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40 JUNE 2015 | EMSWORLD.com approximately 1000 hours. The doula also noted the patient's vaginal tear had started lightly bleeding again. That's when they called EMS. The husband reports the patient has no other significant medical history, takes no medications except the labetalol and has no allergies. Your clinical exam finds pupils that are 3–4 mm, equal and reactive to light bilaterally; no JVD; and mild bilateral rales (crackles). She winces and opens her eyes with palpation of her upper right abdominal quadrant. Her uterus is palpable, but there's no abdominal mass or rigidity present. She has not been incontinent of feces or urine, and you note capillary bleeding from a small external vaginal tear. The husband says the tear occurred during the childbirth. The patient is drowsy but follows commands and moves all her extremities with no apparent motor deficits. Distal circulation and sen- sation are intact and appear to be normal on all extremities. She appears puffy, with +3 pitting edema noted to all four extremities. The patient's vital signs are as fol- lows: HR, 90/min. and regular; BP, 188/124 mmHg; RR, 24/min. with adequate tidal volume; SpO 2 , 90% on room air; and EtCO 2 , 28 mmHg with a normal waveform. The lead II ECG reveals a normal sinus rhythm, and the 12-lead ECG is nondiagnostic for any acute changes. What are you initial concerns with this patient? What does your differential diagnosis include? What is your manage- ment plan? HELLP Syndrome HELLP is an acronym created to describe a syndrome characterized by hemolysis (rupture or destruction of red blood cells), elevated liver enzymes and low platelet count. 1 It is a not-uncommon life-threat- TABLE 1: LIVER DISORDERS OF PREGNANCY, TIMING AND CLINICAL FINDINGS Disorder Timing Clinical Findings Hyperemesis gravidarum First trimester Nausea, vomiting, weight loss Intrahepatic cholestasis of pregnancy Second and third trimesters Pruritis (itching; worse at night), jaundice, fatigue, anorexia, abdominal pain, steatorrhea HELLP syndrome and preeclampsia Third trimester Abdominal pain, nausea, vomiting, malaise, headache, visual changes, edema, jaundice Acute fatty liver of pregnancy Third trimester Nausea, vomiting, abdominal pain, fatigue, anorexia, jaundice CONTINUING EDUCATION For More Information Circle 30 on Reader Service Card 888-458-6546 3121 Millers Lane Louisville, KY 40216 Tel: 502-775-8303 Fax: 502-772-0548 S A F E T Y A P P L I A N C E C O M P A N Y www.junkinsafety.com PROUDLY MANUFAC TURED IN THE USA JSA-400 Aluminum Break-Apart Stretcher Specifcations Dimensions: 66 ¼" L x 17 ½" W x 2 5⁄8" H Folded Length: 49 ½" Folded Depth: 3 ½" Adjustable to: 80" Load Capacity: 400 lbs. Shipping Weight: 21 ½ lbs. Designed to gently maneuver stretcher under patient without rolling or lifting. The center of the Junkin Aluminum Break-Apart Stretcher can be opened to allow the patient to be X-rayed while secured on the stretcher. Features sturdy, lightweight aluminum construction with an adjustable length and three patient restraint straps. Folds for easy storing and separates in half during application and removal. JSA-400 Instructors, help your students learn smarter. Increase your class pass rate with afordable, high- quality multi-platform study tools created by top national educators and industry experts. Learn more at limmercreative.com/for-instructors. Support • Value • Expertise 207-482-0622 | limmercreative.com For More Information Circle 31 on Reader Service Card