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Recognition and time critical actions
Stabilization and activation
Suspected myxedema coma ICD-10 E03.5
Altered mental status
Hypothermia
Bradycardia
Hypoventilation
Hypotension or shock
Hyponatremia mmol/L
Hypoglycemia mmol/L
Resuscitation bay
Cardiac monitor
Core temperature monitoring
Frequent glucose checks mmol/L
ICU and endocrinology early notification
Anticipated mechanical ventilation
Anticipated vasopressor support
If airway failure or hypercapnia, intubate
Difficult airway risk
Low dose induction strategy
If shock, initiate vasopressor therapy
Norepinephrine first line
Avoid aggressive rewarming induced vasodilation
Passive rewarming only
Warm blankets
Warmed IV fluids if hypovolemic
Early empiric glucocorticoid coverage
Hydrocortisone before thyroid hormone if possible
Continue until adrenal insufficiency excluded
Early IV thyroid hormone replacement
Do not delay for lab confirmation if high suspicion and unstable
Reduced loading dose for frailty or coronary disease
Hemodynamic and ventilation targets
Physiologic targets
Mean arterial pressure 65 mmHg or higher
Higher target if chronic hypertension
Arterial line if on vasopressors
Oxygen saturation target per clinical context
COPD with chronic hypercapnia individualized
Avoid hypercapnia
PaCO2 trend in mmHg
Capnography if ventilated
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.