thyroid storm... need help

[nimbex, RN]

Work in a CCU, so don't see thyroid storm,,,, well never. Looked up in critical care book, understood it to some extent but still need help.

very sick pt. in "the storm" went into rapid afib, rapid resp. rate, stable BP, did massive doses of propranolol, cardizem, ativan, never affected the rate.

massive doses of PKU or PTU (sorry), sski, and all the thyroid stuff.

Return next night, he is confused to the nines, combative, climbing out the bed ect.

So I think I understand the thyroid storm, yet not the confustion behind it. MD states thyrotoxicosis? Yet why ?

And why are we doing massive ativan...?

I begged for haldol, got a one time order for 5mg IV and it worked for an hour.

After 4-5 calls to MD later, I talk him into haldol 5mg Q1hr. prn. which works.

So question is why the confusion? Why the trend to use narc's? . We wanted to avoid haldol because of potential tachycardia but hell at 170, it's already there... safety has to become a priority....

What do you all do?

THANK YOU

[sixes]

According to Med surg book Luckmann and Sorensen. CNS assessment irritability,agitation,convulsions, coma, psycotic behavior

Intervention. Decrease synthsis of thyroid hormones by admin. PTU or methimazole-- Sodium iodid 1-2gr slowly IV drip: Lugol's solution orally 30gtt/day-- Propranolol to slow heart rate--CHF tx with diuretics and digitalis

Hope this helps I have never had to take care of anyone in this condition.

[Tweety, BSN, RN]

I just had a friend go through this. I've never heard of it either until she went through it.

Basically she said she had severe anxiety attacks and though she was going insane (and her eyes were buldging), and her heart was racing. Interesting she never had to go to the hospital as an inpatient. She said Ativan was a miracle for her, snapped her right out of it until the PTU kicked in.

This was three weeks ago and she's fine now.

She's a accupuncture and alternative medicine doctor (I think she has a phd) anyway, she also used nutrition, but I'm not sure how, the was asking about how to cook rutabagas (sp?) before she started the PTU because it on a list of certain foods that would help.

I know this isn't answering any questions you asked, but it's an interesting phenomena that seems to be rare.

[nimbex, RN]

thank you both, it seems like we're on the right track.... just wish he would kick out of it faster, still confused and still haven't slowed that darned thyroid down enough.

very frustrating for staff, even more so for patient and family