure above 140/90.  These patients require immediate obstetric care and should be transported for hospital evaluation.

2. Case Update

Paramedics confirm that the patient is not in active labor.  They initiate patient transport and obtain vascular access en route to the nearest Perinatal Center.  Repeat vital signs are HR 115, BP 182/112, RR 22, O2 saturation 99% on RA.  The patient begins to have a full body tonic-clonic seizure during transport.