frontal
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A 60-year-old woman comes to the emergency room in a coma. The patient's temperature is 90°F. She is bradycardic. Her thyroid gland is enlarged. There is bilateral hyporeflexia. The next step in management is
A) Await results of T4, TSH
B) Obtain T4, TSH; begin thyroid hormone and glucocorticoid
C) Begin rapid rewarming
D) Obtain CT scan of the head
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| achilles
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C- begin rapid rewarming and then go for B-thyroid function tests and steroids ??
good questions frontal !!
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| amygdalaa
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B? This is myxedema coma. I know rapid rewarming is not the answer.
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| Rasul
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B. I read somewhere that rapid rewarming can actually hurt pt with myxedema-coma.
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| achilles
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well i guess i got this one wrong...yup rapid rewarming is not the thing to do as it would lead to hypotension and cardiovascular collapse because of all the peripheral vasodilatation.
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| achilles
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good rasul !!
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| frontal
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The diagnosis is simple. The answer is B. I too fell in the rapid rewarming trap. Here is the explanation:
The answer is b. The clinical concern in this patient is myxedema coma. Once this diagnosis is considered, treatment must be started, as it is a medical emergency. Treatment is initiated; should lab results not support the diagnosis, then treatment would be stopped. An intravenous bolus of thyroxine is given (300 to 500 mg), followed by daily intravenous doses. Glucorticoids are given concomitantly. Intravenous fluids are also needed; rewarming should be accompanied slowly, so as not to precipitate cardiac arrhythmias. If alveolar ventilation is compromised, then intubation may also be necessary.
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| frontal
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Sorry, the post appeared twice. I've edited it.
Edited by frontal on 03/20/06 - 09:21 AM
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| chemamr
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 B. Good question.
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