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AndreyPopov /iStock / Thinkstock EMSWORLD.com | JUNE 2015 39 A 33-year-old female presents supine in bed approximately 24 hours after giving birth. She responds to painful stimuli by opening her eyes, and she is noticeably disoriented and lethargic when asked questions. Her only complaint is of abdominal pain. A primary exam reveals a patent airway, adequate though rapid breathing, and a strong and rapid radial pulse. Her skin is cool, pale and dry. The patient's husband and a doula are on scene. They report the patient gave birth at home yester- day with the doula's help. This was the patient's fifth pregnancy and fifth vaginal birth. The pregnancy was complicated by the development of gestational hypertension in the third trimester; it was treated with labetalol. The patient checked her blood pres- sure daily during the remainder of her pregnancy, and both the doula and husband agree she experienced no further episodes of hypertension. The patient started having contractions yesterday around 0700 hours and had an uncomplicated childbirth at 1100. The intact placenta delivered without complications, and some mild hemorrhage secondary to a minor external vagi- nal tear stopped on its own with the application of direct pressure. The neonate was vigorous at birth and has been in good health since. The husband says the patient initially complained of an acute onset of upper right quadrant abdominal pain that woke her at about 0600. She described the pain as sharp, nonradiating and reproducible with palpation. She also complained of nausea and vom- ited twice. At no time did she experience syncope or complain of chest pain or pressure or discom- fort, difficulty breathing, dizziness, weakness, back pain or headache. The husband noticed she became increasingly drowsy during the next few hours but thought she was tired from the delivery. He used an automated blood pressure cuff previously purchased from a pharmacy to take the patient's blood pressure, which was 154/100 mmHg. He called the doula at HELLP Syndrome How to recognize and treat this life-threatening complication of pregnancy By Scott R. Snyder, BS, NREMT-P, Sean M. Kivlehan, MD, MPH, NREMT-P, Kevin T. Collopy, BA, FP-C, CCEMT-P, NREMT-P, WEMT This CE activity is approved by EMS World, an organization accredited by the Continuing Education Coordinating Board for Emergency Medical Services (CECBEMS), for 1 CEU. OBJECTIVES • Define HELLP syndrome. • Discuss the pathophysiology of HELLP syndrome. • Differentiate HELLP syndrome from the other liver disorders of pregnancy. • Identify the signs and symptoms of HELLP syndrome. • Discuss prehospital management of the patient with HELLP syndrome. CONTINUING EDUCATION To take the CE test that accompanies this article and receive 1 hour of CE credit accredited by CECBEMS, go to rapidce.com . Test costs $6.95. Questions? E-mail editor@EMSWorld.com. CONTINUING EDUCATION Kevin Collopy and Sean Kivlehan are featured speakers at EMS World Expo, Sept. 15–19, in Las Vegas. Visit EMSWorldExpo.com.