11/9 Flashcards

1
Q

THYROID STORM MEDICATIONS

A

Administer medications in order

1- Propranolol / esmolol
2- Propylthiouracil / Methimazole
3- Iodine
4- Hydrocortisone

Pro-PTU - I - m

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Thyroid storm is almost always associated with __________ that should be investigated

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

If you are going to discharge, this needs to always be a step

A

2-3 follow up planning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Fever management nin thyroid storm

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Critical medications in myxedema coma

A

Levothyroxine
Hydrocortisone
Dextrose-containing fluids for hypoglycemia and hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Given the high likelihood of _________ as the inciting factor in decompensated hypothyroidism, _______________ are recommended in initial treatment

A

sepsis

broad-spectrum antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

NAT basics- imaging/ labs

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

5 diagnoses related to thrombocytopenia of which the emergency physician should be aware

A

1- immune thrombocytopenia (ITP)
2- thrombotic thrombocytopenic purpura (TTP)
3- disseminated intravascular coagulation (DIC)
4- hemolytic uremic syndrome (HUS)
5- heparin-induced thrombocytopenia (HIT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

With the exception of patients with ______________, thrombocytopenic patients with life-threatening bleeding should be transfused to a platelet count of 50

A

Thrombotic thrombocytopenic purpura (TTP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

ITP is defined as a platelet count below 100 × 109/L caused by _______________

A

immune-mediated destruction of platelets.

immune thrombocytopenia (ITP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

In children, a _____________ is classically reported prior to the onset of ITP

A

viral villness

immune thrombocytopenia (ITP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

DIC is a clinical syndrome with a wide array of presentations/etiologies caused by:

A

Intravascular coagulation cascade activation, with a subsequent loss of inhibitory control mechanisms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Diagnosis of DIC involves a combination of laboratory tests and clinical evaluation. Laboratory findings suggestive of DIC include

A

low platelets
elevated D-dimer
decreased fibrinogen
prolongation of clotting times ie PT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

The overlying principles of the treatment of TTP are these 2 principals

A

replenishment of ADAMTS13 and removal and/or reduction of the offending antibody (in acquired cases).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

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 ______________________

A

neurologic dysfunction in up to 50% of affected patients.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Hemolytic uremic syndrome (HUS) - should you use antibiotics?

A

the current recommendation is not to use antibiotics due to evidence that they may increase shiga toxin production or release