spmvj
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A 62-year-old man with coronary artery disease and atrial fibrillation is transferred to the intensive care unit following a change in mental status. He was noted by his family to be progressively more lethargic over the last week. He has been taking amiodarone for maintenance of sinus rhythm. He also has been treated with tamsulosin for benign prostatic hyperplasia. On examination, his rectal temperature is 30.6 C (87.0 F), blood pressure is 106/70 mm Hg, pulse is 37/min, and respirations are 6/min. Heart and lung sounds are normal. His abdomen is soft. He is minimally responsive to painful stimuli. There is a delay in the relaxation time of the deep tendon reflexes. Which of the following is the most appropriate next step in management?
A. Administer atropine, 1 mg intravenous bolus
B. Administer triiodothyronine, intravenously
C. Order STAT thyroid function tests
D. Start transcutaneous pacing
E. Warm the patient with a heating blanket
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| doyoudig
Forum Guru
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-- E first then maybe C?
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| Kamsi
Forum Guru
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E then A
Pt ishypothermic n bradycardic so increase HR with atropine .Amiodarone will be resposible for any thyroid disorder
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| Doc750
transfer:step 3 prison
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E
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| spmvj
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The correct answer is C. The most likely diagnosis is myxedema coma, which was confirmed by the patient’s thyroid function tests. Confirmation of the diagnosis is important, as the therapy may have adverse effects such as myocardial ischemia, especially triiodothyronine in patients with preexisting coronary disease.
As the patient is not hypotensive, there is no urgent need to reverse the bradycardia. Giving atropine (choice A) and beginning transcutaneous pacing (choice D) are therefore incorrect.
Administering triiodothyronine (choice B) is incorrect. Once the diagnosis has been established, administering levothyroxine or triiodothyronine is appropriate. Saturation of thyroid hormone receptors should reverse the symptoms of myxedema coma. Mortality is still high, however, even with therapy.
Vasodilatation by active reheating (choice E) may precipitate severe hypotension in the hypothermia of myxedema coma. Such patients may be warmed passively.
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| suv
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good question!
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| elitoki
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THANKS!
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| peraspera
Forum Elite
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thank you, good q !!!
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