This is why it's called experience, right? - Eclampsia

[Epi-do]

I am really beating myself up over this call, and just wanted some input about if I am being too hard on myself or not.

We get dispatched for a seizure and show up to find a young woman laying on the floor, postictal. The patient's mother is next to her, talking to her when we walk in. I ask what happened and mom states the patient had a seizure and has never had one before.

I ask my partner to put oxygen on the patient, assess her mental status, and to get baseline vitals for me while I talk to mom. Mom states the patient is 5 days post partum and was pre-eclamptic during her pregnancy. She had been put on htn meds and labor was induced at 38 weeks due to continuing high blood pressure and excessive fluid retention. Given her history, I know this patient is eclamptic. We get her on our cot, out to the truck, and head to the hospital.

I get her on the monitor, dex her, and start an IV. She is finally coming around and is asking about her baby. I talk to her some more and try and get some additional info out of her, but she still isn't completely back with me and is a little bit confused about what happened.

I am trying to remember the dosage for mag, "just in case," and am drawing a blank on it so I decide to grab the protocol book and look it up. As I am doing that, I hear something so I turn around and my patient is in the throughs of a grand mal seizure.

Before continuing with the run, let me briefly go over out protocols. The pre-eclampsia/eclampsia protocol refers you to the seizure protocol once the patient begins to seize. Per that protocol, we are to put the patient on high flow oxygen. If they are status (which is defined for us as a seizure >3 min or 2 or more seizures without regaining consciousness) we give versed, check blood sugar, and then can give mag only if the patient is pregnant and in their 3rd trimester.

And now, back to the story....

I push 5 mg of versed and the second seizure stops. I know this patient is eclamptic and needs the mag, but per protocol cannot push it. In the middle of my "what the.....son of a #%$*!" moment I totally forgot that I could get orders online from a doc at the ER. I had to call in a report anyway, so it wouldn't have been a big deal. Granted, we were only 5-7 minutes from the ER at this point, but I feel like such an idiot for not thinking to ask for the order.

Throughout the run, her BP was 160s/100-110, HR 100-120, RR 18-20, SpO2 100%, blood sugar 213, and sinus tach on the monitor.

I realize that I have only been a medic for a couple months, that I have alot to learn, and that I am going to make mistakes. I did get this girl to the ER before she had a 3rd seizure, and the doc met me in the room and immediately ordered a mag drip, but I can't help but feel like crap because I knew that is what she needed, I had it to give to her, and I had a brain fart that prevented me from thinking to call for the order to give it to her.

So, am I being to hard on myself, or do I need to chock this one up to experience and "let it go" (for lack of a better choice of words at the moment)?

 

[Onceamedic]

I feel your pain girl. I think this is what the old hands mean when they say "life ain't like school". School gets it in your brain, the street gets it out of your head and into your hands. Every call I go on I can think of at least one thing I could have done better. I deal with it by knowing that I do the very best on every call that I can, and while I may not be the best (yet), I am the best they got. Fortunately, my "O crap" moments have not resulted in harm to the patient. Your patient was not harmed this time either.

You will never forget this and the next time you need to call for a med, you will do it. These mistakes sear the lesson into your gut where it will be when you need it again. Vow to learn from it, and move on.

 

[emtjack02]

I wonder what else was going on with your pt. b/c eclampsia is by definition over with birth. But still sounds like heck of a call.

 

[Epi-do]

I wonder what else was going on with your pt. b/c eclampsia is by definition over with birth. But still sounds like heck of a call.

Actually, patients can suffer from eclampsia while being post partrum.

Eclampsia is defined as seizure activity or coma unrelated to other cerebral conditions in an obstetrical patient with preeclampsia. While most cases present in the third trimester of pregnancy or within the first 48 hours following delivery, rare cases have been reported prior to 20 weeks' gestation or as late as 23 days postpartum.

Link to article here.

Other sources on the net state it can happen up to 6-8 weeks after delivery.

 

[tydek07]

Hi,

Take it as a learning moment. As mentioned by others, you will remember what to do next time. Everyone makes mistakes, yes, even the most seasoned of medics make a mistake here and there.

Take Care and stay safe,

 

[emtjack02]

After doing some more reading I found:
"One third of eclamptic seizures occur after delivery, usually during the first 48 hours but occasionally as long as 28 days after delivery.[55] After 48 hours postpartum and without predelivery signs of preeclampsia, other diagnoses such as intracranial hemorrhage should be considered."
Marx: Rosen's Emergency Med Concepts, 6th ed.
I was always taught that it ended basically when they gave birth...guess that's not entirely accurate.

 

[eric2068]

If there is the perfect medic out there, I haven't met them yet. Yes, we have all made runs that we could have done better on, but I tell ya, ya done good. Covered the basics. Treated the seizures with Versed, good call. As far as mag goes, that is just now going into our protocols, so I can't comment on that. I also did not know that a patient could be eclamptic s/p pregnancy. Gives me an excuse to research. The fact that you want to better next time shows me that you are a good medic. Keep it up.

