Thyroid Storm-POD

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THYROID STORM PRESENTATION

  • Fever

  • Altered mental status

  • Tachycardia

CAUSES

  • Infection

  • MI

  • DKA

  • Pregnancy

  • Trauma

  • Untreated thyroid disease

  • Ingestion of thyroid hormone

TREATMENT

  • Control body temperature

    • Cool IV fluids, external cooling

  • IV Fluids

    • High output cardiac failure- preload dependent

    • Add glucose as they have low glycogen stores

  • Beta Blocker

    • Propranolol 0.5- 1mg IV over 3-5 minutes

      • Prevents conversion of T4àT3

      • Non selective beta blocker

      • Titrate to HR<100

    • Stop Thyroid hormone synthesis

      • Propylthiouracil 1000mg PO/NG or PR

        • Preferred in pregnancy

        • Prevents conversion of T4àT3

      • Hydrocortisone 100mg IV q 8

        • Blocks T4àT3

        • Thyroid storm causes depression of hypothalamic- pituitary axis

      • Iodine

        • Inhibits thyroid hormone release

        • Do not give for at least 1 hour after starting PTU

      • Antibiotics

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MASSIVE TRANSFUSION PROTOCOL- POD

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MASSIVE TRANSFUSION PROTOCOL WHEN TO INITIATE IT?

  • ABC (assessment of blood consumption) score >2- each assigned 1 point

    • Pulse >120

    • SBP <90

    • + FAST

    • penetrating torso injury

  • Shock index >1.4 (HR/sBP)

  • active bleeding requiring multiple transfusions

WHAT DOES IT CONSIST OF?

  • 1:1:1 ratio of RBC:Plasma:Platelets

TO PREP FOR BLOOD ARRIVAL

  • 2 large bore IVs

  • baseline labs- cbc, type and screen, Pt/PTT/INR, fibrinogen, BMP with magnesium

  • prepare the Belmont- rapid transfusion and warmer to prevent hypothermia

  • If trauma patient give Tranexamic acid 1gm IV over 10 minutes and then 1gm IV over 8 hours.

DURING MTP

  • Repeat labs every hour checking for electrolyte abnormalities. CORRECT THEM!

    • Hyperkalemia

    • Hypocalcemia

    • Hypomagnesemia

  • Ensure patient is not hypothermic

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Takotsubo Cardiomyopathy POD

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broken-heart.jpg

TAKOTSUBO CARDIOMYOPATHYWHAT IS IT?

  • Weakening of the left ventricle after an emotional stress

  • Aka Broken Heart

PRESENTATION

  • Classically in postmenopausal women after an emotional stress

  • Chest pain and SOB

  • ECG resembles a STEMI

  • Rapid but small rise in troponin (actual STEMI troponin takes longer to rise but has higher peak)

  • NEGATIVE angiogram

  • ECHO- ballooning of LV

HOW DID IT GET ITS NAME?

Takotsubo= a pot used to catch octopi—resembles the LV apical ballooning that occurs

takotsubo.jpg

ED MANAGEMENT: STEMI alert

** only way to differentiate from a STEMI is a negative angiogram.

PROGNOSIS: much better than STEMI.

  • Most patient’s fully recover in 2 months

  • In hospital mortality= 4%

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