Walking into the PACU following an appendectomy on a Saturday afternoon, the on-call obstetrician pages you about a pregnant patient in the ED. You work at a 50-bed hospital in a mountain town that provides basic obstetric services but has no ICU and a limited blood bank. The patient is a 32-year-old G1P0 healthy woman at 29 weeks gestation who was hiking when she felt lightheaded and generally unwell. In the ED, her blood pressure is 190/100, she has protein in her urine and mildly elevated LFTs, and is complaining of a headache. She is diagnosed with preeclampsia with severe features, and you have concerns about progression to HELLP syndrome.
You and the obstetrician quickly determine that the patient needs transfer to a facility with a higher level of care for both maternal and fetal indications. You work together to manage her blood pressure; the headache resolves with BP control...