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. PMH: Nil DHx: Nil SHx Non-smoker Works as semi-professional Rugby Player 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 SimMum From Clinical Skills if available Lifepak defib with training leads Training ‘resus’ equipment trolley ED Resus Room Time: (45 mins) Simulation: 30 Debrief: 10 Recover: 5 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% (15l) C - Hr 96 Bp 187/104 D – GCS E1 V1 M1 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

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