Round 17 (Postpartum Fever)

Summary: <br> CAUTION: THESE NOTES CONTAIN SPOILERS!!!<br> <br> <br> <br> Case Introduction<br> <br> <br> <br> 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.<br> <br> <br> <br> Initial Vitals<br> <br> <br> <br> * Temp 102.7F* HR 145* RR 32* BP 141/85* O2 93%<br> <br> <br> <br> Critical Actions<br> <br> <br> <br> * 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)<br> <br> <br> <br> Final Diagnosis<br> <br> <br> <br> Post Partum Thyroid Storm<br> <br> <br> <br> Tips and Tricks<br> <br> <br> <br> * 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)<br> <br> <br> <br> Further Reading<br> <br> <br> <br> Thyroid Storm <a href="https://emcrit.org/ibcc/thyroid-storm/">(EMCrit)</a><br>