EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.
Issue link: https://emsworld.epubxp.com/i/516933
42 JUNE 2015 | EMSWORLD.com and 30% occurred postpartum. 5 Symptoms characteristic of HELLP include epigastric or upper right quadrant abdominal pain (the most common symp- tom), malaise, nausea and vomiting. 8,9 These symptoms make it easy to mistake HELLP syndrome for other etiologies of abdominal pain, including cholecystitis, pancreatitis, pyelonephritis and gastroenteritis. Any pregnant patient beyond 20 weeks' gesta- tion or postpartum who presents to the ED complaining of abdominal pain should be evaluated for HELLP syndrome. 10 Less- common symptoms include headache, visual changes, edema with significant weight gain, and jaundice. 2 Hypertension (blood pressure more than 140/90 mmHg) and proteinuria (protein in the urine) occur in about 85% of cases but, unlike preeclampsia, need not be present in patients with severe HELLP syndrome. When HELLP is suspected based on clinical findings, the diagnosis is confirmed based on the presence of all the laboratory abnormalities that make up its acronym: hemolysis, elevated liver enzymes and low platelet count. A typical workup in an emer- gency department would include an ultra- sound of the right upper quadrant to rule out cholecystitis, of the kidney to rule out hydronephrosis, and a fetal examination. A urinalysis would help rule out urinary tract infection and kidney stones. The laboratory workup would include at a minimum: 11 • Complete blood count with platelet count; • Peripheral blood smear; • Chemistry profile; • Aspartate transaminase (AST), ala- nine aminotransferase (ALT), bilirubin, alkaline phosphatase and lipase; • Coagulation profile and fibrinogen. Management Before discussing prehospital management of the patient with HELLP syndrome, it may be useful to understand the typical inpatient and outpatient management a woman with the syndrome will receive. After a diagnosis of HELLP syndrome is made, the initial steps in patient manage- ment include stabilizing the mother if necessary, assessing the condition of the fetus and deciding if immediate delivery is required. 2 HELLP syndrome with maternal hyper- tension is controlled with medications such as labetalol, nifedipine and hydralazine in both the outpatient and inpatient settings. In patients admitted to labor and delivery units between 24–32 weeks' gestation, mag- nesium sulfate is administered to prevent maternal seizures, though its use as seizure prophylaxis is controversial . In addition to seizure prophylaxis, magnesium sul- fate offers neuroprotective properties in the developing fetus and neonate and can decrease the incidence and severity of cere- bral palsy in preterm infants. 10 CONTINUING EDUCATION For More Information Circle 33 on Reader Service Card Proudly made in the USA 800.558.6765 grahammedical.com COMFORT 1® BLANKET The Convenience of Single-Use • Single-use eliminates the stains and tears that happen with washable linens. • Blankets can be placed in warmers up to 150 degrees. • At 50" x 80", blankets provide ample coverage. • Proudly made in the United States. For More Information Circle 34 on Reader Service Card