*** UNCHECKED BOXES AND LINED THRU ORDERS ARE NOT APPLICABLE

ALLERGIES:
ADMITTING DIAGNOSIS: Thyroid Storm
Intrauterine Pregnancy
ADMIT TO:  [  ] ICU
ACTIVITY:  [  ]Bedrest with bathroom privileges with assistance  
[  ]Other:__________________________________________________________________
MONITORING:  Vital Signs every hour .
Continuous Fetal Monitoring.
[  ]Cooling blanket if T > 101 and fever nonresponsive to Acetaminophen
LABS:   CBC with differential daily
Chem 12 daily
Free T4 and free T3 daily
[  ] ABG if pulse ox < 90%, respiratory distress or altered consciousness.
RADIOLOGY:  [  ] OB Ultrasound for fetal weight and AFI
[  ] CXR
[  ] Echocardiogram
IV THERAPY:  [  ] Saline lock with 0.9% NaCL, 3 mL flush every 8 hours and before and after medications
Lactated Ringers 1000 mL to run at 150 mL/hour
MEDICATIONS:  1.) O2 @      [ ] 2      [ ] 4      [ ] 6       Liters/min via      [ ] NC      or      [ ] FM.
2.) Tylenol 500 mg 1-2 PO Q 4-6 hr PRN pain or T > 101F.
3.) Propylthiouracil (PTU) 300 mg orally (PO) or nasogastric tube (NG); every 6 hours .
4.) One to two hours after the administration of PTU give:
Potassium Iodide, saturated solution (SSKI) 5 drops PO / NG every 8 hours .
If SSKI not available may give sodium iodide 1 gram PO /NG every 12 hours.
If SSKI and sodium iodide not available may give Lugol's solution 10 drops every 8 hours
IF ALLERGIC TO IODINE MAY GIVE lithium carbonate 300 mg PO / NG every 6 hours
5.) Propranolol (Inderal) ___ mg (4080 mg) PO / NG every 6 hours .
[  ] Propranolol (Inderal) 1 mg/min IV every 5 minutes  for a total of 6 mg.
IF HISTORY OF SEVERE BRONCHOSPASM MAY GIVE Reserpine (Serpasil)  2.5 mg IM every 4 hours
6. Dexamethasone (Decadron) 2 mg IV or IM every 6 hours X 4 doses
If dexamethasone is not available may give Hydrocortisone (Solu-Cortef) 100 mg IV every 8 hours
[  ] Ceftriaxone (Rocephin) 1 gram IVPB every 24 hours.
[  ] MOM 30 mL PO every 12 hours PRN constipation
[  ]
Aluminum Hydroxide / Magnesium Hydroxide (Maalox) 30 mL PO every 4 hours PRN indigestion
[  ] Zaleplon (Sonata) 5 mG PO HS PRN insomnia
[  ] Acetaminophen 650 mG PO every 4 hours PRN mild-mod pain (level 1 6)
[  ] Other: ______________________________________________________________  

DIET:  NPO until stable, then regular diet
[  ] Clear liquid diet
[  ] Other: ______________________________________________________________
CALL PHYSICIAN FOR COMPLAINTS OF:
  Respiratory rate less than 12 or greater than 25 per minute
Complaint of sore throat
Rash
Temperature >100.4 F
Chest pain
 02 Sat less than 90% on room air
Decreased loss of consciousness
Respiratory distress
Date:____________    Time:_____________   Physician Signature:_________________________    [  ] RBO

Date:____________    Time:_____________    Noted: _______________________________________
 

PATIENT I.D. LABEL

 

 

THYROID STORM IN PREGNANCY PHYSICIAN ORDERS

1. Jorge H. Mestman: Endocrine Diseases in Pregnancy.  In Gabbe ed: Obstetrics - Normal and Problem Pregnancies, 4th ed.new York, NY,Churchill Livingstone, 2002. p 1149
2. American College of Obstetricians and Gynecologists (ACOG). Thyroid disease in pregnancy. Washington (DC): American College of Obstetricians and Gynecologists (ACOG); 2002 Aug. 10 p. (ACOG practice bulletin; no. 37).

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