[All_Smiles_RN]

It appear to me that you are looking at a panic attack as being the culprit here. Like others have said, she was having a tachy arrhythmia and the panic that ensued was a reaction to that situation. Read up on the thyroid and arrhythmias. Learn from this situation:

http://www.mayoclinic.com/health/hyp...344/DSECTION=2

http://www.mayoclinic.com/health/hyp...344/DSECTION=6

http://jcem.endojournals.org/cgi/content/full/87/3/968

[sharona97]

Hi Amy,

Aside from her obvious need for treatment I just wanted to tell to you your dedication for compassionate nursing is very impressive. Good job, and I hope you never have to deal with a situation like that for the length of time you did again. How were you afterwards? Spent I'm sure.

[steelcityrn]

Under those circumstances, that woman in severe anxiety/panic would only respond to medications. There would be no way you could have gotten her to comply with purse lip breathing. She was way beyond that. Maybe calling a code would have helped everyone, but I think you did fine, was working under great pressure and f/u on orders quickly.

[al7139]

Thank you all for your support and feedback. I am so new at this that sometimes I feel like I never went to school! Good to know that I did the right thing.
We did call our Medical Response Team to the room, but they werent much help. They can be called for any change in a pt that we feel is beyond us, but not quite a code. Usually its an ICU RN, an RT, and the Patient Care Supervisor for the hospital. THey in turn can run codes, call anesthesia, MD etc. if need be. We had called the md , but it tok us so long to get him to show up and give the right orders. How frustrating! I was practically yelling into the phone "I don't think you understand! I need sedatives as well as heart meds!" My research indicates that an overabundance of thyroid hormone can cause her arrhythmia, as well as severe panic attacks, so it's hard to tell which came first in this situation. I agree that it was a life theatening arrhythmia, but heart meds alone were not enough.
There was no way I was leaving the room for anything, so I had another RN pulling meds for me. She was totally relying on me for reassurance and trusting me to get her through this...How could I leave? All I could think was my instructor in school saying never to leave a pt in trouble, and get someone else to fetch and carry for you. Thank God our unit is a tight team who will help you out when you really need it!
And yes, after that I was really spent! I swear I felt hung over the next day when I woke up! Probably all the Adrenaline!
Amy

[BBFRN]

http://www.emedicine.com/ped/topic2247.htm

Here's some info on thyroid storm.

[al7139]

Thank you to Baptized by Fire for that link. Although it was mostly pediatric info, it was still helpful. I also looked up thyroid storm in my textbooks from school. After this patient, I will always be alert to the potential for problems with anyone who has a history of hyperthyroidism or recent thyroid surgery. After reading up on it, I can see that while it's hard to tell which came first (the panic or the arrhythmia), it's probably the arrhythmia that caused her panic, and then it just cascaded from there. Luckily, she finally got what she needed to help her and did fine.
Amy

[BBFRN]

Yeah, I should've provided a better link . Another thing to consider with your thyroid patients is hypocalcemia. I have seen dysrhythmias with sx's of anxiety mostly in hyperthyroid patients who are hypocalcemic.

[jmgrn65]

I am concerned that your MRT kept saying it was a panic attack and what were they going to do. Well lets see treat the symptoms, hr over 180 a rapid response team should have protocols that have meds for tachy and for the high bp. She was paniced because of her hr duh!
I think the poster did everything right. good job

[NancyNurse08]

Forgive me, but I'm not understanding really well. You are on a telemetry unit but it's not a PCU? Your floor has no protocols for SVT?