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)