Your first priority is to maintain a patent airway and
correct Mrs. Smith's hypoventilatiun. Prepare her for
immediate intubation and mechanical ventilation. After
intubation, auscultate for equal breath sounds and tape
the tube securely.
Arrange for a portable chest X-ray and an electrocardiogram.
Insert a urinary catheter and nasogastric tube.
Start a second
I.V. line
and obtain a
blood sample
for lab work,
including thyroid
honnone
levels. Also obtain
urine and
sputum samples
for lab work.
Administer the
first dose of a broadspectrum
antibiotic, as ordered,
to cover any underlying
infection.
Because Mrs. Smith is
exhibiting signs of clinical shock, you'll use the second
I.V. line to begin a rapid infusion of isotonic fluid and
vasopressors, as ordered. Apply blankets to help rewarm
her.
Myxedema coma is treated based on clinical presentation
and medical history. Keep Mrs. Smith on the cardiac
monitor and administer an infusion of 300 to 500 meg of
I.V. levothyroxine over 2 minutes. The onset of action for
intravenous levothyroxine is 6 hours and the drug is fully
effective in 24 hours.