Prehospital interventions should focus on the ABCs. The prehospital provider is faced with clinical presentations as varied as acute psychosis and frank coma. Prehospital protocols should stress support of airway, breathing, and circulation with emergent transport to the ED, as with all critically ill patients. Altered mental status protocols should be followed with determination of blood glucose and administration of naloxone and thiamine as appropriate. One must be prepared to provide gentle passive external rewarming for hypothermic patients, consider warm humidified oxygen to provide volume support for hypotensive patients, and consider chemical and physical restraints for those patients actively psychoticand combative. All patients should be placed on a cardiac monitor and have continuous pulse oximetry. Defer starting specific treatments, such as b-blockers and steroids, until a more thorough evaluation can be performed in the ED. Table 3
lists emergent diagnostic tests and therapeutic interventions that should be performed immediately on patients with a clinical picture of myxedema coma or thyroid storm.
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