1) acetazolamide for iatrogenic contraction alkalosis is standard tx IMHO (most drugs are "off label") along with K repletion etc

2) PO acetazolamide probably fine, great bioavailability

3) prevention with amiloride is great, I love amiloride

4) triamterene is maybe nephrotoxic so less of a fan

yes 💯

it works to evaluate the immediate effect of a bolus because renal compensation doesnt have time to take effect within such a short timeframe

this is one of the few situations where the formula works well (it also works in SIADH or a DDAVP clamp)

When we intubate someone we assume responsibility for all of their vital functions, no matter how mundane 💯

repeated PRN doses could eventually cause trouble if nobody is paying attention to the Mg level. Often these PRN Mg q12hr orders are put in and nobody pays a ton of attention to them from the physician side.

it’s not uncommon for beta-blockers to kill patients with thyroid storm.

this is well described in published literature.

people present with subacute illness, walk into the hospital, and they’re coding 6 hours later.

this deterioration is usually mis-attributed to the thyroid storm (not the tx)

meh, failing to diagnose serotonin syndrome really just spares you 30 minutes of debating cyproheptadine on rounds 😂

I'm betting 1000% they got better with supportive care alone, which is what happens in serotonin syndrome.

My message to EM docs:

If you can diagnose thyroid storm, give basic thyroid storm drugs (thionamide, steroid, iodine etc), identify/treat underlying issues (eg sepsis), and provide standard hemodynamic resus you're done an insanely amazingly great job! You're done!

(Just forget bbl)

There is no evidence to support B-bl for sinus tachycardia in thyroid storm

This practice has been wrongly extrapolated from the treatment of ambulatory patients with thyrotoxicosis

ALWAYS TREAT THE CAUSE OF SINUS TACH

Sinus tach is like a fire alarm. Beta-blocking it is silencing the alarm.

yeah overall it seems like a good guideline to me

and HOLY MOLY the AHA/ACC guidelines have gotten so much more readable and concise, they're almost up to the level of a european guideline 😂

yeah. most articles on this aren’t great because it’s kinda beyond their area of focus. but I was hoping for something better from the big fancy new guideline.

keep giving random drugs until the swelling subsides. (which will happen naturally over time irregardless) 😂

Thrombolytic-induced angioedema is bradykinin-mediated.

Steroids/epinephrine/antihistamines don't seem to work.

Epinephrine risks causing HTN & promoting intracranial hemorrhage post-tPA with no real benefit.

My approach to this problem is here: emcrit.org/ibcc/ais/#th...