Part 2 Final Exam Viva Demonstration - The Thyroid and Anaesthesia with James

Send us Fan MailThanks so much James for being on our first episode AND being quizzed on thyroid anaesthesia.We hope this will be useful for anyone studying anaesthesia but especially those about to sit the ANZCA part 2 exam!The CaseYou are called down to review a patient for the evening emergency list in your tertiary hospital. 60yo female with SBO for laparotomy, looks unwellA: speakingB RR 30 sats 92% on RA 98% 6L HM O2.C 2 16G iv. HR 130, BP 100, 2L CSL given.D GCS 15. In 7/10 pain. Total 10 of morphine iv given by paramedics and ED in last 2 hours. Temp 38.5deg. Broad spec antibx given. E. 80kg. 150cm. BMI 35. Large goitre.How do you treat this?This is very uncommon and I would always consult endocrinology to advise!o   Supportiveo   Cool patiento   Hydrationo   Oxygen and ventilation Reduction of synthesis of thyroid hormoneo   Dexamethasone 4mg iv q8hr or hydrocortisone 100mg iv q6-8ho   Iodine: sodium iodide (1 g IV or Lugol's solution 4–8 drops orally q6–8h) or supersaturated potassium iodide solution (5 drops orally q6h)o   Iv methimazole (20mg 4-6hrly) carbimazole 20-30 enterally tdso   Propylthiouracil (200-400 mg o q6-8hrs Reduction of peripheral conversion of T4 to t3o   Propylthiouracilo   Hydrocortisoneo   propranolol 80mg o 6hrly or 5mg iv. Over 10mins  repeat 3x prn. Decrease metabolic effects of thyroido   Beta blockerso   Propranolol, esmololo   Caution in COPD. o   Maybe iv diltiazem Othero   plasma exchangePlease rate, post a review and subscribe!Check out https://anaesthesiacollective.com/education/first-part-exam/ for general information and a collection of model answersand sign up to the ABCs of Anaesthesia facebook group https://www.facebook.com/groups/2082807131964430and check out the ABCs of Anaesthesia YouTube channel for more contenthttps://www.youtube.com/c/ABCsofAnaesthesiaIf you have any questions, please email [email protected]  Disclaimer:The information contained in this podcast is for medical practitioner education only. It is not and will not be relevant for the general public.This contains general information about medical conditions and treatments. The information is not advice and should not be treated as such. The medical information is provided “as is” without any representations or warranties, express or implied. The presenter makes no representations or warranties in relation to the medical information on this episode. You must not rely on the information as an alternative to assessing and managing your patient with your treating team and consultant.You should seek your own advice from your medical practitioner in relation to any of the topics discussed in this episode’Medical information can change rapidly, and the author/s make all reasonable attempts to provide accurate information at the time of filming. There is no guarantee that the information will be accurate at the time of viewingThe information provided is within the scope of a specialist anaesthetist (FANZCA) working in Australia.The information presented here does not represent the views of any hospital or ANZCA.These podcasts are solely for training and education of medical practitioners, and are not an advertisement. They were not sponsored and offer no discounts, gifts or other inducements. This disclaimer was created based on a Contractology template available at http://www.contractology.com.