EM Cases Just The Nuggets: Thyroid Storm Pt 4
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Part 4: POCUS and Choice of Beta Blocker In Part 3, we reviewed the Treatment Sequence. In Part 4, we discuss POCUS and Choice of Beta Blocker Role of POCUS to Guide Treatment In the hands of a capable operator, POCUS provides helpful information to guide therapy. The key question is around cardiac function, which informs beta blocker choice: High Output Heart Failure
Low Output Heart Failure
Why does it matter? Propranolol has historically been the beta blocker of choice for controlling the sympathetic surge in hyperthyroidism and it has the added benefit of inhibiting conversion of T4 to the more metabolically active T3. However, administering a beta blocker can be lethal in unstable patients who have cardiogenic shock with low EF, as the beta blockade can further reduce cardiac output! Therefore, our experts recommend using esmolol for most patients, as it is short acting and can be turned off rapidly if a patient starts to decompensate. Propranolol should be reserved only for patients who clearly have a hyperdynamic EF and a stable BP. This was just one nugget. There are lots more to learn from the podcast. Dr. Anton Helman & The EM Cases Team |
Emergency Medicine Cases
Dear Reader, Part 2 – Stroke Mimics In part 1, we reviewed the classification of strokes as Disabling vs Non Disabling and how it affects treatment approach. In part 2, we review common stroke mimics. Stroke miss rate and mimics – the 10% rule Emergency physicians miss approximately 1 in 10 strokes. Short term morbidity and mortality are 8 fold higher in missed strokes. Conversely, a similar proportion of “strokes” turn out to be mimics. Recognizing the difference is critical for avoiding...