 

[lizhiniatsos]

I'll ditto what everyone else said....non of us perfect (tho' there are a few who would claim differently ) and good effort and learning point on your part! We do not even carry mag. (they took it away a couple years ago...still working on getting it back) so if she had been in our ambulance all we could've done is the versed. You done good ~ just keep that desire to take optimal care of your patients and to never stop learning and you'll become the best you can be~

 

[rhan101277]

Even though I am just a basic. The medication contraindications worry me. I only work part-time and I worry about forgetting them. That i will be assisting a patient with a med and be forgetting something important.

I do want to go to medic class in the fall, but I fear doing it part-time, I may not be able to stay up to speed on everything I need to in order to do my best

 

[medic417]

Even though I am just a basic. The medication contraindications worry me. I only work part-time and I worry about forgetting them. That i will be assisting a patient with a med and be forgetting something important.

I do want to go to medic class in the fall, but I fear doing it part-time, I may not be able to stay up to speed on everything I need to in order to do my best

Never fear my friend. There is no shame in referring to your protocol/drug book prior to administering meds. In fact many of the errors in EMS are because for some unknown reason many in EMS think they unlike Doctors and nurses have no need to double check prior to administering a drug. The majority of meds we give will not cause patient any harm adding an additional 30-60 seconds time prior to giving to double check. In fact when tired even a drug you give often you might avoid a dosage error by taking that extra time. Any one that says to be a great Paramedic you must know every drug and never check the book is someone I would avoid as at some point they will harm someone.

 

[rhan101277]

Never fear my friend. There is no shame in referring to your protocol/drug book prior to administering meds. In fact many of the errors in EMS are because for some unknown reason many in EMS think they unlike Doctors and nurses have no need to double check prior to administering a drug. The majority of meds we give will not cause patient any harm adding an additional 30-60 seconds time prior to giving to double check. In fact when tired even a drug you give often you might avoid a dosage error by taking that extra time. Any one that says to be a great Paramedic you must know every drug and never check the book is someone I would avoid as at some point they will harm someone.

One medic i worked with had a field guide. Guess on the way to the call you could see what you needed. What about getting our the trust guide right in front of the patient if they are alert and oriented.

 

[medic417]

One medic i worked with had a field guide. Guess on the way to the call you could see what you needed. What about getting our the trust guide right in front of the patient if they are alert and oriented.

Doctors do that. There is nothing wrong with it. In fact it would instill more confidence in the patient that they are getting proper care.

 

[lizhiniatsos]

I agree with this wisdom of quickly checking your field guide for medication dosages etc. as you CALMLY treat your patient....it's the frantically flipping through the pages of such, with wide eyed horror and explicatives spewing forth, that kinda gets your patient a little edgy if they are still alert and oriented...in which case a little bilateral carotic pressure will ease their mind~;0!

 

[lizhiniatsos]

...rather, 'carotid' pressure

 

[dmiracco]

Epi-Do, yes this patient needed Mag secondary to Eclampsia however the bottom line here is that the patient was having a seizure and you stopped it with a benzo. Also giving a benzo to this patient who is postpartum is less of an isssue because you wouldnt be worried about the medication having to cross the placenta into the fetus.
I would challenge you to take this call to your training/clinical officer and motion that this protocol be changed to state that it is acceptable to administer mag to a postpartum patient. But dont sweat it because in cases like theses I feel you should look at the end result and learn from what you could have done better.

 

[rhan101277]

I agree with this wisdom of quickly checking your field guide for medication dosages etc. as you CALMLY treat your patient....it's the frantically flipping through the pages of such, with wide eyed horror and explicatives spewing forth, that kinda gets your patient a little edgy if they are still alert and oriented...in which case a little bilateral carotic pressure will ease their mind~;0!

You apply carotic pressure to ease your patients mind? Is that something in the protocols?

 

[Ridryder911]

You won't do that again, huh? Now that you have learned .... good for you! You will never make that same mistake again.

My saying is.." I know I am smart, because they say you learn off your mistakes""...

Quit beating yourself up. Your a probie and as I said, you will NEVER do that again. This how we truly learn... knowledge plus application.

Now, chin up and go on.. You'll be a better medic.

R/r 911

 

[jedirye]

This thread owns because, I'll be honest, I also thought eclampsia ends at birth as well. Extremely interesting!

-rye

 

[BLSBoy]

Epi, there is NO shame at all in checking with med control.

Hell, I do it everytime I have pt contact. <_<:glare:

 

[Epi-do]

Epi, there is NO shame at all in checking with med control.

Hell, I do it everytime I have pt contact. <_<:glare:

Oh, I don't have a problem contacting med control. I have done it plenty of other times in the past. I just had a brain fart this time around.