versed vs mag for postpartum eclampsia.

[NomadicMedic]

My thoughts are for active seizing patients, they'll get versed. In this case I'd give the versed then start prepping our 4gms in 20cc over 3-5 minutes.

Did she remain seizing until arrival to the ED? I'd like to see the doc tube a seizing patient alone in the back, or RSI someone alone in the back while managing her in 8 minutes.

Nope. The versed quickly terminated the seizures.

 

[VFlutter]

Also, although LPPE is high on the differential, there are many causes other than eclampsia that could be cause seizures so I don't think it's necessarily wrong to forgo magnesium.

 

[rescue1]

While I think mag is preferred even for postpartum eclampsia, the fact that the Versed worked would suggest to me that you did the right thing. At that point there aren't any fetal issues to worry about and as Chase pointed out, it could be potentially not be LPPE.

I've found there are two types of doctors who don't really "get" EMS. One type thinks that EMS is held to the same standard as a fully staffed ED with a physician and gets frustrated when that ridiculous standard of care isn't reached. The other is constantly surprised that paramedics have access to medications besides epi and oxygen. Either way, I wouldn't stress about it.

How do you guys administer mag? We have these nifty 50mL and 100mL NSS bags that someone 'borrowed' from the hospitals that you can use to rapidly infuse it over 5-10 minutes without worrying about slowly pushing a syringe.

 

[VentMonkey]

How do you guys administer mag?

Also, our suspected eclamptic seizure protocol calls for 2-4 grams of Mag first before moving to a benzo (Versed).

 

[rescue1]

Also, our suspected eclamptic seizure protocol calls for 2-4 grams of Mag first before moving to a benzo (Versed).

Yeah ours too.

We have the same vials, it's just much easier to shoot some into a bag and drip it quickly as opposed to pushing it 1mg/minute while the patient flails around, which can be borderline impossible if you're by yourself in the back.

 

[GMCmedic]

We have nifty little premixed 50ml bags with either 2G or 1G(5G total on the truck).

They would be nice if they were ever used. Still working on cutting that cost

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[VFlutter]

For the 4g bolus we put 8ml of the 5mg/10ml Magnesium vials into a 100ml bag and run at 200 ml/hr. If you have time to start an infusion then put 2-4g in a 100ml bag. Don't mix a large dose bag for your bolus and infusion together.

We have nifty little premixed 50ml bags with either 2G or 1G(5G total on the truck).

They would be nice if they were ever used. Still working on cutting that cost

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Those are usually used for electrolyte replacement. Probably way more cost efficient to get the 5g/10ml vials.

 

[NPO]

My protocol says mag first, 2-4g IVP. I would lean towards the 4g.

In fact, for eclampsia, it doesn't even include benzos, but of course, you could just treat with mag and go to benzos if that didn't work.

I had an eclampsia patient about a month ago. It was interesting. We transported straight to L&D and bypassed the ED. I asked one of the veteran nurses at L&D quite a bit. She said they rarely see it anymore because of prenatal care.

This was very obvious by how terrible the nurses had a grasp on the situation, running around, yelling, throwing things, etc.

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[Eden]

Our drug of choice for eclampsia is mag. 5gr/100ml drip. Can go to benzo after that