11/9 Flashcards
THYROID STORM MEDICATIONS
Administer medications in order
1- Propranolol / esmolol
2- Propylthiouracil / Methimazole
3- Iodine
4- Hydrocortisone
Pro-PTU - I - m
Thyroid storm is almost always associated with __________ that should be investigated
A Trigger:
sepsis, pregnancy, recent surgery, discontinuation of anti-thyroid medication, etc.
It is important to look for and treat an inciting event in addition to treating the hyperthyroidism
If you are going to discharge, this needs to always be a step
2-3 follow up planning
Fever management nin thyroid storm
APAP
NSAIDs remove the thyroid hormone from the protein binding site, freeing the thyroid hormone to be readily converted into active hormone. Therefore, NSAIDs should not be used for the management of fever.
Critical medications in myxedema coma
Levothyroxine
Hydrocortisone
Dextrose-containing fluids for hypoglycemia and hypotension
Given the high likelihood of _________ as the inciting factor in decompensated hypothyroidism, _______________ are recommended in initial treatment
sepsis
broad-spectrum antibiotics
NAT basics- imaging/ labs
Perform a head computed tomography (CT) in a child <1 y old if non-accidental trauma head trauma is suspected
Skeletal survey may be considered
Labs: CBC, coagulation panel, CMP, amylase, lipase, and urinalysis.
5 diagnoses related to thrombocytopenia of which the emergency physician should be aware
1- immune thrombocytopenia (ITP)
2- thrombotic thrombocytopenic purpura (TTP)
3- disseminated intravascular coagulation (DIC)
4- hemolytic uremic syndrome (HUS)
5- heparin-induced thrombocytopenia (HIT)
With the exception of patients with ______________, thrombocytopenic patients with life-threatening bleeding should be transfused to a platelet count of 50
Thrombotic thrombocytopenic purpura (TTP)
ITP is defined as a platelet count below 100 × 109/L caused by _______________
immune-mediated destruction of platelets.
immune thrombocytopenia (ITP)
In children, a _____________ is classically reported prior to the onset of ITP
viral villness
immune thrombocytopenia (ITP)
DIC is a clinical syndrome with a wide array of presentations/etiologies caused by:
Intravascular coagulation cascade activation, with a subsequent loss of inhibitory control mechanisms
Diagnosis of DIC involves a combination of laboratory tests and clinical evaluation. Laboratory findings suggestive of DIC include
low platelets
elevated D-dimer
decreased fibrinogen
prolongation of clotting times ie PT
The overlying principles of the treatment of TTP are these 2 principals
replenishment of ADAMTS13 and removal and/or reduction of the offending antibody (in acquired cases).
HUS shares some clinical features with TTP. Both manifest as microangiopathic hemolytic anemia and thrombocytopenia; however, HUS emphasizes renal injury while TTP shows minimal renal injury, instead causing ______________________
neurologic dysfunction in up to 50% of affected patients.