Diagnosis and management of intraoperative thyroid storm in a child with undiagnosed Graves' disease: a case report.

BACKGROUND: Thyroid storm is a life-threatening manifestation of thyrotoxicosis and presents with fever, diaphoresis, tachycardia, hypertension, and widened pulse pressure. CASE PRESENTATION: We present a case of intraoperative thyroid storm in a 12-year-old female undergoing posterior spinal fusion. Despite adequate depth of anesthesia and analgesia, the patient was persistently tachycardic and hypertensive. The surgical procedure was uneventful. A thyroid panel drawn immediately after surgery showed undetectable thyroid stimulating hormone (TSH) and high free thyroxine (T4) consistent with thyroid storm. CONCLUSIONS: Intraoperative thyroid storm in a pediatric patient is extremely rare with nonspecific clinical symptoms. Low to undetectable TSH and elevated free T4 is diagnostic.

Limiting Outward Flow From the Patient's Airways to the Airway Operator: Head Chamber for Intubation of COVID-19 Patients.

We present the prototype of an adjunct to personal protective equipment (PPE) for intubation of patients with coronavirus disease 2019 (COVID-19). Acknowledging the risk of infection for the airway operator and personnel in the room when tracheal intubation is required for a COVID-19 patient, we designed a chamber that creates a microenvironment around the patient's head that limits the outward flow from a patient's airways to the airway operator with a filtered suction system in order to limit viral spread and lower contamination risk during intubation in non-negative-pressure rooms. The device was successfully tested in a simulation setting.