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
EMSWORLD.com | JUNE 2015 43 In a healthy individual platelet levels are considered normal between 150,000– 400,000 mm 3 . Platelet replacement is indi- cated when a patient with HELLP syndrome has platelets below 20,000 mm 3 prior to a vaginal delivery or below 50,000 mm 3 prior to a cesarean section. This practice is con- troversial; the problem is that the adminis- tered platelets will be destroyed in the same fashion as the patient's own platelets were. Critical care transport teams should be sure to determine the patient's baseline and most recent platelet counts and consider early platelet administration. The final treatment for HELLP syndrome is delivery of the fetus, and it is considered the only effective treatment. 2 Immediate delivery is indicated when the pregnancy is greater than 34 weeks' gestation, there are signs of fetal stress, or with severe mater- nal complications such as DIC, multiorgan dysfunction, liver failure or hemorrhage, renal failure, pulmonary edema or abrup- tio placentae. In the prehospital setting, initial manage- ment of the patient with HELLP syndrome centers on airway, breathing and circula- tion. Place patients with an altered level of consciousness in a position that facilitates an open airway, most commonly supine or semi-Fowler's. When positioning a preg- nant female supine, take care to prevent the gravid uterus from compress- ing the vena cava, preventing blood return to the heart and creating supine hypotensive syndrome. Prevent this by tilting the patient onto her left side by padding under the right hip. Patients experiencing pu l- monary edema may be hypoxic, requiring the administration of supplemental oxygen with a delivery device (nasal cannula, nonrebreather mask) with a flow rate adequate to improve SpO 2 to greater than 94%. Continuous positive airway pressure (CPAP) can be considered in patients with pulmonary edema who have no contraindications for use of the device. Patients in respira- tory failure who are breathing inadequately should be ventilated with a bag-mask device and receive endotracheal intubation if they cannot be adequately ven- tilated via a BLS airway. Bag-mask venti- lation of a pregnant female can be made more difficult by the need for greater airway MACS is Making Ambulance Crews Safer with the Mac's Bariatric Ambulance Lift. With a 1,300 lbs. weight capacity the lift is prepared for any job you can roll on it. The platform is universal and will accommodate whatever equipment you choose to use. The Bumper Stow Technology makes the lift available to the ambulance crew at all times and functions as a bumper and step. Don't Strain Your Back... Go See Mac! 800-795-6227 sales@macsliftgate.com www.macsliftgate.com For More Information Circle 35 on Reader Service Card Liver Disorders of Pregnancy Hyperemesis gravidarum (HG) is characterized by intractable nausea and vomit- ing during pregnancy. Nausea and vomiting occur to some degree in 50%–90% of all live births. 16–18 HG occurs in about 0.3%–2% of all live births, with onset typically beginning between the fourth and 10th week of gestation and resolving by the 20th week. 18,19 Uncontrolled persistent vomiting can lead to electrolyte imbalance, weight loss and nutritional deficiency that can require hospitalization. Intrahepatic cholestasis of pregnancy (ICP) is a rare complication of preg- nancy that occurs in the second and third trimesters and has a prevalence between 0.32%–5.6% in the United States. 20,21 Its exact cause is unknown, but cholestasis (slowing or stopping of the flow of bile from the liver and gallbladder) results in an elevation in serum bile concentration. The most common and noticeable clinical manifestation is pruritis, most commonly localized in the palms and soles of the feet. Preeclampsia is a disorder characterized by hypertension, edema and protein- uria that occurs after 20 weeks' gestation. It affects about 5%–10% of all pregnant woman and typically occurs late in the third or late second trimester and can also occur postpartum. 22 It is thought to occur secondary to abnormalities in placental development that result in widespread vasoconstriction. Severe preeclampsia is characterized by the onset of edema and neurologic symptoms such as headaches and visual disturbances, nausea and vomiting. The onset of grand mal seizures in a woman with preeclampsia indicates eclampsia is present. Acute fatty liver of pregnancy (AFLP) is a rare but potentially fatal complication of pregnancy that occurs in the third trimester. Occurring in approximately one in every 7,000–15,000 pregnancies, AFLP has a maternal mortality rate of 18% and a fetal mortality rate of 23%. 23,24 The disease is the result of a defect in the gene that controls mitochondrial fatty acid beta-oxidation. When the defect is present, fetal fatty acids accumulate in the mother's liver, leading to hepatic dysfunction.