Eclampsia

AUDIENCE: Emergency medicine residents. INTRODUCTION: Eclampsia is the development of a generalized seizure in pregnant patients with hypertension of pregnancy.1 Eclampsia exists on the spectrum of hypertension-related disorders in pregnancy, occurs in 1 out of 1,000–10,000 deliveries,1–3and is associated with significant maternal and fetal morbidity and mortality.4 Given the emergent nature of eclampsia and the benefit of rapid treatment, emergency medicine (EM) physicians need to quickly recognize and treat this rare pathology. Although residents have three to four years before becoming an attending, not all emergent pathologies may present clinically during their training. It is important to simulate rare, treatable conditions such as eclampsia to give learners exposure confidence in managing this disease. EDUCATIONAL OBJECTIVES: By the end of this simulation session, learners will be able to: 1. Demonstrate care of a gravid patient with altered mental status. 2. Demonstrate care of a gravid patient with seizures. 3. Recognize care involved in assessment of fetal status. 4. Execute appropriate subspecialty consultation. 5. Recognize the clinical signs and symptoms of eclampsia. 6. Distinguish different treatment options for eclampsia. 7. Identify magnesium toxicity and reversal agent. 8. Differentiate the spectrum of preeclampsia. EDUCATIONAL METHODS: As an educational strategy, simulation allows learners to partake in experiential learning. By creating a safe and supportive learning environment, simulation allows learners to facilitate deliberate practice and transfer learning in debriefing sessions. High-fidelity sessions involve software and technology to mimic realistic patient environments, which also activate learners’ affective states to aid in decision-making abilities in complex medical cases. This session was conducted using a high-fidelity mannequin, SimMom (Laerdal), and a controlling Laerdal LLEAP Software. Faculty-led debriefing followed the simulation case and included discussion regarding presentation, spectrum, and management of the obstetrical emergency.5 RESEARCH METHODS: Resident participants completed an evaluation form consisting of questions on a 5-point Likert scale assessing the realism and usefulness of the simulation. RESULTS: All 18 residents who participated in the simulation completed an evaluation form, and all agreed or strongly agreed the case was realistic and useful. DISCUSSION: Incorporating high-stakes, low-frequency presentations through simulation can be readily applied in residency education and well-received by residents. Increasing the difficulty through adjusting the clinical history and exam may challenge learners further. TOPICS: Medical simulation, eclampsia, pregnancy, obstetrics, emergency medicine.