Preeclampsia-Eclampsia: Altered Mental Status in a Third-Trimester Pregnant Patient

Abstract

Abstract This simulation case was designed for medical students and emergency medicine residents. It involves a third-trimester pregnant woman who is brought to the emergency department with acute altered mental status. Careful history and physical examination reveal signs of severe preeclampsia. This should prompt consideration of the postictal state as the cause of the patient's altered mental status. The scenario also reviews treatment parameters and options for blood pressure and seizure management in such patients. Since preeclampsia is a late-pregnancy disease and many institutions have policies triaging such patients directly for labor and delivery evaluation, this condition may not be seen frequently in the emergency department. However, given the significant morbidity associated with it, emergency medicine residents should be comfortable with management parameters and treatment options. This simulation case provides an opportunity for learning and practice on a high-risk condition in a safe environment. Emergency medicine residents and rotating medical students participated in this case. The case was well-received and participants commented that it was a valuable educational experience. They do not see such pathology often and this case served as a reminder about the diagnostic and treatment parameters. They thought that the postictal history component is broadly applicable to other patients and that its inclusion in the case was helpful.

Keywords

• Altered Mental Status
• Seizures
• Pre-Eclampsia
• Preeclampsia Eclampsia
• Postictal
• Pregnancy Trimester