16 ED Simulator Based Training Scenario Guide Eclampsia

16 ED Simulator Based Training – Scenario Guide Eclampsia 16 Set Scenario (Start) Scenario (Progression) Equipment Adult 27 year old 33/40 Primagravida, is being brought in by ambulance, she has been fitting for 10 mins. Arrives Fitting and Hypertensive Requires Basic airway support Needs magnesium for eclampsia Seizures Terminate Requires Anaesthetic and Obs Involvement Sim-Man (complete kit) + Wig And Blanket for abdomen – Consider Sim. Mum From Clinical Skills if available ED Resus Room Time: (45 mins) Simulation: 30 Debrief: 10 Recover: 5 PMH: Nil DHx: Nil SHx • Non-smoker • Works as semi-professional Rugby Player Lifepak defib with training leads Training ‘resus’ equipment trolley Main objectives (Clinical and Educational Context): • Recognize the diagnosis of eclampisa and treat with magnesium as opposed to classical seizure management • Support with basic airway interventions • Identify the need to involve specialists early for definitive management (delivery of baby) • Consider the use of labetolol for BP control Simulator start state Position Unconcious on ED trolley in resus bay – “fitting” Physiology A – Snoring noises B - RR 18, Sats 93% (15 l) C - Hr 96 Bp 187/104 D – GCS E 1 V 1 M 1 BM 8 E – T 36. 7 Clinical Findings • Unresponsive, Actively Seizing • Hypertension • Pitting oedema • Proteinuria Expected course: Pre-Alert (? team Considers Eclampsia) Arrival and initial ABC assessment Recgonise Eclampsia Start Magnesium Contact Obs/ ITU Seizure Terminates Refer for Definitive Care

End Obs + Critical Care Referal, Consider Labetolol Seizure Terminates, remains Drowsy and hypertensive (210/ 106) Consider Eclampsia/ Gives Magnesium Pre-Alert/ Arrival Consider Scenario Stop or Faculty to Provide Senior Support ( If prompting ask to find Protocol on Insight Becomes Increasingly hypoxic – Sats to 85% Continued Seizure Does Not Consider Eclampsia/ does not give Magnesium 16