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Anonymous asked in Science & MathematicsMedicine · 1 decade ago

The next step in management is :?

6: 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 glucocorticoids

c. Begin rapid rewarming

d. Obtain CT scan of the head

e. Urgent echocardiography

Update:

Answer B..........Thanks

6 Answers

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  • 1 decade ago
    Favorite Answer

    Answer: b

    This woman sounds like she is in myxedema coma, ie severe hypothyroidism, based on the fact that she is hypothermic, bradycardic and has a goitre with signs of decreased neuromuscular excitability (ie hyporeflexia).

    The next step is to draw blood for T4 and TSH and begin intravenous L-thyroxine (thyroid hormone) and hydrocortisone (glucocorticoids).

    Do NOT await result of thyroid function test (too late), rapid rewarming (doesn't treat the problem and will drop BP rapidly), no point in obtaining CT brain (unless she doesn't wake up after correction of hypothyroidism) or urgent echo (which will show myocardial hypocontractility and pericardial effusion which is non-specific)

    Source(s): I'm an endocrinologist.
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  • marrs
    Lv 4
    3 years ago

    Did you get harm patting your self on the lower back for that one? I propose this is not precisely rocket technologies, is it Jethro? LOL Yeah i could have performed a similar ingredient myself, besides i could have glanced via way of the concepts just to look if there was once despite specified in there that could have a smidgen of interest for me, in the different case i could basically pop open a lager and permit the better half do it because of the certainty this is a individual's technique. that should, of course, provide an evidence for why i'm divorced now.

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  • answer B-Obtain T4, TSH; begin thyroid hormone and glucocorticoids

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  • 1 decade ago

    its not B its C, rapid warming, the immediate next step in management is rapid warming as the patient is hypothermic. you could do the labs later....

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  • 1 decade ago

    B sounds right but i,m a non-educated iddiot :(

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  • Anonymous
    1 decade ago

    B

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