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clinical skills
case study
assessment
cardiac arrest
out-of-hospital
emergency

Clinical case review: out-of-hospital cardiac arrest following thyroid storm

02 April 2021
Features
02 April 2021
Volume 13 · Issue 4

Abstract

Acute thyrotoxicosis (thyroid storm) caused by hyperthyroidism is a rare but severe endocrine imbalance which, in extreme cases, may lead to ventricular fibrillation and ultimately, without intervention, death. The authors attended such an incident and, following clinical interventions, achieved return of spontaneous circulation with a good outcome for the patient and subsequent hospital discharge.

This article gives a narrative review of a clinical case, puts it into the context of current research evidence and provides a discursive review of emergency prehospital clinical practice. This incident occurred before the coronavirus pandemic so draws on the clinical guidelines used at the time.

The patient, a woman in her late 20s, suddenly collapsed at home without warning and was found to be unconscious and not breathing by her partner. Immediate basic life support was given via ambulance telephony advice.

A paramedic team leader situated nearby was dispatched along with a dual-crewed ambulance. The team leader was the first to arrive on scene, seven minutes after the 999 call, and immediately established that the patient was in cardiac arrest, which was confirmed by no respiratory or cardiac output. Furthermore, an electrocardiogram (ECG) reading showed ventricular fibrillation (VF). One defibrillation shock was administered, and cardiopulmonary resuscitation (CPR) recommenced. The patient's airway was managed using an oropharyngeal (OP) airway and bag-valve mask, which was sufficient in enabling adequate ventilatory support to be provided (Deakin et al, 2015).

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Thyrotoxicosis
Thyroid storm
Cardiac arrest
Paramedic
Out of hospital
Ambulance