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
- 1 decade agoFavorite Answer
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.
- marrsLv 43 years ago
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- 1 decade ago
answer B-Obtain T4, TSH; begin thyroid hormone and glucocorticoids
- 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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- reseda1420Lv 41 decade ago
B sounds right but i,m a non-educated iddiot :(
- Anonymous1 decade ago