20 something healthy African American female with signs preeclampsia. Been on mg drip but dc'd in route to OR. On arrival BP 175/104, 86, 100% RA, plt 122, spinal placed without incident, BP maintained 140's post spinal. Baby delivered no probs. just after seeing her baby pt has c/o nausea and very anxious, check BP and in low 80's so I give ephedrine and versed 2mg in that order, at this point patient is unresponsive pupils equal and responsive but discongugated. Breathing is regular and maintaining sats at 100% (6 l via FM). I start treating her pressure more aggressively thinking this all could be due to hypotension (since she has been running near 200 sys) and ask the nurse to get flumazenil. So BP increased back to 160's and still unresponsive, at this point flumazenil arrives and give .2 mg and the patient arouses and acts as if nothing happened. Anybody else seen such a small dose of versed have this effect? Is there some correlation with Mg or preeclampsia?


Also what are your thoughts on a patient with recent low back injury (injury on the job), patient says she has a bulging disk but no imaging has been done do to preg. Patient is in major pain from the back injury and can hardly lay flat on her back. What are your thoughts and concerns with spinal?




It was a pretty fun 17 hr call day