Round 17 (Postpartum Fever)

CAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction You are working a shift at EM Clerkshift General when a sepsis alert is paged overhead for a young female  who appears diaphoretic and confused. Initial Vitals * Temp 102.7F* HR 145* RR 32* BP 141/85* O2 93% Critical Actions * Workup and treat for sepsis upfront (Cultures, Lactate, IVF, Abx)* Order TSH with Free T4* Administer non-selective Beta Blocker (Propanolol)* Administer Inhibitor of Thyroid Hormone Synthesis (Methimazole or PTU)* Administer Steroids, +/- Iodine (must be given after inhibitor) Final Diagnosis Post Partum Thyroid Storm Tips and Tricks * Be aware of common post-partum pathologies (PP depression, hyper/hypothyroidism, cardiomyopathy, infections, eclampsia, etc)* Have a DDX for Fever other than infectious (especially if refractory to acetaminophen)* Administer treatment in correct order (BB first, inhibitor second, Iodine at least 1 hour after inhibitor, steroids) Further Reading Thyroid Storm (EMCrit)